多部门合作在多重耐药菌医院感染防控中的作用

目的探讨多部门合作在多重耐药菌(MDRO)医院感染防控中的作用。方法回顾性分析多部门合作管理实施前(2019年1~12月)期间所有住院患者1478例进行检测统计,从2020年1月开始实施多部门合作管理,具体包括:(1)建立多部门合作管理组织体系;(2)建立MDRO三级管理网络;(3)多学科联合培训;(4)临床科室配备临床药师;(5)采用医院感染监控系统对微生物标本的送检、MDRO的检出率、耐药菌普的变迁、抗菌药物的使用等进行实时监控;(6)由院感科、医务处牵头,定期对MDRO检出率高的科室和重点科室进行联合查房检查;(7)采用PDCA循环模式对医院感染防控措施的各个环节质控;对多部门合作管理实施后(2020年1~12月)所有住院患者1849例进行检测统计,对比实施前后医院感染发生率和MDRO检出率、手卫生依从率和接触隔离执行率及治疗性使用抗菌药物标本送检率和抗菌药物合理使用率。结果多部门合作管理实施后医院感染发生率和MDRO检出率明显低于实施前(χ²=46.611,χ²=16.814,P<0.05);手卫生依从率和接触隔离执行率明显高于实施前(χ²=25.357,χ²=29.227,P<0.05);治疗性使用抗菌药物标本送检率抗菌药物合理使用率明显高于实施前(χ²=25.576,χ²=33.624,P<0.05)。结论多部门合作管理的实践发挥学科间优势互补,提高医务人员对MDRO防控措施落实的执行力,可有效降低MDRO医院感染发生率。

Multi-department cooperation in prevention and control of multi-drug-resistant bacteria nosocomial infectionata hospital

Objective To explore the role of multi-department cooperation in the prevention and control of nosocomial infection of multi-drug-resistant bacteria(MDRO).Methods Theretrospective analysis was conducted on 1478 inpatients before the implementation of multi-department cooperative management(January 2019 to December 2019).The implementation of multi-department cooperative management began in January 2020,including:(1)the establishment of multi-department cooperative management organization system;(2)Establish a three-level MANAGEMENT network of MDRO;(3)Multidisciplinary joint training;(4)Clinical departments shall be equipped with clinical pharmacists;(5)The hospital infection monitoring system was used to conduct real-time monitoring on the submission of microbial samples,the detection rate of MDRO,the changes of drug-resistant bacteria and the use of antibiotics;(6)Led by the department of hospital pathology and medical Service,regular joint ward rounds should be conducted in the departments and key departments with high DETECTION rate of MDRO;(7)PDCA cycle mode was adopted for quality control of all links of nosocomial infection prevention and control measures;After the implementation of multi-department cooperative management(January 2020 to December 2020),all the hospitalized patients in 1849 cases were detected and counted,and the incidence of nosocomial infection,the detection rate of MDRO,the compliance rate of hand hygiene,the implementation rate of contact isolation,and the specimen inspection rate of therapeutic use of antibiotics and the reasonable utilization rate of antibiotics were compared before and after the implementation.Results The incidence of nosocomial infection and the detection rate of MDRO were significantly lower after the implementation of multi-department cooperative management than before(χ²=46.611,χ²=16.814,P<0.05).The hand hygiene compliance rate and contact isolation implementation rate were significantly higher after the implementation of multi-department cooperative management than before(χ²=25.357,χ²=29.227,P<0.05).After the implementation of multi-department cooperative management,the sample test rate of therapeutic use of antibiotics was significantly higher than that before the implementation of multi-department cooperative management(χ²=25.576,χ²=33.624,P<0.05).Conclusion The practice of multi-department cooperative management brings into full play the advantages of interdisciplinary complementarity,improves the ability of medical staff to implement the prevention and control measures for MDRO,and can effectively reduce the incidence of nosocomial infection in MDRO.