多重耐药菌感染干预效果多中心研究

Multicenter study on effectiveness of intervention in multidrug-resistant organism infection

目的了解采取干预措施对降低多重耐药菌(MDRO)感染的效果。方法2013年10月—2014年9月对我国12个省市46所医院进行调查,其中2013年10月—2014年3月为基线调查阶段(干预前),该阶段未采取任何干预措施;2014年4—9月为实施干预措施阶段(干预后),比较干预前后MDRO感染情况及防控措施依从性。结果共监测34 081例病例,住院总日数为302 818 d,MDRO医院发病的感染(HOI)1 122例次,HOI例次发病率为3.71‰。各种MDRO以CRAB HOI例次日发病率(2.47‰)最高,各重症监护病房(ICU)以外科ICU HOI例次日发病率(5.55‰)最高。总体MDRO HOI例次日发病率由干预前的3.96‰,降至干预后的3.53‰,差异有统计学意义(P=0.03);干预后呼吸ICU和急诊ICU HOI例次日发病率均低于干预前(均P<0.05)。干预后各项防控措施:实施隔离、同种病原体隔离、悬挂隔离标识、手卫生、戴手套、物品专用依从率,以及医生、护士、保洁员知晓率均明显提高,差异均有统计学意义(均P<0.05)。结论通过采取MDRO防控措施及对其依从性进行监测,可有效提升各措施的依从性,降低MDRO HOI发病率。

Objective To evaluate the effectiveness of intervention measures in reducing infection caused by multidrugresistant organisms（MDROs）.Methods From October 2013 to September 2014,a survey was conducted among46 hospitals of 12 provinces and cities in China,from October 2013 to March2014 was baseline investigation stage（before intervention）,from April 2014 to September 2014 was intervention stage（after intervention）,the occurrence of MDRO infection and compliance to prevention and control measures before and after intervention were compared.Results A total of 34 081 cases were monitored,the overall patient-days were 302 818 d,there were 1 122 episodes of hospital-onset infection（HOI）,HOI case rate was 3.71‰.Of various MDROs,infection case rate caused by carbapenem-resistant Acinetobacter baumannii per 1 000 patient-days was highest（2.47‰）;Of different intensive care units（ICUs）,incidence of HOI per1 000 patient-days was highest in surgical ICUs（5.55‰）.The overall MDRO HOI case rate decreased from3.96/1 000patient-days before intervention to 3.53/1 000 patient-days after intervention,the difference was significant（P=0.03）.HOI case rate per 1 000 patient-days in respiratory and emergency ICUs decreased significantly after intervention（both P〈0.05）.The compliance to prevention and control measures（isolation,hanging isolation signs,hand hygiene,wearing gloves,item exclusive use）,as well as doctors,nurses,and cleaning staff awareness enhanced significantly after intervention（all P〈0.05）.Conclusion By carrying out prevention and control measures on MDROs and monitoring the compliance to various measures,compliance to various measures can be improved,and MDRO HOI can decrease effectively.