综合干预预防新生儿多药耐药菌医院感染的效果分析

Effectiveness of comprehensive intervention in prevention of nosocomial infection of multidrug-resistant bacteria in newborns

目的分析主动监测等综合干预措施防控新生儿病区医院感染状况的效果。方法回顾性调查收集2014年1月1日-2015年12月31日实施综合干预措施前医院新生儿病房住院患者5305例感染资料,2016年1月1日-2018年12月31日开展主动监测等综合干预措施包括对具备感染高危因素的新生儿8456例入院实施标准预防,确诊多药耐药菌感染者开具接触隔离医嘱、督导落实隔离措施及手卫生依从性。前瞻性收集干预后数据,分析比较干预前后医院感染发生率、耐药菌检出率、手卫生依从率的变化。结果实施主动监测等综合干预措施后医院感染的发生率由1.96%(104/5305)下降至1.50%(127/8456)(P=0.042),耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青酶烯的肠杆菌(CRE)医院感染率分别从0.17%(9/5305)、0.21%(11/5305)下降至0.05%(4/8456)、0.08%(7/8456)(P<0.05);隔离率从52.38%(22/42)、上升至90.00%(27/30)(P=0.001);手卫生依从率从90.07%(363/403)上升至94.05%(1471/1564)(P=0.005)。结论实施主动监测和标准预防措施及开具接触隔离医嘱、督导落实隔离措施及手卫生依从性等综合干预措施,能有效降低新生儿患者医院感染发生率及防控多药耐药菌院内感染的发生。

OBJECTIVE To study the effect of comprehensive interventions such as active monitoring on the prevention and controlling of nosocomial infections in neonatal ward.METHODS A retrospective survey collected data on 5305 cases of infection patientsin neonatal wards of the hospital before the implementation of comprehensive intervention from Jan.1,2014 to Dec.31,2015,and 8456 cases of patients underwent active monitoring and comprehensive intervention measures including standard prevention for neonates with high risk of infection,contact and isolation prescription for those diagnosed multidrug-resistant bacteria,supervision,supervision of the implementation of isolation measures and hand hygiene compliance from Jan.1,2016 to Dec.31,2018.Data were collected prospectively after the intervention,and the changes in the incidence of nosocomial infection,detection of drug-resistant bacteria,and compliance with hand hygiene before and after the intervention were analyzed and compared.RESULTS The incidence of nosocomial infection rate decreased from 1.96%(104/5305)to 1.5%(127/8456)(P=0.042),hospital infection rate of MRSA and CRE decreased from 0.17%(9/5305)and 0.21%(11/5305),respectively to 0.05%(4/8456)and 0.08%(7/8456),respectively(P<0.05).Isolation rate increased from 52.38%(22/42)to 90.00%(27/30)(P=0.001),and hand hygiene compliance rate increased from 90.07%(363/403)to 94.05%(1471/1564)(P=0.005).CONCLUSIONS Comprehensive intervention measures such as active monitoring,standard prevention,contact and isolation prescription,for patients diagnosed with multidrug-resistant bacteria,supervison of the implementation of quarantine measures and compliance with hand hygiene can effectively reduce the incidence of nosocomial infection in neonatal patients and spread of multidrug resistant nosocomail infection.