ICU分区管理对多重耐药菌院内感染的防控作用  

Efficiency of ICU ward partition management in the prevention and control of nosocomial infections with multi-drug resistant organisms

作　　者：陈洁琼 许兆军[1] 陈瑜[1] 陈培服[1] 詹晔斐[1] CHEN Jie-qiong;XU Zhao-jun;CHEN Yu;CHEN Pei-fu;ZHAN Ye-fei(Intensive Care Unit,Ningbo NO.2 Hospital,Ningbo,Zhejiang315010,China)

机构地区：[1]宁波市第二医院重症医学科,浙江宁波315010

出　　处：《预防医学论坛》2025年第1期11-14,共4页Preventive Medicine Tribune

基　　金：浙江省自然科学基金项目(LY19H190001);浙江省宁波市医学重点学科建设项目资助(2022-F16);浙江省宁波市第二医院重点学科项目资助(2023-Y06)。

摘　　要：目的探讨通过病区分区管理,创建相对无/低耐药菌的重症医学科(ICU)病区环境对多重耐药菌(MDRO)院内感染的影响,为优化ICU多重耐药菌感染防控策略提供科学依据。方法选取2018年3月-2022年12月在我院ICU病房32张床位治疗的8802例患者为研究对象,采用干预前后对照的方法,按照ICU分区干预的不同阶段将患者分为基线期189例、干预期481例、维持期8132例。基线期对ICU的32张床位随机收治患者;干预期将ICU分为2个病区,根据患者感染情况分配ICU病区;维持期实施干预期常态化管理。收集ICU环境高频接触物表培养3520份,包括基线期480份、干预期1120份、维持期1920份。比较ICU分区管理不同阶段患者的MDRO发生率与环境MDRO检出率差异。结果ICU病区患者基线期、干预期和维持期MDRO发生率分别为16.40%(31/189)、5.61%(27/481)及1.88%(153/8132),差异有统计学意义(χ^(2)=188.947,P<0.001),基线期MDRO发生率最高,维持期MDRO发生率最低。基线期、干预期和维持期的环境高频接触物表MDRO检出率分别为8.75%(42/480)、1.88%(21/1120)及1.09%(21/1920),差异有统计学意义(χ^(2)=98.475,P<0.001),基线期环境高频接触物表MDRO检出率最高,维持期环境高频接触物表MDRO检出率最低。环境高频接触物表以多重耐药鲍曼不动杆菌检出率为最高,差异有统计学意义(χ^(2)=55.119,P<0.001)。结论基于患者感染情况实施分区管理,创建无/低耐药菌的ICU病区环境可有效降低患者MDRO发生率及环境高频接触物表MDRO检出率。Objective To explore the impact of creating Intensive Care Unit(ICU)with relatively drug-free/low drug-resistant organisms on nosocomial infections caused by multidrug-resistant organisms(MDRO)through ward partition management,so as to provide scientific basis for optimizing the prevention and control strategy of MDRO infection in ICU.Methods A total of 8802patients who were treated in the 32-bed ICU of the hospital from March 2018to December 2022were enrolled in this study.Using apre-and post-intervention comparison method,patients were divided into three phases based on the stages of ICU zoning intervention:baseline phase(189cases),intervention phase(481cases),and maintenance phase(8132cases).During the baseline phase,patients were randomly assigned to the 32beds in the ICU;During the intervention period,the ICU was divided into 2wards,and patients assigned to the ICU ward according to their infection status;and routine ward partition management during the maintenance period.A total of 3520surface cultures of high-frequency contact items in the ICU environment were collected,including 480at baseline 1120during the intervention period,and 1920during the maintenance period.The incidence of MDROs in patients and the rate of environmental MDROs in different stages of ICU ward partition management were compared.Results The incidence rates of MDROs in the ICU during the baseline,intervention,and maintenance phases were 16.40%(31/189),5.61%(27/481),and 1.88%(153/8132),respectively,with statistically significant differences(χ^(2)=188.947,P<0.001).The highest incidence of MDROs was observed during the baseline phase,while the lowest incidence was observed during the maintenance phase.The detection rates of MDROs on environmental high-touch surfaces during the baseline,intervention,and maintenance periods were 8.75%(42/480),1.88%(21/1120),and 1.09%(21/1920),respectively,and the difference was statistically significant(χ^(2)=98.475,P<0.001).The highest detection rate of MDROs on high-frequency contact surfaces in the en

关 键 词：重症监护病房 多重耐药菌 环境污染定植 分区管理 院内感染 

分 类 号：R378[医药卫生—病原生物学] R63[医药卫生—基础医学]