集束化管理策略在多重耐药菌管理中的应用

Application of bundle strategies in the management of multidrug-resistant organisms

目的探讨集束化管理策略在多重耐药菌(MDRO)管理中的应用。方法 2013年7月1日起对某三甲综合医院住院患者MDRO管理实施集束化干预措施,监测常见MDRO感染/定植患者相关隔离措施的实施情况,2013年4—6月为干预前组,2013年7—9月为干预第1阶段,2013年10—12月为干预第2阶段,比较干预前后各项措施合格率及常见MDRO日感染率。结果 2013年4—12月共检出非重复菌株3 430株。"接触隔离"医嘱合格率干预前为78.14%,干预第2阶段为95.95%;悬挂床旁隔离标识、配置床旁速干手消毒剂、患者佩戴蓝色腕带合格率干预前分别为52.70%、66.89%、87.16%,干预第2阶段均达100.00%。医疗用品及环境消毒、病床安置合格率干预前分别为23.65%、15.54%,干预第2阶段分别为79.79%、77.66%。医务人员手卫生知识知晓率、依从率以及正确率干预前分别为69.70%、45.76%、76.35%;干预第2阶段分别为90.23%、87.50%、94.58%;干预前及干预后各阶段各项隔离措施实施的合格率比较,差异均有统计学意义(均P<0.01)。干预前阶段、干预第1阶段和干预第2阶段常见MDRO日发病率分别为3.24‰、2.63‰、2.20‰。结论应用集束化管理策略对MDRO进行监测和干预,各项隔离措施合格率提高,MDRO感染日发病率下降。

Objective To explore the application of bundle strategies in the management of multidrug-resistant organisms（MDROs）.Methods From July 1,2013,bundle intervention measures were applied in the management of MDROs from inpatients in a tertiary first-class hospital,the implementation of isolation measures for MDRO-infected/colonized patients were monitored,April-June 2013 was pre-intervention group,July-September 2013 was the first stage of intervention,October-December 2013 was the second stage of intervention,the qualified rate of each measure and incidence of MDRO infection per 1 000 patient-days before and after intervention were compared.Results From April to December 2013,a total of 3 430 non-repetitive isolates were detected.The qualified rate of doctors＇ order＂contact isolation＂before intervention and in the second stage of intervention were 78.14%and95.95%respectively;the qualified rate of hanging bed-side isolation signs,providing bed-side quick-drying hand disinfectant,and patients wearing blue wristbands before intervention were 52.70%,66.89%,and87.16%respectively,and in the second intervention stage were all 100.00%.The qualified rate of disinfection of medical supplies and environment,as well as patients＇ bed assignments before intervention were 23.65% and 15.54% respectively,in the second stage were 79.79% and77.66%respectively.Health care workers＇ awareness rate of hand hygiene knowledge,hand hygiene compliance rate,and hand hygiene correct rate before intervention were 69.70%,45.76%,and 76.35% respectively;in the second stage were90.23%,87.50%,and 94.58% respectively;the qualified rate of implementation of each isolation measure before intervention and in different stages after intervention were all significantly different（all P0.01）.The incidence of MDRO infection per 1 000 patient-days before intervention,in the first and second intervention stages were 3.24‰,2.63‰,and2.20‰respectively.Conclusion After the monitoring and intervention in MDROs with bundle management strategies,the qualified rate of each measure improved,incidence of MDRO infection per 1 000 patient-days decreased.