日本某三级综合医院预防控制MRSA医院感染的多部门协作模式成效实证分析

Empirical analysis of multisectoral collaboration model in prevention and control of nosocomial infection caused by MRSA in a tertiary general hospital in Japan

目的以日本某三级综合医院控制耐甲氧西林金黄色葡萄球菌(MRSA)医院感染为切入点,分析日方在防控MRSA感染领域的多部门协作模式的实践经验。方法本研究以赴日培训为契机,在现场考察和专访记录的基础上,收集、整合的数据部分来自培训资料,部分收集于公开发表的文献和医院的宣传出版物。结果 ICC(infection control committee)和ICT(infection control team)执行医院感染管理的具体活动,包括巡视、监测、咨询、培训及系统性决策;临床微生物实验室能力建设,积极拓展新技术新项目,在提升实验室诊断感染病症的质量和效率的同时,兼顾取得经济效益;抗菌药物管理队伍建设,通过ICT-TDM(therapeutic drug monitoring)对医院内感染患者实现"综合性、个体化"的团队治疗,是该医院实现抗菌药物合理使用的一个新模式。结论 MRSA发生耐药性的原因是多方面的,预防控制MRSA感染同样需要多部门的协作模式。

OBJECTIVE To study the practical experience of multisectoral collaboration model in prevention and control of methicillin-resistant Staphylococcus aureus（MRSA）infection by taking the control of MRSA nosocomial infection in a tertiary general hospital in Japan as an example.METHODS Taking the opportunity of training in Japan,the training data were collected and integrated based on the site inspection and personal interviews,and some of the data were obtained from the published literatures and advocacy publications of the hospital.RESULTS The specific activities for control of nosocomial infections were executed by infection control committee（ICC）and infection control team（ICT）,including the inspection,surveillance,consultation,training,and systematic decision-making.The clinical microbiology laboratory has enhanced the quality and efficiency in laboratory diagnosis of infectious diseases and thus acquire economic benefit by actively developing new techniques and new programs.The antibiotic management team was established to achieve the ＂integrated＂, ＂individualized＂ teamwork treatment for the patients with hospital-acquired infections through the ICT-TDM（therapeutic drug monitoring）,which was a new model to realize reasonable use of antibiotics.CONCLUSIONThere are a variety of causes for the drug resistance of the MRSA strains,and it is necessary to further address the multisectoral collaboration model so as to prevent and control the MRSA infection.