基于信息化集成平台的多重耐药菌医院感染集束化管理策略实践及其成效  

Practice and effectiveness of bundled management strategies for multidrug-resistant organisms infections based on information integrated platform

作　　者：黄燕华 姚美华 曹利华 茅敏华 沈敏 郁智慧 陈春美 宋琳衍 邢健红 周俊[7] 江华 高晓东 唐红萍 HUANG Yan-hua;YAO Mei-hua;CAO Li-hua;MAO Min-hua;SHEN Min;YU Zhi-hui;CHEN Chun-mei;SONG Lin-yan;XING Jian-hong;ZHOU Jun;JIANG Hua;GAO Xiao-dong;TANG Hong-ping(Affiliated Qidong Hospital of Nantong University,Qidong,Jiangsu 226200,China;不详)

机构地区：[1]南通大学附属启东医院感染管理科,江苏启东226200 [2]南通大学附属启东医院检验科,江苏启东226200 [3]南通大学附属启东医院呼吸与危重症医学科,江苏启东226200 [4]南通大学附属启东医院体检中心,江苏启东226200 [5]南通大学附属启东医院信息科,江苏启东226200 [6]南通大学附属启东医院护理部,江苏启东226200 [7]南通大学附属启东医院重症医学科,江苏启东226200 [8]南通大学附属启东医院药学部,江苏启东226200 [9]复旦大学附属中山医院感染管理科,上海200032

出　　处：《中华医院感染学杂志》2025年第1期115-120,共6页Chinese Journal of Nosocomiology

基　　金：“感·动中国”医疗机构感染预防与控制科研项目重大项目(GY2023011);江苏省医院管理创新研究基金资助项目(JSYGY-3-2023-531);南通市卫健委课题面上资助项目(MS2023120);南通大学临床医学专项资助项目(2022LQ011);南通市卫健委课题科研立项课题(QNZ2023105)。

摘　　要：目的探讨基于信息化集成平台的多重耐药菌(MDROs)综合防控管理新模式在MDROs医院感染防控中的应用成效。方法选取2020年01月01日-2023年12月31日南通大学附属启东医院住院患者MDROs相关资料,根据是否应用信息化集成平台综合管控MDROs,分为干预前组和干预后组,比较两组临床分离菌及其主要来源分布、主要MDROs菌株检出率及医院感染例次发生率、部分侵入性操作相关MDROs感染发病率、医院感染率等。结果干预前后分别收集非重复临床分离菌2691、3342株,其中革兰阴性菌株占76.85%、79.41%,革兰阳性菌株占17.69%、17.35%,菌株主要来源呼吸道、血液、尿液标本;干预后耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类肺炎克雷伯菌(CRKP)、耐碳青霉烯类大肠埃希菌(CREC)医院感染例次率较前显著下降(P<0.05),主要MDROs医院总感染例次率由0.068%降至0.045%(P<0.05);导尿管相关尿路MDROs感染发病率由0.40‰降至0.14‰、中央血管导管相关血流MDROs感染发病率由0.65‰降至0.15‰,差异均有统计学意义(P<0.05);此外,信息化综合管理实施后医院感染率、医院感染漏报率、住院患者抗菌药物使用率均较前显著降低(P<0.05),医院感染病例病原学送检率、医护人员手卫生依从性、手卫生正确率及MDROs防控措施完全落实率均显著改善(P<0.05)。结论该信息化综合管理模式可有效改善医院MDROs感染现况,降低医院MDROs感染率,值得医疗机构广泛推广应用,但亦需根据自身情况进行量身改进。OBJECTIVE To explore the effect of the new comprehensive management mode of multidrug-resistant organisms(MDROs)based on informatization bundle integrated platform on prevention and control of MDROs health care-associated infections.METHODS The related data were collected from the patients with MDROs infections who were hospitalized in Affiliated Qidong Hospital of Nantong University from Jan.1,2020 to Dec.31,2023.The patients were divided into the preintervention group and the postintervention group according to the fact whether the information integrated platform was applied for comprehensive management of MDROs.The clinical isolates of pathogens,specimen sources,isolation rates of major MDROs,case-time rates of health care-associated infections,incidence rates of invasive operation-associated MDROs infections and incidence of health care-associated infections were observed and compared between the two groups.RESULTS Totally 2691 non-fermenting clinical isolates were collected from the preintervention group,3342 from the postintervention group;the gram-negative bacteria accounted for 76.85%in the preintervention group,79.41%in the postintervention group;the gram-positive bacteria accounted for 17.69%in the preintervention group,17.35%in the postintervention group.The strains were mainly isolated from respiratory tract specimens,blood specimens and urine specimens.The incidence rates of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Klebsiella pneumoniae(CRKP)and carbapenem-resistant Escherichia coli(CREC)health care-associated infections were remarkably lower after the intervention than before the intervention(P<0.05).The total case-time rate of MDROs health care-associated infections was decreased from 0.068%to 0.045%(P<0.05).The incidence of urinary catheterassociated urinary tract MDROs infection was decreased from 0.40‰to 0.14‰,the incidence of central venous catheter-associated bloodstream MDROs infections was decreased from 0.65%to 0.15‰,and there were significant differences

关 键 词：多重耐药菌 医院感染 信息化 集束化管理 预防与控制 

分 类 号：R183[医药卫生—流行病学]