摘要
目的探讨护理专科质量监测在多重耐药菌(multi-drug resistant organism,MDRO)管理中的作用和意义,通过实施护理专科质量监测达到控制或降低MDRO院内感染/定植率,防止MDRO院内暴发流行的目的。同时了解院内感染/定植的MDRO的临床分布并找出需重点监控的细菌类型。方法选取2013年1月至2018年12月四川大学华西医院感染性疾病中心感染病房的MDRO感染/定植患者为研究对象对其实施护理专科质量监测。根据实施情况分为三组:实施前组(2013年1月至2015年1月)、实施初期(2015年2月至2016年12月)和实施成熟期(2017年1月至2018年12月)。统计描述MDRO院内感染/定植的临床分布,采用卡方检验比较三组MDRO院内感染/定植率。结果感染病房2013年1月至2018年12月中有148例患者发生MDRO院内感染/定植。其中CRAB的院内感染/定植率最高(49.7%),其次是CRPA(18.9%)、CRE(16.4%)、MRSA(10.1%)。VRE(5.0%)的院内感染/定植率较其他四种MDRO处于相对低位水平。比较实施护理专科质量监测前后,CRAB的院内感染/定植率呈现较明显下降趋势,虽然下降趋势无统计学意义,但CRE的院内感染/定植率在2013年到2018年有比较明显的上升趋势,差异有统计学意义。其余三种MDRO感染/定植率虽然在实施护理专科质量监测前后比较,差异无统计学意义,但也起到了有效控制和延缓MDRO院内感染/定植率增长的作用。结论在防控MDRO院内感染/定植中需重点监控CRAB、CRPA、CRE,尤其是CRE,是护理专科质量监测的重点和难点。护理专科质量监测对控制或降低MDRO尤其是CRAB院内感染/定植及防止其院内暴发流行具有重要作用和意义。但对CRE的防控效果不明显,故需在MDRO管理流程中加入更加针对CRE的防控措施同时使用针对CRE更敏感的护理监测指标。在护理专科质量监测中如何避免霍桑效应,采用更加有效地评价其执行效果的监测方法,是此后监测工
Objective To explore the role and significance of nursing specialty quality monitoring in the management of multi-drug resistant organism(MDRO).To control or reduce the nosocomial infection/colonization rate of MDRO by implementing nursing specialist quality monitoring to prevent the outbreak of MDRO in hospital.Also understand the clinical distribution of nosocomial infection/colonization of MDRO and find out the type of bacteria that need to focus on monitoring.Methods Patients with MDRO infection/colonization in the infectious ward of the Infectious Disease Center of West China Hospital of Sichuan University from January 2013 to December 2018 were selected as the research subjects to perform nursing specialist quality monitoring.According to the implementation,it is divided into three groups:the pre-implementation group(January 2013-January 2015),the initial implementation period(February 2015-December 2016),and the implementation mature period(January 2017-December 2018).Statistics describe the clinical distribution of nosocomial infection/colonization in MDRO.Chi-square test was used to compare the nosocomial infection/colonization rate among the three groups of MDRO.Results Infectious wards from January 2013 to December 2018,148 patients developed MDRO nosocomial infections/colonization.CRAB had the highest nosocomial infection/colonization rate(49.7%),followed by CRPA(18.9%),CRE(16.4%),and MRSA(10.1%).The nosocomial infection/colonization rate of VRE(5.0%)was relatively low compared to the other four MDROs.Compared before and after the implementation of the nursing specialist quality monitoring,the nosocomial infection/colonization rate of CRAB showed a significant downward trend,although the downward trend was not statistically significant,and the nosocomial infection/colonization rate of CRE had a relatively obvious upward trend from 2013 to 2018.The difference was statistically significant.Although there is no statistically significant difference between the other three MDRO infection/colonization rates
作者
王珺
宋锦平
Wang Jun;Song Jinping(Centre of Infectious Diseases,West China Hospital of Sichuan University,Chengdu,Sichuan 610041;Nursing department,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China)
出处
《四川医学》
CAS
2020年第3期308-312,共5页
Sichuan Medical Journal
关键词
护理
质量监测
多重耐药菌
nursing
quality monitoring
multi-drug resistant organism
