46所医院多药耐药菌预防控制措施依从性与发生医院感染的关系

Abstract

目的：了解不同地区多药耐药菌（MDROs）医院感染发生的特点及不同预防控制措施的依从性，探讨不同预防控制措施的落实与降低多药耐药菌医院感染的关系。方法2013年10月－2014年9月对我国6个地区46所医院进行了调查，使用统一的监测方法、调查表，经过统一培训，分析 MDROs感染数据及预防控制措施依从性。结果共监测病历34081份、住院日302818 d ，检出13049株感染／定植病原菌，其中MDROs 2803株， MDROs检出率为21．48％，发生医院感染1122例，日感染率3．71‰；其中东北地区检出率及日感染率最高分别为41．44％及9．60‰，华南地区检出率及日感染率最低分别为12．75％及0．95‰；不同预防控制措施中，护士及保洁员知晓率与CRAB医院感染率下降密切相关，手卫生依从性与MRSA医院感染率的下降密切相关。结论通过采取多药耐药菌预防控制措施，能有效降低多药耐药菌医院感染的发生，其中不同MDROs预防控制的关键措施有所不同。

OBJECTIVE To understand the characteristics of the multidrug‐resistant organisms (MDROs) infections in different regions and the compliance of control measures and explore the relationship between the implementa‐tion of the control measures and the reduction of incidence of the MDROs infections .METHODS From Oct 2013 to Sep 2014 ,a surgery was conducted by using the unified monitoring method and questionnaires ,involving 46 hospi‐tals from 6 regions of China ,the unified training was carried out ,and the data of the MDROs infections and the compliance of control measures were collected and observed .RESULTS A total of 34 081 copies of medical records have been monitored ,covering 302 818 patient‐days;totally 13 049 strains of pathogens causing infections or being colonized have been detected ,of which 2 803 (21 .48% ) were the MRDOs .The nosocomial infections occurred in 1 122 cases ,with the daily infection rate of 3 .71‰ ;the isolation rate was the highest (41 .44% ) in the northeast‐ern region ,the lowest (12 .75% ) in the southern China;while the daily infection rate was the highest (9 .60‰) in the northeastern region ,the lowest (0 .95‰) in the southern China .The awareness rate of the nurses and cleaning staff about the control measures was closely associated with the reduction of incidence of CRAB infection ,and the hand hygiene compliance was closely associated with the reduction of incidence of MRSA infection .CONCLUSIONS The implementation of the measures of control of MDROs can effectively reduce the incidence of MDROs infections ,and the key control measures vary in the MDROs .