多学科协作模式防控ICU多重耐药菌感染

Clinical effect of multidisciplinary team on prevention and control of multidrug-resistant organism infections in ICU

目的探讨ICU多重耐药菌(MDRO)感染控制中应用多学科协作模式的临床效果及价值。方法选取2016年1月-12月医院ICU收治的758例患者作为对照组,2017年1月-12月收治的患者827例作为干预组,其中对照组实施常规多重耐药菌感染预防和控制措施,干预组实施多学科协作模式。比较两组患者多重耐药菌医院感染、各项防控措施执行情况和患者病情转归。结果干预组827例患者发生感染75例,感染率为9.07%,发生例次感染93例次,例次感染率为11.25%。对照组758例患者发生感染96例,感染率为12.66%,发生例次感染116例次,例次感染率为15.30%。两组患者感染率、例次感染率差异均有统计学意义(χ~2=5.314,5.689;P=0.023,0.018);干预组多重耐药菌感染率4.23%(35/827)低于对照组的8.71%(66/758),两组比较差异有统计学意义(χ~2=13.275,P<0.001);干预后各项防控措施:戴手套、穿隔离衣、物品专用、转科告知的依从性,医生、护士及护工的知晓率均提高,差异有统计学意义(P<0.05);干预组MDRO感染患者住院天数及住院费用均少于对照组(P<0.001);干预组MDRO感染患者治疗的转归情况优于对照组(P<0.05)。结论应用多学科协作模式对预防和控制ICU中多重耐药菌医院感染效果明显,值得临床推广应用。

OBJECTIVE To explore the clinical and value of multidisciplinary team in prevention and control of multidrug-resistant organism（MDROs）infections in ICU.METHODS Totally 758 patients who were treated in ICU from Jan 2016 to Dec 2016 were chosen as the control group,and 827 patients who were treated from Jan 2017 to Dec 2017 were set as the intervention group.The conventional prevention and control measures were taken in the control group,and the multidisciplinary team model was carried out in the intervention group.The incidence of MDRO infections,status of implementation of prevention and control measures and treatment outcomes were observed and compared between the two groups of patients.RESULTS Totally 75 of 827 patients had infections in the intervention group,with the infection rate 9.07%,and 93 case-times of patients had infections,with the case-time infection rate 11.25%.Totally 96 of 758 patients had infections in the control group,with the infection rate12.66%,and 116 case-times of patients had infections,with the case-time infection rate 15.30%;there were significant differences in the infection rate and the case-time infection rate between the two groups of patients（χ2=.314,5.689;P=0.023,0.018）.The incidence rate of MDROs infections was 4.23%（35/827）in the intervention group,significantly lower than 8.71%（66/758）in the control group（χ2=3.275,P〈0.001）.The compliance rates of the prevention and control measures,wearing gloves and isolation gowns,dedicated use of articles and transferring notification as well as the awareness rates of doctors,nurses and nursing workers were significantly increased after the intervention measures were taken（P〈0.05）.The length of hospital stay of the patients with MDROs infection was significantly shorter in the intervention group than in the control group,and the hospitalization cost of the patients with MDROs infection was significantly less in the intervention group than in the control group（P〈0.001）.The treatment outcomes of the patients with MDROs infection were better in the intervention group than in the control group.CONCLUSION The multidisciplinary team model may achieve remarkable effect on prevention and control of the MDRO infections in the ICU,and it is worthy to be promoted in the hospital.