多部门协作管理模式在提高血培养标本送检率及送检质量中的应用  

Application of multi-sector cooperation in improving submission rate and quality of blood culture specimens

作　　者：徐丽华[1] 任霄剑 张婷 刘金芝 范晓婷[3] 刘艳华[1] XU Li-hua;REN Xiao-jian;ZHANG Ting;LIU Jin-zhi;FAN Xiao-ting;LIU Yan-hua(Department of Healthcare-associated Infection Management,Zibo Central Hospital,Zibo 255000,China;Department of Obstetrics,Zibo Central Hospital,Zibo 255000,China;Department of Nursing,Zibo Central Hospital,Zibo 255000,China)

机构地区：[1]淄博市中心医院医院感染管理科,山东淄博255000 [2]淄博市中心医院产科,山东淄博255000 [3]淄博市中心医院护理部,山东淄博255000

出　　处：《中国感染控制杂志》2020年第4期360-364,共5页Chinese Journal of Infection Control

基　　金：山东省医药卫生科技发展计划基金资助项目(2015WS003)。

摘　　要：目的探讨多部门协作管理模式在规范血培养送检、抗菌药物使用中的效果。方法选取某三甲医院2017-2018年住院患者送检的血培养标本为研究资料。2017年1-12月为干预前组,2018年1-12月为干预后组。2017年12月开始成立多部门协作管理小组,并逐步实施其他干预措施。比较多部门协作管理模式干预前后,住院患者治疗性抗菌药物使用前血标本送检率、血培养送检方式、标本污染率及阳性率、抗菌药物使用率等情况。结果干预后全院治疗性、限制级、特殊级抗菌药物使用前血标本送检率分别为22.29%、30.16%、60.30%,高于干预前的14.91%、18.55%、47.05%,差异均有统计学意义(均P<0.001)。血培养双套及以上送检构成比由干预前的15.48%提升至干预后的26.97%。干预后血培养污染率较干预前降低(1.02%VS 2.98%),干预后血培养阳性率较干预前升高(11.67%VS 9.52%)。干预后住院患者抗菌药物使用率为34.11%,低于干预前的37.88%;干预后限制级、特殊级抗菌药物使用率分别为14.67%、2.56%,低于干预前的15.60%、3.73%;差异均有统计学意义(均P<0.001)。治疗性抗菌药物联用构成比较,差异有统计学意义(P<0.001)。结论通过开展环节质控和行政管理相结合的多部门协作管理模式,有效提高了血培养送检率,改善了血培养的送检质量。Objective To explore the effect of multi-sector cooperation management mode on standardizing submission of specimens for blood culture and application of antimicrobial agents.Methods Blood culture specimens from hospitalized patients in a tertiary first-class hospital from 2017 to 2018 were selected as research data. January-December 2017 was as pre-intervention group and January-December 2018 was as post-intervention group. From December 2017, a multi-sector cooperation management team was established, and other intervention measures were gradually implemented. Submission rate, submission mode, contamination rate, and positive rate of blood culture specimens, as well as antimicrobial use rate in hospitalized patients before and after the implementation of intervention of multi-sector cooperation management mode were compared.Results After intervention, submission rate of blood specimens of the whole hospital before therapeutic, restrictive and special-class antimicrobial use were 22.29%, 30.16% and 60.30% respectively, which were higher than 14.91%, 18.55% and 47.05% before intervention, difference were all significant(all P<0.001). The proportion of double and above sets blood culture increased from 15.48% before intervention to 26.97% after intervention. Contamination rate of blood culture after intervention was lower than before intervention(1.02% vs 2.98%), and positive rate of blood culture was higher than before intervention(11.67% vs 9.52%). Antimicrobial use rate after intervention was lower than that before intervention(34.11% vs 37.88%);use rates of restrictive antimicrobial agents and special-class antimicrobial agents after intervention were 14.67% and 2.56% respectively, which were lower than 15.60% and 3.73% respectively before intervention, differences were both significant(both P<0.001). There was significant difference in the constituent of combined use of therapeutic antimicrobial agents(P<0.001).Conclusion Through multi-sector cooperation management mode combining quality control and administr

关 键 词：多部门协作 血培养 抗菌药物 送检率 送检质量 

分 类 号：R197.323[医药卫生—卫生事业管理]