基于DRGs的多重耐药菌感染防控现状分析

Analysis of the current situation of prevention and control ofspecific drug-resistant bacterial infections based on DRGs

目的:基于疾病诊断相关分组(DRGs)了解山西某三甲医院多重耐药菌感染高风险科室的防控现状。方法:通过DRGs评价医疗服务绩效的能力指标——病例组合指数(CMI)调整不同科室多重耐药菌感染发生率,识别出多重耐药菌感染的高风险科室,对其多重耐药菌感染防控措施执行情况调查分析。结果:CMI调整后的不同科室多重耐药菌感染发生率差异有统计学意义(χ^(2)=42.284,P<0.05),确定CMI最低(2.54)、多重耐药菌感染发生率最高(1.54%)的呼吸重症监护病房为高风险科室,2018至2021年该科室医生24h开立接触隔离医嘱执行率为63.47%;医务人员手卫生依从率在45%~70%不等,手卫生执行正确率在70%~100%不等;在患者周围环境以及医务人员高频接触物体表面分离出14种79株致病菌,其中革兰阴性菌占65.82%;抗菌药物使用率呈上升趋势(β=0.207,P<0.05),抗菌药物使用强度(AUD)有所下降,但下降趋势不具有显著性(β=-0.634,P>0.05),AUD与多重耐药菌感染发生率之间没有相关关系(r=0.059,P=0.829)。结论:DRGs将不同科室收治病例的疾病诊断、诊疗复杂程度、疾病严重程度等情况标准化,科学客观评价不同科室多重耐药菌感染发生率,准确识别出需重点管理的高风险科室,通过对其调查分析发现,多重耐药菌感染防控措施的执行存在诸多不足,需持续改进。

Objective:Based on the disease diagnosis-related groups(DRGs)to understand the status of prevention and control of multi-resistant bacteria infection in high-risk departments of a 3A hospital in Shanxi.Methods:Case mix index,an ability index of DRGs to evaluate the performance of medical services,was used to adjust the incidence of multi-resistant bacterial infection in different departments,identify high-risk departments with multi-resistant bacterial infection,and investigate and analyze the implementation of prevention and control measures against multi-resistant bacterial infection.Results:After CMI adjustment,there was a significant difference in the incidence of multi-drug resistant bacteria infection in different departments(χ^(2)=42.284,P<0.05).It was determined that the severe respiratory illness with the lowest CMI(2.54)and the highest incidence of multi-drug resistant bacteria infection(1.54%)was a high-risk department,and the implementation rate of doctors 24-hour contact isolation orders in this department from 2018 to 2021 was 63.47%.The compliance rate of medical staff s hand hygiene varies from 45%to 70%,and the correct implementation rate of hand hygiene varies from 70%to 100%.Fourteen kinds of 79 strains of pathogenic bacteria were isolated from the surrounding environment of patients and the surface of high-frequency contact objects of medical staff,among which gram-negative bacteria accounted for 65.82%.The utilization rate of antibacterial drugs showed an upward trend(β=0.207,P<0.05),and the intensity of antibacterial drug use(AUD)decreased somewhat,but the downward trend was not significant(β=-0.634,P>0.05).There was no correlation between AUD and the incidence of multi-drug resistant bacteria infection(r=0.059,P=0.829).Conclusion:DRGs standardized the disease diagnosis,diagnosis and treatment complexity,disease severity and other conditions of cases in different departments,scientifically and objectively evaluated the incidence of multi-resistant bacterial infection in different departments,and accurately identified high-risk departments that needed key management.Through the investigation and analysis,it was found that there were many deficiencies in the implementation of prevention and control measures for multi-resistant bacterial infection,and continuous improvement was needed.