信息化与危急值管理在提高多药耐药菌预防控制执行力中的应用

Application of information and critical value management in improving prevention and controlling of multi-drug resistant bacteria

目的强化对多药耐药菌的监测与报告,提高预防控制的执行力,控制多药耐药菌的感染与传播,为临床治疗提供参考依据。方法建立医院感染信息化监测系统,于2011年1月-2013年12月将微生物实验室检出的2 070株多药耐药菌进行分析,并向临床进行危急值报告,及时采取干预措施,定期评价干预效果,数据采用SPSS 17.0软件进行统计分析。结果 2011-2013年全院病原学送检样本中多药耐药菌检出率分别为7.93%、6.65%、5.22%,差异有统计学意义(P<0.01),在检查多药耐药菌管理措施执行中,医师开立"接触隔离"医嘱从45.24%上升至93.33%、黏贴"隔离标识"的执行率从75.00%上升至98.18%、消毒隔离措施落实从77.38%上升至93.33%、手卫生依从性从39.29%上升至78.18%等。结论通过信息化与危急值管理方法,实现对多药耐药菌的实时监测与报告,有利于各项消毒隔离与防护措施的及时落实,能有效提高多药耐药菌的预防控制执行力,降低多药耐药菌在医院内的发生与传播。

OBJECTIVE To strengthen the monitoring and reporting on multi-drug resistant bacteria, and improve the execution of prevention and control so as to limit the spread of multi-drug resistant bacteria and provide references for clinical treatments. METHODS An information monitoring system about nosocomial infections were established. From Jan. 2011 to Dec. 2013, 2 070 strains of multi-drug resistant bacteria isolated from microbiological lab were analyzed. The clinical critical values were reported and interfered measures were taken timely. The interfering effect was evaluated regularly. SPSS 17.0 was explored for statistical analysis. RESULTS From 2011 to 2013, the detection rates of multi-drug resistant bacteria in the inspected samples were 7. 93%, 6. 65% and 5.22% respectively. The differences were significant （P〈0. 01）. The results found that the execution rate of physicians giving doctorrs advice of ＂contact isolation＂ increased from 45.24% to 93.33% and the execution rate of sticking ＂isolation marks＂ went up from 75.00% to 98.18%. Implement rate of disinfection and isolation measures rose from 77. 38% to 93. 33%, and hand hygiene compliance rate increased from 39. 29% to 78.18%. CONCLUSION Management method through information and the critical value can realize real-time monitoring and reporting on multi-drug resistant bacteria, and is conducive to the implement disinfection, isolation and protection measures, which can effectively improve the prevention of multi-drug resistant bacteria and control the spread of them.