基于HTRM理念的管理模式在多重耐药菌防控管理中的应用

Application of Management Mode Based on HTRM in Multi-Drug Resistant Bacteria Control and Management

目的探讨基于医疗团队资源管理策略(healthcare team resource management,HTRM)理念的管理模式在多重耐药菌(multidrug-resistant organisms,MDROs)防控管理中的应用效果。方法收集2019年1月—2022年12月漳州市第三医院888例MDROs患者临床数据,按照MDROs防控管理模式分为实施前组(2019年1月—2020年12月)565例及实施后组(2021年1月—2022年12月)323例。实施前组采用传统管理模式,实施后组采用基于HTRM理念的管理模式。观察两组MDROs防控策略落实率、MDROs管理处置时间、MDROs患者周围环境清洁卫生质量合格率、MDROs分布科室及菌种构成。结果实施后组开具隔离医嘱落实率、设置隔离标识落实率、诊疗顺序正确率、护理顺序正确率、用物专用落实率及医用物品正确处理落实率均高于实施前组(P<0.05)。实施后组样本采集-接收时间、检出-报告时间及核实-反馈时间均短于实施前组(P<0.05)。实施后组患者周围环境(呼吸机、操作平台、清洁工具)清洁卫生质量合格率均高于实施前组(P<0.05);实施后组内科及其他科室患者感染率降低,碳青霉烯类铜绿假单胞菌感染率低于实施前组(P<0.05)。结论实施基于HTRM理念的管理模式能够有效提高MDROs防控措施的落实率,提高防控措施执行力,有效控制MDROs在院内的传播,提高防控质量。

Objective To explore the application effect of the management model based on the concept of healthcare team resource management(HTRM)in the prevention and control management of multidrug-resistant organisms(MDROs).Methods Clinical data of 888 MDROs patients in the Third Hospital of Zhangzhou from January 2019 to December 2022 were collected and divided into pre-implementation group(565 cases,from January 2019 to December 2020)and post-implementation group(323 cases,from January 2021 to December 2022)according to the prevention and control management mode of MDROs.The preimplementation group adopted a traditional management model,while the post-implementation group adopted a management model based on the HTRM concept.The implementation rate of MDROs prevention and control strategies,the management and disposal time of MDROs,the qualified rate of cleaning and hygiene quality of the surrounding environment of MDROs patients,and the distribution of MDROs in departments and bacterial species composition were observed in both groups.Results The implementation rate of isolation medical orders issued,isolation standards set,diagnosis and treatment sequence accuracy,correct rate of nursing sequence,usage specific implementation rate and correct handling rate of medical items in the post-implementation group were higher than those in the pre-implementation group(P<0.05).The sample collection receiving time,detection reporting time,and verification feedback time of the post-implementation group were all shorter than those of the pre-implementation group(P<0.05).The qualified rate of cleanliness and hygiene quality in the surrounding environment(ventilator,operating platform,cleaning tools)of patients in the post implementation group was higher than that in the pre-implementation group(P<0.05).After implementation,the infection rate of patients in internal medicine and other departments decreased,and the infection rate of carbapenem Pseudomonas aeruginosa was lower than that in the pre-implementation group(P<0.05).Conclusion Implementing a management model based on the HTRM concept can effectively improve the implementation rate of MDROs prevention and control measures,enhance the execution ability of prevention and control measures,effectively control the spread of MDROs in the hospital,and improve the quality of prevention and control.