多学科协作模式对防控重症监护病房多重耐药菌患者感染率的影响研究

Study on the Influence of Multi-disciplinary Cooperation Mode on the Infection Rate of Multiple Drug-resistant Bacteria in ICU

目的探讨多学科协作模式防控对重症监护病房多重耐药菌患者感染率的影响。方法选取我院ICU(2017年1月至2019年1月)收治的1500例患者,根据不同MDRO感染预防分为2组,对照组(n=750)接受常规预防措施,观察组(n=750)接受多学科协作模式,对比两组患者感染情况、MDRO感染率和MDRO感染患者防控措施、治疗相关指标以及疾病转归。结果观察组感染率与例次感染率分别为68例(9.07%)、84例(11.20%),对照组分别为142例(18.93%)、165例(22.00%),两组患者部位包括伤口部位、手术部位、泌尿道、下呼吸道,感染率和例次感染率对比差异明显(P<0.05)。两组患者主要MDRO感染包括嗜麦芽窄食单胞菌、鲍氏不动杆菌、洋葱伯克霍尔德菌、肺炎克雷伯菌、铜绿假单胞菌,MDRO感染率对比,观察组为4.27%(32/750),对照组为11.87%(89/750),两组对比差异明显(P<0.05)。观察组MDRO感染患者护工知晓、护士知晓、医师知晓、转科告知、终末消毒、物品专用、穿隔离衣、戴手套执行率分别为255例(85.00%)、297例(99.00%)、297例(99.00%)、29例(100.00%)、32例(100.00%)、531例(99.07%)、985例(78.99%)、1885例(93.92%),对照组分别为201例(67.00%)、279例(93.00%)、278例(92.67%)、32例(84.21%)、79例(88.76%)、518例(93.67%)、812例(59.97%)、1528例(76.02%),两组对比差异明显(P<0.05)。观察组MDRO感染患者住院时间和日均费用分别为(13.82±2.88)d、(953.54±254.62)元,对照组分别为(22.46±4.21)d、(1257.65±277.68)元,两组对比差异明显(t=10.7277、5.4270,P<0.05)。观察组无效、一般、有效、死亡分别为4例(12.50%)、22例(68.75%)、5例(15.63%)、1例(3.13%),对照组分别为32例(35.96%)、44例(49.44%)、4例(4.49%)、9例(10.11%),两组MDRO感染患者疾病转归对比差异明显(P<0.05)。结论多学科协作模式可为患者提供全程药学服务和个体化诊疗,因此用药更加安全,缩短住院时间,减少了日均费用,同时正确的药物指导也降低了不良反应,避免了耐药菌产生,因此转归结果更好。

Objective To explore the effect of multi-disciplinary cooperation mode prevention and control on the infection rate of multiple drug-resistant bacteria in ICU.Methods 1500 patients in ICU of our hospital(January 2017-January 2019)were divided into two groups according to different MDRO infection prevention.The control group(n=750)received routine prevention measures,and the observation group(n=750)received multidisciplinary cooperation mode.The infection situation,MDRO infection rate,MDRO infection prevention and control measures,treatment related indicators and disease outcome of the two groups were compared.Results The infection rate of the observation group and cases were 68(9.07%),84(11.20%),the control group were 142(18.93%),165(22.00%),the two groups included wound site,operation site,urinary tract,lower respiratory tract,the infection rate and cases were significantly different(P<0.05).The main MDRO infection in the two groups included Stenotrophomonas maltophilia,Acinetobacter baumannii,Burkholderia cepacia,Klebsiella pneumoniae,Pseudomonas aeruginosa.The comparison of MDRO infection rate between the two groups was 4.27%(32/750)in the observation group and 11.87%(89/750)in the control group.The implementation rates of MDRO infection in the observation group were 255 cases(85.00%),297 cases(99.00%),297 cases(99.00%),29 cases(100.00%),32 cases(100.00%),531 cases(99.07%),985 cases(78.99%)and 1885 cases(93.92%),respectively,and 201 cases(67.00%),279 cases(93.00%)and 278 in the control group The differences between the two groups were significant(P<0.05).The average hospitalization time and daily expenses of MDRO patients in the observation group were(13.82±2.88)d and(953.54±254.62)yuan,respectively,and those in the control group were(22.46±4.21)d and(1257.65±277.68)yuan,respectively,with significant differences between the two groups(t=10.7277,5.4270,P<0.05).In the observation group,4 cases(12.50%),22 cases(68.75%),5 cases(15.63%),1 case(3.13%),32 cases(35.96%),44 cases(49.44%),4 cases(4.49%)and 9 cases(10.11%)were ineffective,general,effective and death,respectively.There was a significant difference between the two groups(P<0.05).Conclusion The multi-disciplinary cooperation mode can provide patients with the whole process of pharmaceutical care and individualized diagnosis and treatment,so the medication is safer,the hospitalization time is shortened,the daily average cost is reduced,and the correct drug guidance also reduces the adverse reactions,avoids the production of drug-resistant bacteria,so the conversion result is better.