多重耐药菌感染综合防控措施的闭环管理及其效果评价  

Effect of closed-loop management of integrated prevention and control measures for multidrug-resistant bacteria infections

作　　者：王敏芳 干铁儿[1] 丁黎敏[1] 朱越献[1] 余旭霞 WANG Min-fang;GAN Tie-er;DING Li-min;ZHU Yue-xian;YU Xu-xia(The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou,Zhejiang310006,China)

机构地区：[1]浙江中医药大学附属第一医院医院感染管理科,浙江杭州310006

出　　处：《中华医院感染学杂志》2021年第18期2850-2854,共5页Chinese Journal of Nosocomiology

摘　　要：目的探讨提高多重耐药菌防控措施的实施率,以预防及降低多重耐药菌在医院内的传播风险。方法浙江中医药大学附属第一医院于2019年1月起施行严格的多重耐药菌防控综合管理措施,采用对照研究,通过分析干预前(2018),干预中(2019),干预后(2020)住院患者微生物标本送检率、接触隔离医嘱开出率、接触隔离措施执行率以及多重耐药菌检出率,评价综合措施的有效性。结果微生物标本送检率从干预前的45.127%,提高到干预后的52.894%(P<0.001)。接触隔离医嘱开出率从干预前的28.349%提高到干预后的95.281%(P<0.001)。2020年各项接触隔离措施执行率均高于2018年和2019年(P<0.001)。多重耐药菌总检出率从干预前的24.659%下降到干预后的20.870%(P=0.015),其中耐碳青霉烯肠杆菌(CRE)及耐碳青霉烯鲍氏不动杆菌(CRAB)的检出率均下降。结论从创新培训方式、建立绩效考核、优化信息流程着手,实施多重耐药菌感染防控闭环管理,可以提高隔离措施执行率,降低多重耐药菌检出率,可有效控制多重耐药菌在医院内的传播风险。OBJECTIVE To explore the ways to raise the rate of implementation of prevention and control measures for multidrug-resistant bacteria.METHODS The integrated prevention and control measures were carried out in the First Affiliated Hospital of Zhejiang Chinese Medical University in Jan,2019,the submission rate of microbial specimens,rate of medical order for contact isolation,implementation rate of contact isolation measures and isolation rate of multidrug-resistant bacteria were observed by means of controlled study before the intervention(2018),during the intervention(2019)and after the intervention(2020),and the effectiveness of the integrated measures was evaluated.RESULTS The submission rate of microbial specimens was increased from 45.127%before the intervention to 52.894%after the intervention(P<0.001).The rate of medical order for contact isolation was increased from 28.349%before the intervention to 95.281%after the intervention(P<0.001).The implementation rates of the contact isolation measures were significatly higher in 2020than in 2018and 2019(P<0.001).The total isolation rate of multidrug-resistant bacteria was reduced from 24.659%before the intervention to 20.870%after the intervention(P=0.015),and the isolation rates of both carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii(CRAB)were reduced.CONCLUSION The closed-loop management of prevention and control measures for multidrug-resistant bacteria infection is carried out by starting from innovating training methods,establishing performance appraisal and optimizing information flow,which may raise the implementation rate of contact isolation measures,reduce the isolation rate of multidrug-resistant bacteria and effectively control the transmission of multidrug-resistant bacteria in the hospitals.

关 键 词：多重耐药菌 感染防控综合措施 闭环管理 效果评价 

分 类 号：R378[医药卫生—病原生物学]