痰标本处理流程优化成效分析

Cost-effectiveness analysis of process optimization of sputum specimens

目的了解不同外观性状痰标本的合格率,探索痰培养检测流程优化方法,缩短痰培养的报告时间(Turnaround-time,TAT),提高检验结果的准确性,指导临床更合理地使用抗菌药物。方法评估痰标本外观性状与镜下涂片合格的相关性,统计呼吸道标本的处理流程记录及不同时间段、不同质量呼吸道标本的阳性率,制定呼吸道标本处理流程优化措施并评估优化成效。结果痰标本的不合格率为42.6%,不同外观痰标本合格率差异有统计学意义,黄脓痰最高70.7%,白沫痰最低为0;不同质量痰标本阳性率差异有统计学意义(P<0.05),合格痰标本的阳性率为38.3%,不合格标本为0;36.2%的痰标本培养24h后菌群正常生长,继续放置24h或更长时间未发现可疑病原菌;在执行流程优化措施后,痰标本的阳性率由27.5%降为18.5%,是由真菌和凝固酶阴性葡萄球菌等可疑定植菌的分离率减少所致,培养鉴定成本减少24.6%;阴性报告的TAT较干预前显著缩短。结论通过开展痰标本处理流程优化项目,降低了可疑定植菌的检出率,缩短了TAT,节约了实验室的成本,促进了实验室的规范化建设和临床的合理用药。

OBJECTIVE To investigate the qualified rates of sputum samples with different appearances, optimize the sputum culture process, shorten turn-around-time （TAT）, and improve the accuracy of the test result so as to guide the reasonable clinical use of antibiotics. METHODS The correlation between the appearances of sputum specimens and the eligibility of smears with microscopic examination was evaluated, then the positive rate of sputum specimens with different qualities and different periods from respiratory specimen processing flow were recorded, the process optimization measures for the respiratory tract specimens were formulated, and the cost- effectiveness analysis was performed. RESULTS The unqualified rate of the sputum samples was 42. 6%, the difference in the qualified rate between the sputum specimens with various appearances was statistically significant, with the yellow purulent sputum the highest （70. 7%）, the foam sputum the lowest （0）, the difference in the qualified rate between the various qualities of sputum specimens was statistically signifieant（P~ 0.05）, the positive rate of the qualified sputum specimens was 38.3%, the unqualified sputum specimens 0. The normal bacterial flora growth has been seen on 36.2% of the sputum specimens after culture for 24 hours, and no isolates of suspected pathogenic strains have been detected after being placed for 24 hours or longer. After the implementation of the process optimization measures, the positive rate of sputum specimens decreased from 27.5 to 18.5%, which was induced by the decrease of isolation rate of suspected colonized bacteria such as fungi and coagulase-negative Staphylofoccus, the cost of culture and identification was cut by 24. 6% the TAT of the negative conduct has been laboratory and reasonable clinical use of antibiotics.