多学科协作联合集束化管理对ICU多重耐药菌感染预防的效果

Effect of multidisciplinary team combined with bundle management on prevention of multidrugresistant organism infection in the intensive care unit

摘要:

目的探讨多学科协作（MDT）联合集束化管理对综合重症监护病房（ICU）多重耐药菌(MDROs)感染防控的效果。方法选取2013年1月—2015年12月某三甲医院ICU住院患者为研究对象，自2014年1月开始将MDT联合集束化管理用于ICU MDROs感染的防控，并在实施1年后进行持续质量改进，比较实施前（2013年）、实施后（2014年）和持续改进后（2015年）ICU住院患者送检标本MDROs检出情况。结果实施前、实施后和持续改进后ICU患者中MDROs感染率分别为26.55%（154/580）、17.13%（117/683）、12.01%（77/641），呈下降趋势，差异有统计学意义（χ2=44.030，P＜0.001）；ICU患者MDROs总检出率分别为64.44%（154/239）、63.59%（117/184）、43.26%（77/178），有降低趋势，差异有统计学意义（χ2=22.284，P＜0.001）。ICU 主要MDROs为多重耐药/泛耐药鲍曼不动杆菌（MDR/PDRAB，占44.54%）。结论MDT联合集束化管理有助于降低ICU MDROs的感染率和检出率。

Abstract:

ObjectiveTo explore the effect of multidisciplinary team (MDT) combined with bundle management on prevention and control of multidrugresistant organism (MDRO) infection in the intensive care unit(ICU). MethodsPatients who were admitted to the ICU in a tertiary firstclass hospital from January 2013 to December 2015 were studied, MDT combined with bundle management has been applied in the prevention and control of MDRO infection in ICU since January 2014, continuous quality improvement program was performed one year later, isolation of MDROs from specimens of ICU patients before implementation（in the year of 2013）, after implementation（in the year of 2014）, and after continuous quality improvement（in the year of 2015） was compared. ResultsThe infection rates of MDROs in ICU patients before implementation, after implementation, and  after continuous quality improvement were 26.55% (154/580), 17.13% (117/683), and 12.01% (77/641) respectively, showing a downward trend, with a significant difference (χ2=44.030, P<0.001); the total isolation rates of MDROs in ICU patients were 64.44%（154/239）, 63.59%（117/184）, and 43.26%（77/178）respectively，showing a downward trend, with a significant difference （χ2=22.284，P＜0.001）. The main MDROs in ICU were multidrugresistant(MDR) and pandrugresistant(PDR) Acinetobacter baumannii (44.54%). ConclusionMDT combined with bundle management can decrease MDRO infection rate and isolation rate  in ICU.