多学科协作模式在多重耐药菌感染管理中的应用研究

Application of Multi-disciplinary Team Mode in the Management of Multidrug-resistant Organism Infection

目的探讨多学科协作(multi-disciplinary team,MDT)管理模式在多重耐药菌(multidrug-resistant organisma,MDROs)感染防控中的实践效果,为有效控制MDROs的产生和传播提供实证依据。方法以湖北省某三级甲等综合医院为研究对象,比较评估MDT模式实施前后MDROs防控措施落实率、环境物表MDROs检出率、特殊级抗菌药物合理使用情况、MDROs医院感染发生率和MDROs检出率,统计分析采用SPSS 20.0软件进行。结果实施MDT管理模式后,MDROs防控措施总落实率由77.00%提高至94.35%(χ~2=1402.110,P<0.001);环境物表MDROs总检出率由9.44%下降至3.47%(χ~2=42.509,P<0.001);碳青霉烯类和替加环素使用前微生物培养未送检率由25.88%下降至13.94%(χ~2=55.545,P<0.001),无适应症使用率由54.45%下降至26.78%(χ~2=196.327,P<0.001);MDROs医院感染发生率由1.21%下降至0.63%(χ~2=301.422,P<0.001);MDROs总检出率由47.30%下降至30.02%(χ~2=302.245,P<0.001)。结论通过实施MDT管理模式,医务人员对MDROs防控措施的执行力明显提高,管理更加科学规范。

Objective To explore the practical effect of multi-disciplinary team(MDT)management mode on the prevention and control of multidrug-resistant bacteria(MDROs),so as to provide methodological evidence-based basis for effective control of the generation and spread of MDROs.Methods A tertiary general hospital in Hubei Pro-vince was selected as the research object.The implementation rate of MDROs prevention and control measures,the detection rate of MDROs in environmental surface,the rational use of special class antibacterial drugs,the incidence rates of the hospital-acquired MDROs,and the detection rate of MDROs were compared and evaluated before and after the MDT mode was carried out.And the statistical analysis was carried out by SPSS 20.0 software.Results After the implementation of MDT management mode,the overall implementation rate of MDROs prevention and control measures increased from 77.00%to 94.35%(χ^2=1402.110,P<0.001),the detection rate of MDROs in environmental surface decreased from 9.44%to 3.47%(χ^2=42.509,P<0.001),the untested rate of microbial culture before use of carbapenems and tegacycline decreased from 25.88%to 13.94%(χ^2=55.545,P<0.001),the non-adaptive use rate decreased from 54.45%to 26.78%(χ^2=196.327,P<0.001),the incidence rates of the hospital-acquired MDROs decreased from 1.21%to 0.63%(χ^2=301.422,P<0.001),and the detection rate of MDROs decreased from 47.30%to 30.02%(χ^2=302.245,P<0.001).Conclusion Through the implementation of MDT management mode,the execution of MDROs prevention and control mea-sures by medical staff has been significantly improved,and the management is more scientific and standardized,and finally effectively reducing the incidence rate of the hospital-acquired MDROs and the detection rate of MDROs.