PDCA循环法改善物体表面消毒效果研究

目的探讨PDCA循环法在重症监护室(ICU)改善物体表面消毒效果中的作用。方法2013年1月—2014年2月在原医院感染管理及多重耐药菌(MDRO)防控基础上,采用PDCA循环法对某院ICU物体表面消毒效果进行干预,收集干预前、中、后3个不同阶段物体表面采样数据,以及患者医院感染和MDRO检出情况等资料。结果干预前、中、后总体采样合格率分别为58.24%、76.74%、88.71%,呈增加趋势,差异有统计学意义(χ2=17.41,P=0.009);医院感染率分别为3.72%、2.42%、1.78%,呈降低趋势(χ2=6.03,P=0.039),医院感染例次率分别为4.36%、2.75%、2.37%,呈降低趋势(χ2=7.24,P=0.046);MDRO检出率分别为34.03%、27.45%、14.05%,呈降低趋势(χ2=33.84,P=0.007),患者医院内检出MDRO比例及MDRO医院感染患者比例均呈降低趋势(χ2值分别为6.14和6.02,均P0.05)。结论采用PDCA法可有效改善ICU物体表面消毒效果,减少医院MDRO感染。

Application of plan do check act cycle in improving disinfection efficacy of object surface

ObjectiveTo evaluate the effect of plan do check act (PDCA)  cycle method in improving disinfection efficacy of object surface in intensive care unit ( ICU).MethodsOn the basis of management of healthcare associated infection (HAI) and prevention of multidrug resistant organisms, disinfection efficacy of object surface in an ICU was intervened, data about surface object specimens taken before, during, and after intervention, HAI in patients, as well as detection of MDROs  were collected.ResultsThe total qualified rate of specimens taken before, during, and after intervention  was 58.24%, 76.74%, and 88.71%，respectively, there was an increased tendency,the difference was significant （χ2=17.41，P=0.009）; the incidence of HAI was 3.72%,2.42%, and 1.78%，respectively, there was a decreased tendency（χ2=6.03，P=0.039）， case infection rate was 4.36%,2.75%, and 2.37% respectively，there was a decreased tendency（χ2=7.24，P=0.046）；detection rate of MDROs was 34.03%,27.45%, and 14.05%，respectively, there was a decreased tendency （χ2=33.84，P=0.007），the percentage of patients who were detected MDROs and HAI caused by MDROs showed a decreased tendency（χ2=6.14, 6.02，both P<0.05）.ConclusionThe implementation of PDCA cycle can effectively improve disinfectant efficacy of ICU object surface, and reduce the incidence of MDRO HAI.