目的 探讨PDCA循环质量管理模式对某三甲康复医院多重耐药菌(MDROs)感染控制的效果。方法 2013年3月~2015年12月本院开展MDROs目标性监测，运用PDCA循环质量管理模式完善工作，并对三年MDROs检出率、MDROs防控知识知晓率、医生开具隔离医嘱率和护士消毒隔离措施执行率进行分析。结果 随着PDCA质量管理持续进行，耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类铜绿假单胞菌(CR-PA)检出率均呈下降趋势(χ2>3.922, P<0.05)，多重耐药鲍曼不动杆菌(MDR-AB)检出率无显著性差异(χ2=8.775, P=0.071)；2015年MDROs防控知识知晓率、医生开具隔离医嘱率和护士消毒隔离措施执行率均显著提高(χ2>399.17, P<0.001)。结论 PDCA循环质量管理模式在康复医院MDROs预防控制中起着重要作用。
Objective To analyze the effect of PDCA cycle quality management model on multi-drug resistant organism (MDROs) infection control in a tertiary rehabilitation hospital.Methods From March, 2013 to December, 2015, targeted surveillance of MDROs infection control was performed with PDCA cycle quality control. The MDROs detection rate, the awareness rate of MDROs prevention and control, the rate of doctor issuing isolation orders and execution rate of medical sanitation disinfection and isolation were analyzed.Results The detection rates of methicillin-resistant staphylococcus aureus and Carbapenem-resistant Pseudomonas aeruginosa decreased (χ2>3.922, P<0.05), while no significant difference was found in the detection rate of multidrug- resistance Acinetobacter baumanii (χ2=8.775, P=0.071). The awareness rate of MDROs prevention and control, the rate of doctor issuing isolation orders and execution rate of medical sanitation disinfection and isolation significantly improved (χ2>399.17, P<0.001).Conclusion PDCA cycle quality management model played an important role in the prevention and control of MDROs in rehabilitation hospital.
[1] Pettigrew MM, Johnson JK, Harris AD. The human microbiota: novel targets for hospital-acquired infections and antibiotic resistance [J]. Ann Epidemiol, 2016, 26(5): 342-347.
[2] Gastmeier P, Geffers C, Herrmann M, et al. Nosocomial infections and infections with multidrug-resistant pathogens frequency and mortality [J]. Dtsc Med Wochenschr, 2016, 141(6): 421-426.
[3] 王力红,赵霞,张京利,等. 追踪方法学与PDCA循环管理在医院感染管理质量控制中的应用[J]. 中华医院感染学杂志, 2014, 24(6): 1539-1541.
[4] 吴淑梅,黄小兰,任泽娟. 集束化管理策略在多重耐药菌管理中的应用[J]. 中国医院感染控制杂志, 2015, 14(12): 840-842.
[5] Heudorf U, F?rber D, Mischler D, et al. [Multidrug-Resistant Organisms (MDRO) in rehabilitation clinics in the Rhine-Main District, Germany, 2014: prevalence and risk factors] [J]. [in German]. Rehabilitation (Stuttg), 2015, 54(5): 339-345.
[6] 黄勋,邓子德,倪语星,等. 多重耐药菌医院感染预防与控制中国专家共识[J]. 中国医院感染控制杂志, 2015, 14(1): 1-9.
[7] 杨蕾,付强. 医院感染管理质量控制的基本内涵及实施策略[J]. 中国医疗管理科学, 2015, 5(2): 17-22.
[8] Mukhopadhyay J. Teicoplanin for treating MRSA pneumonia [J]. BMJ, 2014, 348: g2317.
[9] Stojanov M, Blanc DS. Characterization of the staphylococcal cassette chromosome mec insertion site in 108 isolates lacking the mecA gene and identified as methicillin-resistant Staphylococcus aureus by the Xpert MRSA assay. [J]. Eer J Clin Microbiol Infect Dis, 2014, 33(11): 1967-1971.
[10] 国家卫生计生委合理用药专家委员会,全国细菌耐药监测网. 2015 年全国细菌耐药监测报告[EB/OL]. [2016-11-3].http://www.carss.cn/Sys/res/file/201512/20151220130134_7741_482f3b7ae95841998a37898e2ab2fa87_2015年监测报告.pdf.
[11] Singh H, Thangaraj P, Chakrabarti A. Acinetobacter baumannii: a brief account of mechanisms of multidrug resistance and current and future therapeutic management [J]. J Clin Diagn Res, 2013,7(11): 2602-2605.
[12] Ren G, Zhou M, Ding N, et al. Analysis on distribution features and drug resistance of clinically isolated Acinetobacter baumannii [J]. Exp Ther Med, 2016, 12(3): 1715-1718.
[13] Senok A, Garaween G, Raji A, et al. Genetic relatedness of clinical and environmental Acinetobacter baumanii isolates from an intensive care unit outbreak [J]. J Infection Dev Ctries, 2015, 9(6): 665-669.
[14] 陈佰义,何礼贤,胡必杰,等. 中国鲍曼不动杆菌感染诊治与防控专家共识[J]. 中国医药科学, 2012, 2(8): 3-8.
[15] 陈玉华,曾翠,龚瑞娥,等. 某三级甲等综合医院多药耐药菌监测与预防控制研究[J]. 中华医院感染学杂志, 2016, 26(1): 200-203.
[16] Safari M, Saidijam M, Bahador A, et al. High prevalence of multidrug resistance and metallo-bata-lactamase(MβL) producing Acinetobacter baumannii isolated from patients in ICU wards, Hamadan, Iran [J]. J Res Health Sci, 2013, 13(2): 162-167.
[17] 饶丽华,涂建斌,王艳琴,等. 多重耐药鲍曼不动杆菌感染的临床分布及耐药性分析[J]. 实验与检验医学, 2015, 33(6): 730-732.
[18] 王正兰,李临平,李雪,等. 多重耐药鲍曼不动杆菌耐药情况及其携带耐消毒剂基因的研究[J]. 实用检验医师杂志, 2015, 7(4): 207-210.
[19] Weber DJ, Rutala WA, Miller MB, et al. Role of hospital serface in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species [J]. Am J Infect Control, 2010, 38(5 Suppl 1): S25-S33.
