综合干预措施降低肿瘤患者多药耐药菌医院感染的研究

Comprehensive intervention in reducing hospital infections of multidrug-resistant organisms in patients with malignant tumor

目的了解多药耐药菌(MDROs)导致肿瘤患者发生医院感染的现状,研究综合干预措施在预防与控制MDROs医院感染的作用。方法将2011年1-12月设为干预前、2012年1-12月设为干预后,采取前瞻性监测方法对40 728例肿瘤患者进行MDROs感染监测,分析感染环节因素,实施过程干预,重点落实MDROs医院感染预防与控制标准操作规程(SOP),应用SPSS13.0统计软件对数据进行统计处理。结果 40 728例肿瘤患者发生医院感染239例,感染率0.59%,其中发生MDROs医院感染54例,感染率0.13%,干预措施的实施使MDROs感染率由干预前的0.18%下降至干预后的0.09%;ICU和肿瘤外科MDROs感染分布率,分别由干预前的75.00%、54.55%下降至干预后的12.50%、16.13%,差异有统计学意义;感染部位以呼吸道为主占33.33%,采取综合干预措施后,呼吸道感染由41.18%下降至20.00%;干预前检出MDROs以大肠埃希菌及鲍氏不动杆菌感染为主,分别占51.35%、24.33%,干预后以大肠埃希菌和葡萄球菌属为主,分别占70.00%、25.00%,干预前后比较,差异均有统计学意义(P<0.05)。结论采取前瞻性监测方法,进行MDROs医院感染目标性监测,及时获取信息,尽早实施MDROs医院感染预防与控制SOP,能有效减少肿瘤患者MDROs医院感染的发生。

OBJECTIVE To investigate the current status of hospital infections of multidrug-resistant organisms（MDROs）in patients with malignant tumor,and study the role of comprehensive intervention in preventing and controlling of MDROs.METHODS The period from Jan.2011 to Dec.2011 was defined as before intervention and from Jan.2012 to Dec.2012 as after intervention.Prospective monitoring method was used to monitor MDROs infection,analyze infection-related factors and implement intervention for 40728 patients with malignant tumor.The implementation of standard operating procedures（SOP）in prevention and control of nosocomial infections in MDROs was focused on.The data were analyzed by SPSS13.0statistical software.RESULTS From Jan.2011 to Dec.2012,40728 cancer patients were admitted in this hospital and 239 patients occurred hospital infections with infection rate of 0.59%,of which 54（0.13%）cases of MDROs infections developed.MDROs infection rate dropped from 0.18% before intervention（Jan-Dec.2011）to 0.09%after intervention（Jan-Dec.2012）.MDROs infection ratio in the intensive care unit（ICU）and tumor surgical department significantly decreased,from75.00%and 54.55%to 12.50%and 16.13%respectively（P〈0.05）before and after the intervention.The main infection sites were respiratory tract（33.33%）,the constituent ratio of respiratory tract infection after comprehensive intervention dropped from 41.18%to 20.00%.Before intervention the hospital infection was mainly caused by Escherichia coli and Acinetobacter baumannii accounting for 51.35% and 24.33% respectively.After intervention,the hospital infection was mainly caused by E.coli and Staphylococcus accounting for 70.00%and25.00%.The difference between before intervention and after intervention was significant（P〈0.05）.CONCLUSIONS Effective prevention and control of MDROs infections can be achieved through accurate and timely obtaining information,using prospective monitoring methods,and implementing the standard operating procedures（SOP）of MDROs in hospital infections as soon as possible.