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目的研究集束化管理措施对减少重症监护病房(ICU)物体表面耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类鲍氏不动杆菌(CRAB)的效果,以寻找提高ICU物体表面清洁程度,降低多药耐药菌感染风险的有效可行的方式。方法于2014年7-9月在ICU实施一系列集束化管理措施,在干预前、后的物体表面各采样270份并进行培养,比较MRSA和CRAB物体表面检出结果是否存在差异。结果共采集ICU高频接触物体表面样本540份,除呼吸内科ICU外,其余科室ICU物体表面MRSA和CRAB检出率较干预前均不同程度下降;采取集束化策略可显著降低ICU内MRSA和CRAB检出阳性率,其中,MRSA检出阳性率由干预前的13.70%下降至干预后的7.03%,CRAB由9.26%下降至4.07%,差异均有统计学意义,且此期间多药耐药菌感染呈明显下降趋势。结论在ICU采取集束化综合管理方案能有效降低物体表面MRSA和CRAB的污染,有利于多药耐药菌的防治。
Objective To investigate the effects of cluster management measures on reducing methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter (B.AB) on the surface of intensive care unit (ICU) in order to find ways to improve ICU objects Surface cleanliness and reduce the risk of multidrug-resistant bacteria in an effective and feasible way. Methods A series of cluster management measures were carried out in the ICU from July to September 2014. Before and after the intervention, 270 samples were collected and cultured on the surface of the objects respectively to compare the results of MRSA and CRAB. Results A total of 540 ICU high-frequency contact objects were collected. The detection rates of MRSA and CRAB in ICU objects of other departments decreased to different extents except for the respiratory medicine department ICU. The clustering strategy could significantly reduce the MRSA and CRAB The positive rate of MRSA was decreased from 13.70% before intervention to 7.03% after intervention, while the CRAB decreased from 9.26% to 4.07%, the differences were statistically significant, and the multidrug-resistant bacteria Infection showed a clear downward trend. Conclusion Integrated management of cluster management in ICU can effectively reduce the contamination of MRSA and CRAB on the surface of objects, which is beneficial to the prevention and treatment of multidrug-resistant bacteria.