河北医科大学学报

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多重耐药目标菌主动筛查联合模拟防控训练的干预效果研究

  

  1. 1.华北石油管理局总医院医院感染管理科，河北 任丘 062552;2.华北石油管理局总医院医务科，河北 任丘 062552;3.华北石油管理局卫生处，河北 任丘 062552
  • 出版日期:2019-11-25 发布日期:2019-11-21
  • 作者简介:苗勤（1975-），女，河南滑县人，华北石油管理局总医院副主任技师，医学学士，从事医院内感染及控制研究。
  • 基金资助:
    中国石油天然气股份有限公司华北油田分公司科技项目专项（2018-HB-G0701）

Research on the intervention effect of active screening of multi-drug resistant target organisms combined with simulation prevention and control training#br#

  1. .Department of Hospital Infection Management， General Hosptial of North China Petroleum  Administration, 
    Hebei Province, Renqiu 062552， China；  2.Department of Medical， General Hosptial North China
    Petroleum  Administration， Hebei Province, Renqiu 062552， China； 3.Department of Sanitation,
    North China Petroleum  Administration， Hebei Province, Renqiu 062552， China
  • Online:2019-11-25 Published:2019-11-21

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摘要： ［摘要］
〖HTH〗目的〖HTSS〗〖KG*2〗探讨主动监测培养与模拟训练防控干预对高风险患者多重耐药菌（multidrug-resistant organisms，MDRO）感染防控效果，为降低MDRO医院感染和制定科学有效的MDRO预防和控制策略提供依据。
〖HTH〗方法〖HTSS〗〖KG*2〗选择2017年2—12月入住重症监护病房（intensive care unit,ICU）的患者222例为试验组，在模拟防控训练的基础上联合多重耐药目标菌主动监测培养；另选择2016年2—12月未实施强制干预措施的患者210例为对照组。比较2组MDRO构成比、MDRO感染率、MDRO定植率及接触隔离依从性。
〖HTH〗结果〖HTSS〗〖KG*2〗2组医院感染率、MDRO医院感染率差异均无统计学意义（P＞0.05）。试验组医务人员实施的MDRO隔离措施中，隔离医嘱、床旁隔离、穿隔离衣、贴隔离标识、床旁放置快速手消与科室间告知依从性均高于对照组，差异有统计学意义（P＜0.05）。试验组主动筛查产超广谱β-内酰胺酶的大肠埃希菌、产超广谱β-内酰胺酶的肺炎克雷伯菌和多重耐药鲍曼不动杆菌, 定植率分别为10.10%、5.72%和16.83%。2组抗菌药物使用率均＞90%，抗菌药物使用前送检率均＜30%。
〖HTH〗结论〖HTSS〗〖KG*2〗ICU多重耐药鲍曼不动杆菌定植情况较严重，定植者较易获得医院内感染，实施主动监测培养与模拟防控训练干预可有效预防和控制多重耐药菌在医院内传播。

关键词: 多重耐药菌, 主动监测培养, 模拟训练, 交叉感染

Abstract: ［Abstract］Objective〖HTSS〗To explore the effect of active monitoring training and simulated prevention and control training on multidrug-resistant organism(MDRO) infection in high-risk patients and to provide evidence for reducing MDRO nosocomial infection and developing scientific and effective MDRO prevention and control strategies.
〖HTH〗〖WTHZ〗Methods〖HTSS〗Simulated prevention and control training and active screening of multi-drug resistant target organisms were carried out on 222 patients in intensive care unit(ICU) who were chosen to be the experimental group from February to December in 2017. Compared with 210 patients in ICU from February to December in 2016, who were chosen to be the control group without mandatory intervention measure. The constituent ratios, the colonization rate of MDRO and the changes of contact isolation compliance were observed between two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗The nosocomial infection rate, the infection rate of MDRO in two groups,there was no significant difference between two groups(P＞0.05), there were significant differences in compliance with the MDRO isolation measures performed by medical staff such as the isolation′s advice, the bedside isolation, the isolation gown, the isolation sign, hand sanitizer and the notice among departments(P＜0.05). The experimental group was screened for escherichia coli producing extended-spectrum β-lactamase（ESBLs-ECO）, klebsiella pneumoniae producing extended-spectrum β-lactamase（ESBLs-KPN ）and multidrug-resistant Acinetobacter baumannii(MDR-AB), the colonization rates of them were 10.10%, 5.72% and 16.83% respectively. The usage rate of antibiotics were all higher than 90% and the bacterial examination rate before the use of antibiotics were all lower than 30% in two groups.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗The situation of multidrug-resistant Acinetobacter baumannii colonization in ICU is quite serious, and patients with colonization are easier to obtain hospital infection. The intervention of active screening culture and simulated prevention and control training are implemented to effectively prevent and control the spread of multidrug-resistant organisms in hospitals.

Key words: multidrug-resistant organisms, active screening culture, simulated training, cross infection

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