心脏外科ICU患儿多药耐药菌感染的综合干预措施研究

Comprehensive intervention measures of multi-drug resistant organism infections in children of cardiac surgery ICU

目的分析心脏外科ICU患儿多药耐药菌(MDRO)聚集事件的控制过程,对医院感染耐药菌株聚集综合干预策略进行评价。方法前瞻性干预管理2014年1月-2016年12月小儿心外监护2起多药耐药菌聚集事件,对照2008年1月-2013年12月4起聚集事件,对多药耐药菌预警时机、隔离措施执行情况、手卫生依从性、防护用品使用、常规环境消毒效果、抗菌药物管理等一系列干预策略,进行综合评价。结果综合干预后,耐药菌聚集事件平均持续时间由28.25d缩短为14.50d,感染患儿耐药菌清除率由41.18%上升为72.73%,干预前后比较差异有统计学意义(P<0.05);实施综合干预措施后,临床24h内隔离措施执行率、医务人员手卫生依从性、环境消毒达标率均明显提高(P<0.05)。结论 MDRO综合干预措施可以明显缩短耐药菌聚集事件的控制时间、提高感染患儿耐药菌清除率。

OBJECTIVE To analyze the control methods of the multi-drug resistant organism（MDRO）clustering events and evaluate the comprehensive nosocomial infection intervention strategy.METHODS Prospective intervention management were adopted in 2 cases of MDRO clustering events in ICU of pediatric cardivascular department from Jan.2014 to Dec.2016.The other 4 cases of MDRO clustering events from Jan.2008 to Dec.2013 were set as control group.The warning time,implementation of the isolation measures,hand hygiene compliance,use of protective articles,routine environmental disinfection effect,antibacterial drug management and a series of intervention strategies of MDRO were comprehensive evaluated.RESULTS After taking comprehensive intervention measures,the average duration of MDRO clustering events reduced from 28.25 dto 14.5 d,MDRO clearance rate increased from 41.18% to 72.73% ,and the difference was significant before and after intervention（P〈0.05）.The implementation rate of clinical 24 hisolation measures,hand hygiene compliance of medical staff and environmental disinfection compliance rate were significantly improved（P〈0.05）.CONCLUSION MDRO comprehensive intervention measures can significantly shorten the duration of MDRO clustering events and improve the microbiological clearance rate in children.