ICU物体表面清洁消毒质量干预在多药耐药菌预防控制中的效果分析

Effect of interventions to cleaning and disinfection quality of ICU objects surfaces on prevention of multidrug-resistant bacteria infections

目的探讨环境物体表面清洁消毒循证综合干预在重症监护病房(ICU)预防和控制多药耐药菌(MDROs)中的作用。方法 2013年1-3月ICU执行传统的物体表面清洁制度,医院感染管理科按常规监测,不作反馈;2013年4月-2014年3月制定有循证依据的干预措施指导临床进行日常环境清洁消毒工作,使用荧光标记、拭子培养监测物体表面的清洁消毒质量,运用PDCA循环管理模式持续提高病区的环境卫生清洁质量。结果通过持续干预,物体表面荧光标记清除率改善明显(P<0.05),由干预前的39.17%上升至72.03%,其中医疗设备物体表面、高频接触卫生表面荧光标记清除率分别上升36.13%、33.81%;MDROs感染患者床单位终末消毒后MDROs阳性率从干预前的4.12%下降至1.08%,干预前后差异均有统计学意义(P<0.05);MDROs每千住院日分离率呈下降趋势。结论 ICU建立以循证医学为基础的医院环境清洁策略和制度,并应用到实践中,可有效预防和控制MDROs感染的发生。

OBJECTIVE To explore the effect of evidence-based comprehensive interventions to cleaning and disin-fection of environmental objects surfaces on prevention of multidrug-resistant organisms （MDROs） infections in in-tensive care units （ICUs） .METHODS The conventional cleaning system of objects surfaces of ICU was implemen-ted from Jan to Mar 2013 ,the routine monitoring was carried out by the nosocomial infection control department , and the feedback was not conducted .From Apr 2013 to Mar 2014 ,the evidence-based intervention measures were developed to guide the daily clinical cleaning and disinfection ,the cleaning and disinfection quality of the objects surfaces was monitored with the use of fluorescence labeling and swab culture ,and the environmental health clean-ing quality was continuously improved by means of PDCA circle management mode .RESULTS The clearance rate of the fluorescence markers on objects surfaces was significantly improve through continuous intervention （P〈0 .05） ,increasing from 39 .17% to 72 .03% ;the clearance rates of the fluorescence markers on the medical equip-ments surfaces and the highly frequent contacting surfaces were increased by 36 .13% and 33 .81% ,respectively . The positive rate of MDROs dropped from 4 .12% before the intervention to 1 .08% after the bed unit terminal dis-infection of the patients with MDROs infections ,there was statistically significant difference （P〈0 .05） .The iso-lation rate of MDROs per thousand patient day showed a down ward trend .CONCLUSION It is an effective way to establish the evidence-based environmental cleaning strategy and system and put it into practice so as to control the MDROs infections .