以消毒为导向的集束化管理模式在ICU环境清洁消毒质量管理中的应用效果

目的 探讨以消毒为导向的集束化管理模式在重症监护病房(ICU)环境清洁消毒质量管理中的应用效果。 方法 运用集束化管理模式对ICU环境清洁消毒工作进行干预, 将2022年1—12月设为干预前, 2023年1—12月设为干预后。比较干预前后ICU保洁人员消毒知识知晓率、环境卫生学监测结果、患者常见多重耐药菌(MDRO)检出情况及医院感染情况。 结果 ICU保洁人员消毒知识知晓率、高频接触环境物体表面荧光标记清除率分别由干预前的68.58%、78.45%提升至干预后的88.45%、96.44%, 差异均有统计学意义(均P＜0.05)。高频接触环境物体表面及医务人员手细菌培养合格率分别由干预前的70.63%、87.90%提升至干预后的88.36%、94.15%, 差异均有统计学意义(均P＜0.05)。高频接触环境物体表面耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率干预前分别为0.49%、1.46%, 干预后分别为0、0.27%, 干预前后比较差异均有统计学意义(均P＜0.05)。干预后ICU患者医院感染发病率(4.97%)、CRAB医院感染发病率(0.77%)较干预前(分别为7.46%、1.62%)低, 差异均有统计学意义(均P＜0.05)。 结论 运用集束化管理模式对ICU环境清洁消毒工作进行干预, 可有效提升ICU环境清洁消毒效果, 增强保洁人员消毒防控意识, 降低MRSA、CRAB检出率, 降低医院感染风险, 保障医疗安全。

Application effect of disinfection-oriented bundle management mode on environmental cleaning and disinfection quality management of intensive care unit

Objective To explore the application effect of disinfection-oriented bundle management mode of environmental cleaning and disinfection quality management of intensive care unit (ICU). Methods The bundle mana-gement mode was used to intervene the cleaning and disinfection of ICU environment. January-December 2022 and January-December 2023 were classified as pre- and post-intervention periods respectively. The awareness rate of disinfection knowledge, monitoring results of environmental hygiene, detection of MDRO and healthcare-associated infection (HAI) of patients before and after intervention were compared. Results The awareness rates of disinfection knowledge and the clearance rate of fluorescent labeling on frequently-touched environmental surface increased from 68.58% and 78.45% (pre-intervention) to 88.45% and 96.44% (post-intervention), respectively, both with statistical significance (both P < 0.05). The qualification rates of bacterial culture from frequently-touched environmental surface and hands of healthcare workers (HCWs) increased from 70.63% and 87.90% (pre-intervention) to 88.36% and 94.15% (post-intervention), respectively, both with statistical significance (both P < 0.05). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) from frequently-touched environmental surface were 0.49% and 1.46% (pre-intervention), as well as 0 and 0.27% (post-intervention), respectively, both with statistical significance (both P < 0.05). The incidences of HAI (4.97%) and CRAB HAI (0.77%) post-intervention were lower than pre-intervention (7.46% and 1.62%, respectively), differences were both statistically significant (both P < 0.05). Conclusion Intervention in environmental cleaning and disinfection of ICU with bundle management mode can effectively improve the effect of cleaning and disinfection in ICU, enhance cleaners'' awareness on disinfection prevention and control, decrease the detection rates of MRSA and CRAB, reduce the risk of HAI, and ensure medical safety.