危急值管理在多重耐药菌感染控制中的应用

Application of critical value management in control of multidrug-resistant organisms infection

目的探讨实施危急值管理对临床多重耐药菌(MDROs)感染的影响。方法选取某三级甲等综合医院2015年4月-2017年3月的所有住院患者为研究对象,比较实施危急值管理干预前(2015年4月-2016年3月)和干预后(2016年4月-2017年3月)患者MDROs感染及检出情况,分析干预前后临床各项预防控制措施依从性的差异。结果干预前后分别检出MDROs 959株和1061株,MDROs检出率从18.98%降至14.79%,差异有统计学意义(χ2=6.811,P=0.009);治疗性使用抗菌药物的微生物送检率从干预前的45.53%升高至干预后的50.02%,差异有统计学意义(χ2=149.751,P<0.001);干预前后MDROs医院感染分别为323和231例次,MDROs医院感染例次日发病率由干预前的0.44‰降至干预后的0.29‰,差异有统计学意义(χ2=25.013,P<0.001);干预后MDROs各项预防控制措施的依从率及医护人员、保洁人员的知晓率等均高于干预前,差异有统计学意义(均P<0.05)。结论实施危急值管理能促进多重耐药菌预防控制措施依从性提高,降低多重耐药菌医院感染率。

OBJECTIVE To explore the effect of critical value management on clinical control of multidrug-resistant organisms(MDROs)infection.METHODS All of the patients who were hospitalized in a three A general hospital from Apr 2015 to Mar 2017 were recruited as the study objects,the incidence of MDROs infection and isolation rate were observed and compared before the critical value management was carried out(from Apr 2015 to Mar2016)and after the critical value management was carried out(from Apr 2016 to Mar 2017),and the compliance of prevention and control measures was analyzed before and after the intervention.RESULTS Totally 959 strains of MDROs were isolated before the intervention,and 1061 strains were isolated after the intervention,with the isolation rate of MDROs decreasing from 18.98%to 14.79%,and there was significant difference(χ2=6.811,P=0.009).The submission rate of microorganisms of therapeutic use of antibiotics was increased from 45.53%before the intervention to 50.02%after the intervention,and there was significant difference(χ~2=149.751,P<0.001).There were 323 case-times of MDROs nosocomial infection before the intervention and 231 case-times after the intervention,the daily case-time incidence of MDROs nosocomial infection was decreased from 0.44‰before the intervention to 0.29‰after the intervention,and there was significant difference(χ~2=25.013,P<0.001).The compliance rate of prevention and control measures and awareness rate of health care workers and cleaning staff were higher after the intervention than before the intervention,and there were significant differences(all P<0.05).CONCLUSION The critical value management may facilitate the improvement of compliance of prevention and control of MDROs infection and reduce the incidence of MDROs nosocomial infection.