基于依从性监测的加强干预对鲍曼不动杆菌感染的防控效果

Effect of intensive intervention based on compliance monitoring on prevention and control of Acinetobacter baumannii infection

目的研究基于依从性监测的加强干预措施对重症监护病房(ICU)鲍曼不动杆菌(AB)感染的预防控制效果。方法选取某三甲医院综合ICU 2019年1月—2020年12月住院患者及医务人员为研究对象。2019年1—12月(干预前)进行基线调查,掌握患者AB感染定植的基础情况。2020年1—12月(干预后)实施加强的多重耐药菌防控策略,成立多部门协作管理小组,进行防控措施依从性监测,比较干预前后防控措施依从性、抗菌药物使用情况、医院感染发病率、AB耐药率的变化。结果干预后医务人员防控措施的依从性有所提高,单间隔离执行率由干预前15.52%提高至干预后27.71%,医务人员手卫生、戴手套、穿隔离衣的依从率、环境表面荧光标记清除率均有不同程度提高,差异均有统计学意义(均P<0.001)。干预后抗菌药物使用率(74.24%)低于干预前(80.06%),差异有统计学意义(P=0.002)。干预后抗菌药物使用强度DDDs值低于干预前。干预后患者的医院感染发病率、AB医院感染构成比、耐碳青霉烯类鲍曼不动杆菌(CRAB)医院感染发病率降低,差异均有统计学意义(均P<0.05)。干预前后患者检出主要病原菌均为AB,干预后AB检出构成比(21.24%)低于干预前(30.77%),差异有统计学意义(P<0.05)。AB对亚胺培南、美罗培南的耐药率分别由干预前的76.32%、74.34%下降至干预后的60.58%、58.39%,对替加环素的耐药率由干预前的10.53%下降至干预后的1.46%,差异均有统计学意义(均P<0.05)。结论基于依从性监测的加强防控措施对降低ICU内AB医院感染和耐药具有良好的效果。

Objective To study the effect of intensive intervention measures based on compliance monitoring on prevention and control of Acinetobacter baumannii(AB)infection in intensive care unit(ICU).Methods Inpatients and health care workers(HCWs)in the general ICU of a tertiary first-class hospital from January 2019 to December 2020 were selected as the research objects.Baseline survey was conducted from January to December 2019(before intervention)to investigate the basic condition of AB infection and colonization in patients.Intensive prevention and control strategies for multidrug-resistant organism(MDRO)were implemented from January to December 2020(after intervention).A multi-department collaborative management team was set up to monitor compliance to prevention and control measures.Compliance to prevention and control measures,antimicrobial use,incidence of healthcare-associated infection(HAI),and changes of drug resistance of AB were compared.Results After the intervention,HCWs’compliance to prevention and control measures improved,implementation rate of single room isolation increased from 15.52%before intervention to 27.71%after intervention,HCWs’compliance rate to hand hygiene,wearing gloves and wearing isolation gown as well as the clearance rate of fluorescent markers on the environmental surface all improved in varying degrees(all P<0.001).After intervention,the utilization rate of antimicrobial agents was lower than that before intervention(74.24%vs 80.06%,P=0.002),DDDs of antimicrobial use density was lower than those before intervention.After intervention,HAI rate,constituent ratio of AB HAI,and incidence of carbapenem-resistant AB(CRAB)HAI in patients decreased,difference was statistically significant(all P<0.05).The main pathogens isolated from patients before and after intervention were both AB,constituent ratio of isolated AB after intervention was lower than that before intervention(21.24%vs 30.77%,P<0.05).Antimicrobial resistance rates of AB to imipenem and meropenem decreased from 76.32%and 74.34%before intervention to 60.58%and 58.39%after intervention respectively,resistance rate to tegacyclin decreased from 10.53%before intervention to 1.46%after intervention(both P<0.05).Conclusion Intensive prevention and control measures based on compliance monitoring has a good effect on reducing HAI and resistance of AB in ICU.