综合干预措施对多药耐药菌感染与定植预防控制效果的研究

Effects of comprehensive interventions to control and prevention of multidrug-resistant bacteria infections and colonization

目的采取综合干预措施,对某三级甲等医院多药耐药菌感染定植进行为期3年的干预,以评价其干预效果。方法 2012年4-6月对全院住院患者开展多药耐药菌前瞻性目标性监测;2012年7月-2015年3月在前瞻性监测的基础上,开展综合干预措施以降低多药耐药菌感染/定植率,并评价预防控制效果。结果 2012年4月-2015年3月检出1 355株新发多药耐药菌/定植菌,前3位多药耐药菌为耐甲氧西林金黄色葡萄球菌、多药耐药/泛耐药鲍氏不动杆菌、耐甲氧西林凝固酶阴性葡萄球菌,分别占24.13%、21.99%、21.33%;全部多药耐药菌分布从2012年第二季度的0.24‰下降至2015年第一季度的0.09‰;全院医务人员、医师、护士和工勤人员手卫生依从性分别从31.83%、21.19%、47.50%和23.29%,上升至52.99%、41.95%、61.73%和52.35%;每床免洗手消毒剂使用量从每日3.9ml上升至5.7ml;多药耐药菌感染与定植率分别与手卫生依从性、免洗手消毒剂领用量呈反相关(P<0.05)。结论通过采取综合干预的手段,可以有效降低多药耐药菌感染与定植率。

OBJECTIVE To take comprehensive interventions to the multidrug‐resistant bacteria infections and colonization in a three‐A hospital for three years and evaluate the intervention effects .METHODS The prospective targeted surveillance of the multidrug‐resistant bacteria was conducted for the patients who were hospitalized from Apr to Jun ,2012 ;the comprehensive interventions were taken to reduce the incidence of the multidrug‐resistant bacteria infections and colonization based on the prospective surveillance from Jul 2012 to Mar 2015 ,and the effects on the control and prevention were evaluated .RESULTS A total of 1 355 strains of new multidrug‐resistant bacteria and colonized bacteria have been isolated from Apr 2012 to Mar 2015 ;the methicillin‐resistant Staphylo‐coccus aureus , multidrug‐resistant or pandrug‐resistant A cinetobacter baumannii , and methicillin‐resistant coagulase‐negative Staphylococcus ranked the top three multidrug‐resistant bacteria ,accounting for 24 .13% , 21 .99% ,and 21 .33% ,respectively .The percentage of all the multidrug‐resistant bacteria was reduced from 0 .24‰ in the second quarter of 2012 to 0 .09‰ in the first quarter of 2015 .The hand hygiene compliance of the health care workers of the whole hospital increased from 31 .83% to 52 .99% ,the hand hygiene compliance of the doctors increasing from 21 .19% to 41 .95% ,the hand hygiene compliance of the nurses increasing from 47 .50%to 61 .73% ,the hand hygiene compliance of the ground skilled worker increasing from 23 .29% to 52 .35% .The usage amount of hand‐washing free disinfectant was increased from 3 .9ml/bed/day to 5 .7 ml/bed/day . The incidence of the multidrug‐resistant bacteria infections and colonization was inversely correlated with the hand hygiene compliance and the usage amount of hand‐washing free disinfectant （ P〈 0 .05 ） .CONCLUSION The incidence of the multidrug‐resistant bacteria infections and colonization can be effectively reduced through the comprehensive interventions .