品管圈对多药耐药菌预防控制的作用与效果评价

Effect of quality control circle on control and prevention of multidrug-resistant organisms

目的探讨品管圈(QCC)在重症医学科多药耐药菌管理中的应用效果。方法 2013年12月成立QCC小组,调查重症医学科多药耐药菌隔离控制措施现状、多药耐药菌知识知晓率及多药耐药菌检出率;根据科室存在的问题,通过头脑风暴和查阅文献,分析原因并实施对应的干预措施后再次调查多药耐药菌隔离控制措施现状、知识知晓率及多药耐药菌的检出率;对QCC活动前后数据进行对照,计数资料采用χ2检验统计分析。结果开展QCC活动后,多药耐药菌隔离控制措施知晓率由67.20%上升至93.33%,隔离措施执行率由52.27%上升至82.5%;多耐药菌检出率由50.42%降低至26.90%,差异有统计学意义(P<0.05);大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌检出率分别由80.00%、55.77%、62.26%降低至23.77%、19.23%、26.47%,差异有统计学意义(P<0.05);鲍氏不动杆菌检出率由55.71%降低至53.95%(P=0.908),耐甲氧西林金黄色葡萄球菌由91.67%降低至33.33%(P=0.054)。结论开展QCC可提高多药耐药菌隔离措施执行率,降低多药耐药菌感染的发生率和检出率,是一种较好的管理工具。

OBJECTIVE To explore the effect of quality control circle（QCC）on management of multidrug-resistant organisms（MDROs）in critical care medicine department.METHODS The QCC team was established in Dec,2013.The current status of isolation and control of the MDROs,awareness of knowledge of MDROs,and isolation rates of MDROs were investigated,the brainstorming and review of literature were carried out to analyze the causes of the existing problems in the departments so as to put forward and implement the targeted interventions,the current status of isolation and control of MDROs,awareness rate,and isolation rates of MDROs were investigated again,the data were compared before and after the QCC activity was implemented,and the count data were statistically analyzed by using chi-square test.RESULTS After the QCC activity was conducted,the awareness rate of the isolation and control measures of MDROs increased from 67.20% to 93.33%,respectively,the isolation rate of MDROs dropped from 50.42%to 26.90%,with significant difference（P〈0.05）.The isolation rate of Escherichia coli decreased from 80.00% to 23.77%,the isolation rate of Klebsiella pneumoniae decreased from55.77%to 19.23%,and the isolation rate of Pseudomonas aeruginosa decreased from 62.26%to 26.47%,with significant difference（P〈0.05）.The isolation rate of Acinetobacter baumannii dropped from 55.71%to 53.95%（P=0.908）,and the isolation rate of methicillin-resistant Staphylococcus aureus dropped from 91.67% to33.33%（P=0.054）.CONCLUSION The conduct of QCC can raise the rate of implementation of isolation measures of MDROs and reduce the incidence and detection rate of MDROs infections;it is an ideal management tool.