多学科协作在儿童多重耐药菌医院感染防控中的应用

Application of multi-disciplinary team in the prevention and control of multidrug-resistant organism healthcare-associated infection in children

摘要:

目的 探讨多学科协作（MDT）管理在儿童多重耐药菌（MDRO）医院感染防控中的效果。 方法 选取2017年1月1日—2018年12月31日某省三级甲等儿童医院住院患者送检微生物培养分离出MDRO的患儿为研究对象。2017年1月1日—12月31日干预前采用常规MDRO医院感染预防和控制措施，2018年1月1日—12月31日实施MDT管理模式。比较实施前后两组患儿各项防控措施依从率、MDRO检出率、医院感染例次发病率、MDRO感染科室分布及感染构成比。 结果 实施MDT管理后，医生开具隔离医嘱、病历夹及患者一览表贴接触隔离标识、床头悬挂隔离标识、床旁速干手消毒剂配置、手卫生依从率及正确率、医疗废物正确处置、可复用医疗器械专用、医务人员知晓MDRO患儿、消毒剂正确配置、转科通知相关部门、环境物体表面清洁消毒等各项防控措施的依从率均明显升高，差异均有统计学意义（均P < 0.05）；MDRO总检出率由22.09%下降至16.50%，耐碳青霉烯类肺炎克雷伯菌（CRKP）、耐碳青霉烯类大肠埃希菌（CREC）、耐甲氧西林金黄色葡萄球菌（MRSA）、耐碳青霉烯类鲍曼不动杆菌（CRAB）、耐碳青霉烯类铜绿假单胞菌（CRPA）的检出率分别由19.25%、10.38%、27.42%、36.39%、15.37%下降至15.29%、6.01%、23.64%、21.99%、11.39%，差异均有统计学意义（均P < 0.05），实施MDT管理前后均未检出耐万古霉素肠球菌（VRE）；实施MDT管理前后MDRO医院感染例次发病率由0.19%下降至0.14%，差异有统计学意义（χ²=4.800，P=0.028）。 结论 实施MDT管理模式，能有效提高MDRO医院感染防控措施的执行率，有效减少儿童MDRO医院感染的发生。

Abstract:

Objective To explore the effect of multi-disciplinary team (MDT) management in the prevention and control of healthcare-aasociated infection(HAI)caused by multidrug-resistant organisms (MDROs) in children. Methods Children who were isolated MDROs in a tertiary first-class children's hospital between January 1, 2017 and December 31, 2018 were selected as research objects. Routine MDRO HAI prevention and control measures were adopted from January 1 to December 31, 2017 before intervention, and MDT management mode was implemented from January 1 to December 31, 2018. The compliance rate of prevention and control measures, MDRO isolation rate, case incidence of HAI, department distribution and constituent ratio of MDRO infection were compared between two groups of children before and after implementation. Results After the implementation of MDT ma-nagement, compliance rates of various prevention and control measures increased significantly, including clinicians' compliance to give isolation order, medical record folder and patient list pasted with contact isolation sign, isolation sign hanging at the head of bed, alcohol-based hand rub placed at beside, compliance rate and accuracy rate of hand hygiene, proper disposal of medical waste, exclusive use of reusable medical devices, medical staff awareness of MDRO-infected children, correct formulation of disinfectant, inform relevant departments of transferred patient, as well as cleaning and disinfection of environmental object surface, differences were all statistically significant (all P < 0.05). The total isolation rate of MDROs decreased from 22.09% to 16.50%, isolation rates of carbapenem-resis-tant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CREC), methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA) decreased from 19.25%, 10.38%, 27.42%, 36.39% and 15.37% to 15. 29%, 6.01%, 23.64%, 21.99% and 11.39% respectively, differences were all statistically significant (all P < 0.05). Vancomycin-resistant Enterococcus (VRE) were not found before and after the implementation of MDT management; case incidence of MDRO HAI decreased from 0.19% before implementation to 0.14% after implementation of MDT management, difference was statistically significant (χ²=4.800, P=0.028). Conclusion The implementation of MDT management can effectively improve the implementation rate of MDRO HAI prevention and control measures, and effectively reduce the occurrence of MDRO HAI in children.