ICU三级感染防控管理多重耐药菌防控效果:一项前瞻性研究OA
Effect of three-tier infection prevention and control management on the prevention and control of multidrug-resistant organism in intensive care unit:a prospective study
目的 探索重症监护病房(ICU)耐药菌防控措施"落实难"的解决策略,并评估其防控效果.方法 选择某三级甲等医院2022年4月—2024年2月入住ICU的患者为研究对象.采用前瞻性、前后对照设计,2022年4月—2023年6月为对照阶段,2023年7月—2024年2月为干预阶段.对照组实施集束化防控措施和常规管理,干预组在实施对照组措施的基础上,建立科室内部管理层-片区/小组-员工三级医院感染管理架构,促进各项感染防控措施落地.采用1∶1倾向性评分匹配(PSM)评估干预前后耐碳青霉烯类细菌(CRO)医院感染及定植发生率.结果 干预组速干手消毒剂和洗手液使用量分别是对照组的6.10、7.26倍,含氯消毒泡腾片和消毒湿巾使用量分别为对照组的7.18、5.69倍,隔离衣使用量是对照组的2.76倍,隔离医嘱下达率从62.89%提升至89.27%,差异均有统计学意义(均P<0.001).PSM前干预组CRO、耐碳青霉烯类鲍曼不动杆菌(CRAB)和耐碳青霉烯类肺炎克雷伯菌(CRKP)获得风险分别是干预前的0.61、0.67、0.80倍,除CRKP外(P=0.245)差异均有统计学意义(均P<0.05);PSM后干预组CRO、CRAB和CRKP获得风险分别是干预前的0.97、0.92、0.97倍,差异均有统计学意义(均P<0.05).结论 实施科室感染防控三级管理后,ICU隔离措施执行情况明显改善,CRO医院感染及定植发生率下降.
Objective To explore the solution strategies for the"difficult implementation"of drug-resistant orga-nism prevention and control measures in intensive care unit(ICU),and evaluate the effectiveness.Methods Patients admitted to the ICU of a tertiary first-class hospital from April 2022 to February 2024 were selected as the research subjects.The prospective,before and after comparison design was adopted,April 2022 to June 2023 and July 2023 to February 2024 were as the control stage and intervention stage,respectively.The control group implemented bundled prevention and control measures and routine management,the intervention group established a three-tier healthcare-associated infection(HAI)management structure(department internal management-section/group-em-ployee)on the basis of implementing measures of control group,the implementation of various infection control measures was promoted.The 1∶1 propensity score matching(PSM)was used to evaluate the incidence of HAI and colonization rate of carbapenem-resistant organism(CRO)before and after intervention.Results The intervention group used 6.10 and 7.26 times more alcohol-based hand rub and hand sanitizers,7.18 and 5.69 times more chlorine-containing disinfectant effervescent tablets and disinfectant wipes,as well as 2.76 times more isolation gowns respectively than the control group,the isolation order issuance rate increased from 62.89%to 89.27%,differences were all statistically significant(all P<0.001).Before PSM,the risk of acquiring CRO,carbapenem-resistant Acinetobacter baumannii(CRAB),and carbapenem-resistant Klebsiella pneumoniae(CRKP)in intervention group was 0.61,0.67,and 0.80 times that of before intervention,respectively,except for CRKP(P=0.245),others were all with statistically significant differences(all P<0.05);After PSM,the risk of acquiring CRO,CRAB,and CRKP in the intervention group was 0.97,0.92,and 0.97 times that of before intervention,respectively,all were with statistically significant differences(all P<0.05).Conclusion After implementing the three-tier management on infection prevention and control in department,the implementation of ICU isolation measures has significantly improved,and the incidences of CRO HAI and colonization have decreased.
裴小琴;马轶;梁子超;刘颖;周昕玥;聂睿彤;马萍;张元川
成都市第三人民医院院感部,四川 成都 610031成都市第三人民医院重症医学科,四川 成都 610031成都市第三人民医院院感部,四川 成都 610031成都市第三人民医院院感部,四川 成都 610031成都市第三人民医院院感部,四川 成都 610031成都市第三人民医院院感部,四川 成都 610031四川天府新区人民医院院感部,四川 成都 610218成都市第三人民医院普外科,四川 成都 610031
医药卫生
碳青霉烯类耐药菌倾向性评分匹配预防与控制效果评价重症监护病房前瞻性研究
carbapenem-resistant organismpropensity score matchingprevention and controleffect evaluationintensive care unitprospective study
《中国感染控制杂志》 2026 (3)
344-351,8
四川省科技厅重点研发项目(2023YFS0115)
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