区域性综合医院鲍氏不动杆菌组合干预预防控制成效分析  

Effect of comprehensive interventions on control of Acinetobacter baumannii in regional general hospitals

作　　者：崔景晶[1] 韩香[2] 姜雪锦[3] 刘欣[3] 张洁[3] 孙吉花[3] CUI Jing-jing;HAN Xiang;JIANG Xue-jin;LIUXin;ZHANG Jie;SUN Ji-hua(The Affiliated Hospital of Binzhou Medical College,Binzhou,Shandong 256603,China;不详)

机构地区：[1]滨州医学院附属医院医疗保险处,山东滨州256603 [2]山东省胸科医院手术室,山东济南250101 [3]滨州医学院附属医院感染管理办公室,山东滨州256603

出　　处：《中华医院感染学杂志》2020年第10期1574-1579,共6页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展计划基金资助项目(2015WS0491,2017WS754)。

摘　　要：目的探讨区域性综合医院鲍氏不动杆菌流行病学趋势及组合干预成效,为临床有效预防控制感染提供依据。方法对滨州市三级甲等综合医院[滨州医学院附属医院(A院)、滨州市人民医院(B院)和滨州市中心医院(C院)]住院患者实施耐碳青霉烯鲍氏不动杆菌(CR-AB)目标性监测,实施感染隔离措施、手卫生执行情况、医务人员自我防护措施、知晓情况、环境消毒等综合干预,对比实施干预前后(2014年1-6月为基线调查阶段,2014年7-12月为采取干预措施阶段)CR-AB感染数据。结果三所医院临床送检各类标本中检出非重复分离菌株13 823株,其中AB 805株,AB分离率为5.82%;805株AB中分离出CR-AB 394株,CR-AB分离率为48.94%。AB及CR-AB分离率均为A院最高,C院最低。三所医院检出CR-AB均以综合ICU所占比例最高、以呼吸系统感染为主。医院实施预防控制干预措施后实施隔离率由干预前的94.14%升至98.39%,悬挂隔离标识率由93.69%升至97.85%,手卫生依从率由干预前的82.05%升至88.98%。CR-AB千日医院感染例次发生率由干预前的0.20‰降至干预后的0.13‰,综合ICU CR-AB发生率由干预前的8.04‰降至干预后的4.27‰,干预前后比较差异均有统计学意义(P<0.05)。结论实施CR-AB目标性监测,通过提升组合干预依从性并实施有效评估,能有效降低CR-AB发生率。OBJECTIVE To explore the epidemiological trend of Acinetobacter baumannii in regional general hospitals and observe the effect of comprehensive interventions so as to provide guidance for clinical control of infection.METHODS The targeted monitoring was carried out for the carbapenem-resistant Acinetobacter baumannii(CR-AB)strains in the patients who were hospitalized in the tertiary three-A hospitals of Binzhou[Affiliated Hospital of Binzhou Medical College(A Hospital),Binzhou People′s Hospital(B Hospital)and Binzhou Central Hospital(C Hospital)].The comprehensive interventions such as isolation measures,hand hygiene measures,self-protection measures,cognition and environmental disinfection were carried out.The data of CRAB infection were observed and compared before(the baseline survey phase from Jan 2014 to Jun 2014)and after(the phase of implementation of the interventions from Jul 2014 to Dec 2014)the interventions were carried out.RESULTS A total of 13823 non-repetitive strains were isolated from the clinical submitted specimens of the three hospitals,805 of which were AB,with the isolation rate 5.82%;totally 394 strains of CRAB were isolated from the 805 strains of AB,with the isolation rate of CRAB 48.94%.The isolation rates of AB and CRAB were the highest in the hospital A,the lowest in the hospital C.Of the CRAB strains isolated from the three hospitals,the percentage was the highest in the general ICU,the respiratory system infection was dominant.The isolation rate was increased from 94.14%before the prevention interventions were carried out to 98.39%after the interventions were carried out,the rate of hanging isolation signs was increased from 93.69%to 97.85%,and the compliance rate of hand hygiene was increased from 82.05%to 88.98%.The thousand-day case-time incidence of CRAB infection was decreased from 0.20‰before the interventions to 0.13‰after the interventions;the incidence of CRAB infection in the general ICU was decreased from 8.04‰before the interventions to 4.27‰after the intervent

关 键 词：组合干预 区域性 鲍氏不动杆菌 预防控制 

分 类 号：R197.3[医药卫生—卫生事业管理]