综合医院多重耐药菌医院感染SHEL模式防控策略研究

Research on prevention and control strategy of SHEL model of multi-drug-resistant bacteria nosocomial infection in general hospitals

目的以信息技术为支撑,运用SHEL模式改善临床多重耐药菌(MDROs)医院感染防控措施的规范性和执行力,提高医院感染防控水平。方法某三甲医院北院区依据《多重耐药菌医院感染预防与控制技术指南(试行)》与《多重耐药菌医院感染预防与控制中国专家共识》,实施常规的MDROs医院感染防控管理(常规组);南院区在此基础上依托“医院感染实时监测系统”,就SHEL模式四要素针对性改善临床科室MDROs医院感染防控工作(SHEL组)。分析比较两组2018年7月至2019年6月间的微生物送检率、MDROs分离率、MDROs医院感染防控措施执行率、MDROs医院感染防控知识考核合格率、手卫生依从率及正确率等。结果SHEL组的微生物送检率、MDROs医院感染防控措施执行率、MDROs医院感染防控知识考核合格率、手卫生依从率及正确率均高于常规组,SHEL组耐甲氧西林金黄色葡萄球菌(MRSA)、多重耐药/泛耐药铜绿假单胞菌(MRD-PA)、耐碳青霉烯类抗菌药物肠杆菌科细菌(CRE)、耐万古霉素肠球菌(VRE)分离率低于常规组;SHEL组耐碳青霉烯类抗菌药物鲍曼不动杆菌(CR-AB)分离率高于常规组;SHEL组全部目标监测菌感染类型中的医院感染占比均低于常规组,差异均具有统计学意义(均P<0.05)。结论实施基于信息技术的MDROs医院感染SHEL模式防控,能促进临床建立主动防控意识,规范防控行为,提高防控执行力,降低MDROs的分离率,持续改进MDROs医院感染防控质量。

Objective To use the SHEL model to improve the standardization and enforcement of nosocomial infection prevention and control measures of clinical multi-drug resistant bacteria(MDROs),and to improve the level of nosocomial infection prevention and control under the support of information technology.Methods According to the Technical Guidelines for the Prevention and Control of Multidrug-resistant Bacteria Nosocomial Infection Prevention and Control(Trial)and the Chinese Expert Consensus on the Prevention and Control of Multidrug-resistant Bacteria Nosocomial Infections,the routine MDROs nosocomial infection prevention and control management was carried out in the north hospital of a tertiary hospital(Routine group).On this basis,the South Campus relied on the"Real-time Nosocomial Infection Monitoring System"to improve the prevention and control of nosocomial infection in MDROs in clinical departments based on the four elements of the SHEL model(SHEL group).The microbiological inspection rate,the isolation rate of MDROs,the implementation rate of MDROs nosocomial infection prevention and control measures,the pass rate of MDROs nosocomial infection prevention and control knowledge assessment,and the compliance rate and accuracy rate of hand hygiene between the two groups from July 2018 to June 2019 were analyzed and compared.Results The microbiological inspection rate,the implementation rate of MDROs nosocomial infectionprevention and control measures,the pass rate of MDROs nosocomial infection prevention and control knowledge assessment,the hand hygiene compliance rate and the correct rate of the SHEL group were higher than those of the conventional group.The MRSA,MRD-PA and the separation rate of CRE and VRE were lower than those of the routine group;the CR-AB separation rate of the SHEL group was higher than that of the routine group;the proportion of nosocomial infections among all target surveillance bacterial infection types in the SHEL group was lower than that of the routine group.The differences were statistically significant(all P<0.05).Conclusion With the implementation of SHEL model for the prevention and control of multi-drug resistant bacteria hospital infections on information technology,it could promote the establishment of active prevention and control awareness in the clinics,standardize the prevention and control of behaviors,improve prevention and control execution,reduce the isolation rate of MDROs,and continuely improve the quality of the prevention and control of MDROs hospital infections.