接触隔离预防控制耐碳青霉烯类耐药菌传播效果分析

Effect of contact isolation interventions on prevention and control of transmission of carbapenem-resistant bacteria

目的分析实施综合接触隔离措施对耐碳青霉烯类肺炎克雷伯菌(CRKP)、鲍氏不动杆菌(CRAB)感染发生状况的影响,为预防与控制耐碳青霉烯类细菌院内传播提供循证依据。方法采用回顾性调查,收集干预前医院2013年1月1日-2014年12月31日肺炎克雷伯菌及鲍氏不动杆菌感染患者的临床信息,2015年1月1日-2016年12月31日实施综合接触隔离措施,措施包括开具接触隔离医嘱、标识、信息干预,手卫生宣传活动等,比较干预前后CRKP及CRAB的隔离率和感染率的变化。结果干预后CRKP隔离率从20.95%升至61.82%,CRAB从16.80%升至51.49%,差异有统计学意义(P<0.05);手卫生依从率从63.93%上升至83.86%,差异有统计学意义(P<0.05);CRKP、CRAB的医院感染率分别从0.51‰、0.68‰降至0.19‰、0.37‰,差异有统计学意义(P<0.05);CRKP检出率从13.15%下降至9.31%,差异有统计学意义(P<0.05),CRAB检出率从36.43%上升至40.27%,差异无统计学意义(P>0.05)。结论开具接触隔离医嘱、标识明确、信息干预、提高手卫生依从率等综合接触隔离措施,能有效减少CRKP、CRAB医院感染的发生。

OBJECTIVE To observe the effects of comprehensive contact isolation interventions on incidence of carbapenem-resistant Klebsiella pneumoniae（CRKP）,Acinetobacter baumannii（CRAB）infection so as to provide evidence-based basis for prevention and control of the transmission of carbapenem-resistant bacteria.METHODS By means of retrospective survey,the clinical data were collected from the patients with K.pneumoniaeinfection and A.baumannii infection who were treated in the hospital from Jan 1,2013 to Dec 31,2014 before the intervention,the comprehensive contact isolation measures,including prescription of contact isolation,identification,information intervention and hand hygiene propaganda,were implemented from Jan 1,2015 to Dec 31,2016.The isolation rates of CRKP and CRAB and the infection rates were observed and compared before and after the intervention.RESULTS The isolation rate of CRKP was increased from 20.95% to 61.82% after the intervention,the isolation rate of CRAB was increased from 16.80% to 51.49% ,and there was significant difference（P〈0.05）.The hand hygiene compliance rate was increased from 63.93% to 83.86% ,and there was significant difference（P〈0.05）.The incidence rate of CRKP nosocomial infection was decreased from 0.51‰ to 0.19‰ ,the incidence rate of CRAB nosocomial infection was decreased from 0.68‰ to 0.37‰ （P〈0.05）.The detection rate of CRKP was decreased from 13.15% to 9.31% （P〈0.05）,the detection rate of CRAB was increased from 36.43% to 40.27% ,and there was no significant difference（P〈0.05）.CONCLUSION The comprehensive contact isolation interventions such as prescription of contact isolation,clear identification,information intervention and improvement of hand hygiene compliance can effectively reduce the incidence of CRAB and CRKP nosocomial infections.