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目的了解基层综合医院多重耐药菌(multidrug-resistant organism,MDRO)感染现状,分析各干预措施的差异,对基层综合医院开展MDRO感染控制工作方法提出指导意见。方法对2013年1月—2015年12月入院的所有患者(51 612例)进行调查,全院共监测6种MDRO。其中2013年1月—2014年6月为干预前调查(干预前),未采取任何干预措施;2014年7月—2015年12月为实施干预措施阶段(干预后),将全院各科室(6组)与干预措施(6组)进行随机配对。比较干预前后6组科室的MDRO检出率、医院感染例次率和干预措施依从率。结果共检出MDRO 611株(非重复株),总体检出率为1.18%。干预前检出率为1.37%,干预后检出率为1.01%(P<0.05);干预后,1、5、6组检出率均低于干预前(P<0.05);2、3、4组的检出率干预前后差异均无统计学意义(P>0.05)。MDRO医院感染例次率由干预前的0.28%降到干预后的0.14%(P<0.05);干预后,1、5、6组的MDRO医院感染例次率均低于干预前(P<0.05);3、4组的MDRO医院感染例次率与干预前差异无统计学意义(P>0.05);而2组在干预前未检出MDRO,无可比性。医护人员知晓率、陪护人员知晓率则分别由干预前的52.97%、20.00%上升到干预后的78.76%、66.34%(χ2=30.670,38.604;P<0.05)。在防控措施依从率指标中,患者床旁手消毒剂配置依从率、转科告知依从率虽有所提升,但差异均无统计学意义(P>0.05);其余指标均较干预前有所提升,且差异均有统计学意义(P<0.05)。结论基层综合医院通过提高手卫生、环境物表清洁消毒依从率,可以有效降低MDRO检出率及医院感染例次率。
Objective To understand the current situation of multidrug-resistant organism (MDRO) infection in primary general hospitals and to analyze the differences among interventions and to provide guidance on the MDRO infection control work in primary general hospitals. Methods All patients (51 612 cases) admitted to hospital from January 2013 to December 2015 were investigated. Six MDROs were monitored in the hospital. Among them, from January 2013 to June 2014, there were no pre-intervention investigation (before intervention) and no interventions; and from July 2014 to December 2015, all the departments (including post-intervention) 6 groups) and interventions (6 groups) were randomly matched. The MDRO detection rate, nosocomial infection rate and intervention rate of six departments were compared before and after the intervention. Results A total of 611 strains of MDRO (non-replicating strain) were detected. The overall detection rate was 1.18%. The detection rate was 1.37% before intervention and 1.01% after intervention (P <0.05). After intervention, the detection rates in groups 1, 5 and 6 were lower than those before intervention (P <0.05) There was no significant difference in the detection rate of the four groups before and after intervention (P> 0.05). The incidence of MDRO nosocomial infections was reduced from 0.28% before intervention to 0.14% after intervention (P <0.05). After intervention, the incidence of MDRO nosocomial infections in 1,5,6 groups was lower than that before intervention (P <0.05 ). There was no significant difference in the incidence of MDRO nosocomial infection between groups 3 and 4 before intervention (P> 0.05). However, MDRO was not detected before intervention in 2 groups. The awareness of medical staff and that of accompanying staff increased from 52.97% and 20.00% before intervention to 78.76% and 66.34% respectively after intervention (χ2 = 30.670,38.604; P <0.05). In compliance with the indicators of prevention and control measures, patients with bedside hand disinfectant configuration compliance rate, transfer subjects informed compliance rate improved, but the difference was not statistically significant (P> 0.05); other indicators were more than before intervention Improve, and the differences were statistically significant (P <0.05). Conclusions The primary general hospitals can effectively reduce the MDRO detection rate and the nosocomial infection rate by improving the compliance rate of hand hygiene and environmental objects table cleaning and disinfection.