多重耐药菌感染信息化透明监管干预模式的效果

Effect of information-based transparent supervision intervention model on multidrug-resistant organism infection

摘要:

目的 探讨基于信息化手段透明监管干预模式在多重耐药菌（MDRO）医院感染防控中的应用效果。 方法 将2019年1—12月某医院46 873例住院患者设为干预前组，2020年1—12月的45 217例住院患者为干预后组。干预组对每日医院感染实时监控系统预警检出MDRO菌株的患者实施透明监管，借助信息化手段透明公开MDRO感染率、检出率，手卫生及环境物体表面清洁消毒ATP检测合格率，MDRO核心防控措施落实率，比较透明监管干预前后的效果。 结果 信息化透明监管干预后，MDRO感染率由0.96%降至0.51%（P < 0.001），MDRO检出率由56.04%降至40.79%（P < 0.001），手卫生依从率由53.31%提高至70.25%（P < 0.001）；环境物体表面清洁、消毒合格率由51.89%提高至91.76%（P < 0.001）；干预后治疗性使用抗菌药物前病原菌送检率呈逐渐升高趋势（P < 0.001），特殊级抗菌药物使用率总体呈下降趋势（P < 0.05）。 结论 借助基于信息化实时监控系统及时预警MDRO感染病例，加强透明监管MDRO核心防控措施落实及使用信息化平台促进特殊级抗菌药物合理使用的过程控制，可以有效降低MDRO医院交叉感染，从而减少MDRO感染的暴发。

Abstract:

Objective To explore the application effect of information-based transparent supervision intervention model in the prevention and control of multidrug-resistant organism (MDRO) healthcare-associated infection(HAI). Methods 46 873 inpatients in a hospital From January to December 2019 were as pre-intervention group and 45 217 inpatients from January to December 2020 were as post-intervention group. Transparent supervision was implemented by intervention group for patients who were isolated MDRO and early warned through daily HAI real-time monitoring system. With the help of information, infection rate and isolation rate of MDRO, qualified rate of ATP detection on hand hygiene and environmental object surface cleaning and disinfection, as well as implementation rate of MDRO core prevention and control measures were transparently opened, effect before and after transparent supervision intervention was compared. Results After information-based transparent supervision intervention, infection rate of MDRO decreased from 0.96% to 0.51% (P < 0.001), isolation rate of MDRO decreased from 56.04% to 40.79% (P < 0.001), hand hygiene compliance rate increased from 53.31% to 70.25% (P < 0.001); qualified rate of environmental object surface cleaning and disinfection increased from 51.89% to 91.76% (P < 0.001); after intervention, detection rate of pathogenic organism before the therapeutic use of antimicrobial agents increased gra-dually (P < 0.001), utilization rate of special grade antimicrobial agents generally decreased (P < 0.05). Conclusion With the help of information-based real-time monitoring system, timely early warning MDRO infection cases, strengthening transparent supervision on the implementation of MDRO core prevention and control measures as well as applying information platform to promote the process controlling of rational use of special-grade antimicrobial agents can effectively reduce MDRO cross infection in hospital and reduce the outbreak of MDRO infection.