持续质量改进对ICU多药耐药菌感染的控制效果

Effects of continuous quality improvement measures in controlling multidrug-resistant organism infection in the intensive care unit

目的应用持续质量改进(CQI)管理原则,完善医院感染各项防控措施,实施全程监督,降低ICU多药耐药菌(MDROs)感染率。方法回顾性分析2012年1-6月入住ICU且>48h的患者178例作为CQI前组、2012年7-12月入住ICU的212例患者作为CQI后组MDROs感染资料,采用SPSS 17.0统计软件对MDRO感染的发生率、种类分布以及对常用抗菌药物耐药率的变化数据进行分析,组间比较用χ2检验。结果通过加强MDROs各项管理控制措施落实及全程监督,MDROs感染率由改进前的17.98%降低至8.49%,检出病原菌以鲍氏不动杆菌为主,占50.00%;送检率由CQI前的76.40%上升至CQI后的93.40%;CQI后综合评价指标为100.00%,差异均有统计学意义(P<0.05)。结论 CQI措施能够有效地预防和控制ICU患者MDROs感染率的发生。

OBJECTIVE To apply the Continuous Quality Improvement （CQI） management principle, perfect all kinds of prevention and control measures and supervise the whole process, so as to reduce the infection rate of multidrug-resistant organism （MDROs） in the Intensive Care Unit （ICU）. METHODS The data of MDROs from 178 patients who stayed in ICU longer than 48 hours during Jan. to Jun. 2012 as CQI pre-group and from 212 patients stayed in ICU during Jul. to Dee. 2012 as CQI post-group were analyzed retrospectively. SPSS 17.0 was used to analyze the incidence of MDRO infection, species distribution and the change of resistant rate. χ2 was used for the comparison between two groups. RESULTS After strengthening all the management and control measures and to apply supervision in the whole process, the infection rate of MDRO was obviously reduced from 17.98 % to 8.49%, among which Acinetobacter baumannii was the top one, accounting for 50.00%. The rate of inspecting was from 74.60% pro-CQI to 93.40% after CQIs the comprehensive evaluation index was 100.00% after CQI, and the difference had statistical significance （P〈0.05）. CONCLUSION CQI policy was an efficient measure in reducing the infection rate of MDRO in ICU.