优化血培养检测流程的效果评价研究

Effect evaluation of optimizing blood culture testing process

目的评价通过优化血培养工作流程的方式是否可以缩短菌血症标本血培养阳性报警时间(TTP)、阳性报警到审核时间(阳性报警后处理时间)和标本周转时间(TAT)。方法本实验采用回顾性研究。对北京大学人民医院2014年1月1日至2021年6月30日收集的阳性血培养标本进行阶段性分析研究。本研究中的传统流程阶段(2014年),共纳入分析阳性血培养标本502瓶;流程优化第一阶段(2016年),较传统流程阶段延长了工作人员在岗时间至22:00,共纳入分析阳性血培养标本976瓶;流程优化第二阶段(2018年),较流程优化第一阶段增加了质谱快速鉴定流程,共纳入阳性血培养标本1029瓶;流程优化第三阶段(2020年),较流程优化第二阶段引入新型VIRTUO BACT/ALERT血培养系统。比较不同阶段中血培养阳性报警时间、血培养阳性报警后处理时间和标本周转时间的差异。统计分析采用秩和检验。结果在传统流程阶段(2014年),阳性报警后处理时间为55.70(47.35,68.45)h;流程优化第一阶段(2016年),阳性报警后处理时间为47.25(33.88,59.96)h,流程优化第一阶段阳性报警后处理时间明显短于传统流程阶段(Z=‒10.734,P<0.001);流程优化第二阶段(2018年)阳性报警后处理时间为47.18(36.41,59.40)h,在17:00之前12.18%革兰阴性杆菌的初步鉴定结果可以在审核前回报临床;流程优化第三阶段(2020年),原有BACT/ALERT 3D系统的血培养标本TTP为39.56(21.52,62.65)h,TAT为78.16(64.68,99.72)h;新型VIRTUO BACT/ALERT系统的血培养标本TTP为37.03(21.08,58.22)h,TAT为73.41(62.88,89.48)h,VIRTUO BACT/ALERT系统较BACT/ALERT 3D系统的TTP明显缩短(Z=‒2.273,P=0.023);VIRTUO BACT/ALERT系统较BACT/ALERT 3D系统的TAT明显缩短(Z=‒4.040,P<0.001)。结论通过对微生物实验室血培养工作流程进行多方面、多措施的持续改进,可缩短血培养中各阶段的处理时间,使临床获得受益。

Objective To evaluate whether the time to positive(TTP),handling time after positive alarm and turnaround time(TAT)of bacteremia blood culture can be shortened by optimizing blood culture workflow.Methods This study was conducted retrospectively.Positive blood culture samples collected from Peking University People′s Hospital from January 1,2014 to June 30,2021 were analyzed in stages.In the traditional process stage of this study(2014),502 bottles of positive blood culture samples were included in the analysis.In the first stage of process optimization(2016),the working time of staff was increased to 22:00,and 976 positive blood culture specimens were included in the analysis.In the second stage of process optimization(2018),the rapid identification process of MALDI-TOF MS was added,and a total of 1029 bottles of positive blood culture samples were included.In the third stage of process optimization(2020)with the introduction of the new VIRTUO BACT/ALERT system.The difference of TTP,handling time after positive alarm and TAT of whole process in different stages of traditional process and process optimization were compared.All data were statistically significant when P<0.05 using rank-sum test.Results In the traditional process stage(2014),the median quartile time of handling time after positive alarm was 55.70(47.35,68.45)h.In the first stage of process optimization(2016),the median quartile time of handling time after positive alarm was 47.25(33.88,59.96)h,and the handling time after positive alarm in the first stage of process optimization was significantly shorter than that in the traditional process stage(Z=‒10.734,P<0.001).In the second stage of process optimization(2018),the median quartile time for handling time after positive alarm was 47.18(36.41,59.40)h,and 12.18%of the preliminary identification results of Gram-negative bacilli before 17:00 could be reported to the clinic before audit.In the third stage of process optimization(2020),the median quartile of TTP and TAT were 39.56(21.52,62.65)h and 78.16(64.68,99.72)h respectively in the original BACT/ALERT 3D system.The new VIRTUO BACT/ALERT system had a median quartile of 37.03(21.08,58.22)h for TTP and 73.41(62.88,89.48)h for TAT.VIRTUO BACT/ALERT 3D had a significantly shorter TTP than BACT/ALERT 3D(Z=‒2.273,P=0.023),the TAT of VIRTUO BACT/ALERT system was significantly shorter than that of BACT/ALERT 3D system(Z=‒4.040,P<0.001).Conclusion By improving the blood culture process of microbiology laboratory in many aspects and measures,the processing time of blood culture in each stage can be shortened and clinical benefits can be obtained.