多学科协作管理在多药耐药菌感染防控中的应用

Effect of multidisciplinary team management on control of multidrug-resistant organism infections

目的探讨多学科协作管理模式在多药耐药菌(MDROs)感染预防和控制中的应用效果,为有效控制MDROs医院感染提供方法学依据。方法以2017年4月-2018年3月湖北省某三甲医院综合ICU、神经外科、神经内科三个科室的MDROs感染住院患者为研究对象,采用直接观察法和目标性监测法收集资料,比较实施多学科协作模式管理MDROs前后各项防控措施的依从率、MDROs医院感染发生率和检出率,数据采用SPSS22.0软件进行统计学分析。结果实施多学科协作模式管理后,医生开具隔离医嘱、悬挂隔离标识、可重复使用医疗器械专人专用、医疗废物正确处置、正确使用个人防护用品等各项防控措施的依从率均升高(P<0.05);MDROs医院感染总发生率由2.47%降至1.52%,差异有统计学意义(χ~2=19.721,P<0.001);MDROs总检出率由76.78%降至64.82%,差异有统计学意义(χ~2=22.068,P<0.001)。结论实施多学科协作模式管理MDROs提高了临床防控措施的执行力,有效降低了多药耐药菌医院感染发生率和检出率,值得临床推广应用。

OBJECTIVE To explore the effect of multidisciplinary team management on prevention and control of multidrug-resistant organism（MDRO）infections so as to provide scientific basis for effective control of the MDRO infections.METHODS The patients who were hospitalized comprehensive ICUs,neurology department and neurosurgery department of a three-A hospital in Hubei province from Apr 2017 to Mar 2018 were recruited as the study objects,the data were collected by using direct observation method and targeted surveillance.The compliance rates of the prevention measures,incidence rates of hospital-acquired MDRO infections and isolation rates of MDROs were observed and compared before and after the multidisciplinary team management was carried out,and the statistical analysis was performed with the use of SPSS 22.0 software.RESULTS The compliance rates of the prevention measures such as making advice of isolation,hanging isolation card,dedicated use of reusable medical devices,proper disposal of medical waste and proper use of personal protective items were significantly increased after the multidisciplinary team management carried out（P〈0.05）.The total incidence rate of hospital-acquired MDROs infection was significantly decreased from 2.47% to 1.52%（χ2=9.721,P〈0.001）.The total isolation rate of MDROs was significantly decreased from 76.78%to 64.82%（χ2=2.068,P〈0.001）.CONCLUSION The multidisciplinary team management may facilitate the implementation of the clinical prevention measures and effectively reduce the incidence of the hospital-acquired MDRO infections as well as the isolation rate of MDROs,and it is worthy to be promoted in the hospital.