某三级综合医院多重耐药菌防控管理新模式探讨

A new management mode for the prevention and control of multidrug-resistant organisms in a tertiary hospital

摘要:

目的 探讨风险评估联合PDCA循环法在多重耐药菌(MDRO)感染防控中的应用效果。 方法 选取某三级甲等综合医院2019年7月—2020年6月“五类七种”目标性监测MDRO的相关资料。2019年7—12月为干预前阶段，2020年1—6月为干预后阶段。根据2019年风险评估的结果，引入PDCA循环法对MDRO检出情况及防控措施落实情况进行干预管理，比较干预前后MDRO检出情况及防控措施执行率。 结果 干预前共纳入MDRO感染患者124例，干预后纳入129例。干预后抗菌药物治疗前病原学送检率(39.43%)高于干预前(33.13%)，差异有统计学意义(P＜0.001)。实施风险评估联合PDCA循环干预后MDRO防控措施总执行率为82.83%，高于干预前的61.75%，差异具有统计学意义(P＜0.05)。干预后MDRO防控措施知晓情况、危急值报告、开具隔离医嘱、经荧光监测床单位清洁消毒、操作前后执行手卫生、MDRO早交班、通知接诊科室采取隔离措施、执行终末消毒8项措施的执行率较干预前均提高，差异均有统计学意义(均P＜0.05)。干预后MDRO检出率为8.08%，低于干预前的10.31%，差异有统计学意义(P＜0.05)。干预后耐碳青霉烯类鲍曼不动杆菌检出率由60.78%下降至48.13%，多重耐药/泛耐药铜绿假单胞菌检出率由35.35%下降至22.90%，差异均有统计学意义(均P＜0.05)。 结论 风险评估联合PDCA循环法可提高MDRO防控措施执行率，使MDRO检出率在抗菌药物治疗前病原学送检率提高的前提下得以降低。

Abstract:

Objective To explore the application effect of risk assessment combined with plan-do-check-action (PDCA)cycle in the prevention and control of multidrug-resistant organism (MDRO) infection. Methods Relevant data of targeted monitoring on MDROs of "five categories and seven types" in a tertiary first-class hospital from July 2019 to June 2020 were selected. The pre-intervention stage was from July to December, 2019, and the post-intervention stage was from January to June, 2020. Based on risk assessment results in 2019, the PDCA cycle method was introduced to intervene and manage the detection of MDROs and the implementation of prevention and control measures. The detection of MDROs and the implementation rate of prevention and control measures before and after the intervention were compared. Results A total of 124 and 129 patients before and after the intervention were included respectively. After intervention, the pathogen detection rate before antimicrobial therapy was higher than before intervention (39.43% vs 33.13%, P < 0.001). The total implementation rate of MDRO prevention and control measures after implementing risk assessment combined with PDCA cycle intervention was 82.83%, which was higher than before the intervention (61.75%), with statistically significant difference (P < 0.05). After intervention, the implementation rates of 8 measures increased with statistically significant differences (all P < 0.05) compared to before intervention, including awareness of MDRO prevention and control measures, critical value reports, giving isolation medical orders, fluorescent monitoring on cleaning and disinfection of bed units, hand hygiene before and after operation, early handover about MDRO, notification of receiving departments to take isolation measures, and final disinfection. The detection rate of MDROs after intervention was 8.08%, which was lower than before intervention (10.31%), with statistically significant difference (P < 0.05). Detection rate of carbapenem-resistant Acinetobacter baumannii (CRAB) decreased from 60.78% to 48.13%, and detection rate of multidrug-resistant (MDR)/extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) decreased from 35.35% to 22.90% after intervention, with both differences statistically significant (both P < 0.05). Conclusion Risk assessment combined with the PDCA cycle can improve the implementation rate of MDRO prevention and control measures, so that the MDRO detection rate can be reduced even with increased pathogenicity detection rate before antimicrobial therapy.