应用综合干预措施提高临床微生物标本送检质量

 目的 应用综合干预措施，提高临床微生物标本送检质量。方法 调查2018年9月—2020年8月某院治疗性使用抗菌药物的住院患者，2019年9月开始实施综合干预措施。综合干预措施包括签订责任书、工作质量考核与反馈、知识培训、信息系统控制等，比较干预前（2018年9月—2019年8月）与干预后（2019年9月—2020年8月）住院患者抗菌药物治疗前微生物标本、无菌性标本、呼吸道标本及血培养标本送检情况。结果 共调查治疗性使用抗菌药物的住院患者40 335例，干预前21 441例，干预后18 894例。干预后抗菌药物、限制级抗菌药物、特殊级抗菌药物治疗前微生物标本送检率分别为65.20%、67.36%、99.02%，高于干预前的63.64%、64.68%、91.27%，差异均有统计学意义（均P<0.05）。无菌性标本送检率由干预前的13.81%提高至干预后的15.85%，呼吸道标本送检率由干预前的37.63%下降至干预后的35.68%，差异均有统计学意义（均P<0.001）。无菌性标本占比由干预前的30.43%提高至干预后的34.84%，呼吸道标本占比由干预前的45.74%下降至干预后的40.09%。两套及以上血培养标本占比由干预前的18.63%上升至干预后的21.95%，差异具有统计学意义（P<0.001）。结论 应用综合干预措施可同时提高临床微生物标本送检率与送检质量。

Application of comprehensive intervention measures to improve the submission quality of clinical microbial specimens

Objective To improve the submission quality of clinical microbial specimens through applying comprehensive intervention measures.Methods Patients who used therapeutic antimicrobial agents in a hospital from September 2018 to August 2020 were investigated,comprehensive intervention measures were implemented from September 2019.Comprehensive intervention measures included signing responsibility agreement,work quality assessment and feedback,knowledge training,and information system control.Submission rates of microbial specimens,sterile specimens,respiratory tract specimens and blood culture specimens of inpatients before(September 2018 to August 2019)and after intervention(September 2019 to August 2020)were compared.Results A total of 40335 inpatients who used therapeutic antimicrobial agents were investigated,including 21441 before intervention and 18894 after intervention.After the intervention,submission rates of microbial specimens before antimicrobial the-rapy,restrictive antimicrobial therapy,and special antimicrobial therapy were 65.20%,67.36%and 99.02%respectively,which were higher than 63.64%,64.68%and 91.27%before intervention(all P<0.05).Submission rate of sterile specimens increased from 13.81%before intervention to 15.85%after intervention,submission rate of respiratory specimens decreased from 37.63%before intervention to 35.68%after intervention(both P<0.001).The proportion of sterile specimens increased from 30.43%before intervention to 34.84%after intervention,proportion of respiratory specimens decreased from 45.74%before intervention to 40.09%after intervention.The proportion of two or more sets of blood culture specimens increased from 18.63%before intervention to 21.95%after intervention(P<0.001).Conclusion Application of comprehensive intervention measures can improve the submission rate and quality of clinical microbial specimens at the same time.