基于SHEL模型的核查表在ICU多重耐药菌感染防控中的应用  

Application of checklist based on SHEL model in the prevention and control of multi-drug resistant organism infection in ICU

作　　者：简福霞 商璀 雷凤琴 JIAN Fuxia;SHANG Cui;LEI Fengqin(Department of Critical Care Medicine,PLA Army Medical Center,Chongqing 400010,China)

机构地区：[1]中国人民解放军陆军特色医学中心重症医学科,重庆400010

出　　处：《检验医学与临床》2024年第13期1955-1959,1963,共6页Laboratory Medicine and Clinic

基　　金：重庆市医学重点学科建设项目(zdxk202102)。

摘　　要：目的评价SHEL模型核查表应用于重症监护病房(ICU)重症患者中以防控多重耐药菌(MRDO)感染的应用效果。方法选取2023年3-6月本院ICU收治的229例重症患者作为对照组,其中入科时已感染MDRO 11例,未感染MDRO 218例。另选取2023年7-10月本院ICU收治的通过自制SHEL核查表核查的244例重症患者作为观察组,其中入科时已感染MDRO 9例,未感染MDRO 235例。以SHEL模型为指导,通过专家函询,根据ICU患者住院期间存在的MRDO感染潜在风险制订防范核查表,采用跟班督查、现场抽查、情景演练等方式逐条进行整改,评价整改前4个月(2023年3-6月)和整改后4个月(2023年7-10月)护士MRDO感染预防措施执行率、患者MRDO感染率。结果2023年3-10月入科无MDRO感染的患者453例,核查表运用前(2023年3-6月)无MDRO感染218例,核查表运用后(2023年7-12月)无MDRO感染患者为235例,核查表运用后比核查表运用前MDRO感染率明显降低,差异有统计学意义(P<0.05)。对照组共有66例MDRO感染患者,有效执行MDRO医院感染核心防控措施有57例次,执行率为86.36%;观察组共有32例MDRO感染患者,均完成核心防控措施的执行,执行率为100.00%。观察组比对照组执行率提升了13.64%,差异有统计学意义(P<0.05)。SHEL模型分析对照组66例MDRO感染患者和观察组32例MDRO感染患者每个维度的MDRO感染集束化防控措施执行率,结果显示,观察组每个维度条目的执行率与对照组比较均升高,且两组执行例数比较,差异有统计学意义(P<0.05)。结论以SHEL模型为基础制订的核查表,能够有效提高ICU护士MRDO的防控执行力,降低重症患者MRDO的院内感染,有利于提高临床感染防控质量。Objective To evaluate the application effect of SHEL model checklist in the prevention and control of multi-drug resistant organism(MDRO)infection in critically ill patients in ICU.Methods A total of 229 critically ill patients admitted to the ICU of our hospital from March to June 2023 were selected as the control group,including 11 cases with infected MDRO and 218 cases without infected MDRO on admission.Another 244 critically ill patients who were admitted to the ICU of our hospital from July to October 2023 and checked by the self-made SHEL checklist were selected as the observation group,including 9 cases with infected MDRO and 235 cases without infected MDRO on admission.Guided by the SHEL model,the prevention checklist was formulated according to the potential risk of MDRO infection in ICU patients during hospitalization through expert consultation,and the rectification was carried out one by one by following the supervision,spot inspection,scenario exercise and other methods.The implementation rate of MDRO infection prevention measures in nurses and the infection rate of MDRO in patients were evaluated four months before the rectification(March to June 2023)and four months after the rectification(July to October 2023).Results In March 2023 to October 2023,works without MDRO infection patients 453 cases,checklist before use(march to June 2023)without MDRO infection in 218 cases,after verification table use(July 2023 to December 2023)for 235 cases of patients with infection of MDRO.The infection rate of MDRO after the application of checklist was significantly lower than that before the application of checklist(P<0.05).There were 66 MDRO infection patients in the control group,and 57 cases of MDRO hospital infection core prevention and control measures were effectively implemented,with an implementation rate of 86.36%.A total of 32 patients with MDRO infection,observation group were complete core execution of prevention and control measures,100.00%were enforced.The implementation rate of the observation gro

关 键 词：SHEL模型 核查表 多重耐药菌 感染防控 重症监护病房 

分 类 号：R184.6[医药卫生—流行病学]