风险预判与主动干预在综合ICU患者多重耐药菌医院感染防控中的关键作用研究

目的:阐述风险预判与主动干预的综合防控措施对综合重症监护病房(GICU)患者多重耐药菌(MDRO)医院感染的防控效果。方法:对2018年1月~2019年12月入住GICU病房(分为A、B两个病区)>48 h的737例患者进行回顾性调查,其中A病区监测患者286例,MDRO防控参照院感科常规制度要求;B病区监测患者451例,MDRO防控采用入GICU时预判患者感染风险,再根据感染风险及患者自身状况对患者采取鼻腔去定植或肠道去定植的综合防控策略。用卡方检验比较两病区患者的感染结果与MDRO感染菌种分布情况,以验证不同防控策略的效果。结果:本研究共监测GICU住院患者737例,研究期间共发生MDRO医院感染85例。其中A病区监测患者286例,MDRO医院感染66例,感染率为23.1%;B病区监测患者451例,MDRO医院感染19例,感染率为4.2%,低于A病区(P<0.001)。单菌种感染结果显示,两病区感染菌种分布存在差异,CR-AB、CR-PA和MASR的感染率都为B病区低于A病区,两病区患者的共患病类型无差异。说明B病区MDRO防控效果优于A病区。结论:感染风险预判与主动干预的综合防控策略,有利于降低GICU患者MDRO医院感染发病率。

The effect of Risk Prediction and Active Intervention on the Control of Healthcare Associated Infection Caused by Multi-drug Resistant Organism in GICU

Objective:To state the effect of risk prediction and active intervention on the control of healthcare associated infection caused by multi-drug resistant organism in comprehensive intensive care unit(GICU).Methods:737 patients admitted to GICU ward(divided into two wards A and B)from January 2018 to December 2019 were retrospectively investigated.Among them,286 patients were monitored in ward A,which MDRO control methods was according to the routine system requirements of hospital infection department.A total of 451 patients were monitored in Ward B,which predicted the patients infection risk when they were admitted to GICU,and then took a control strategy of nasal or intestinal colonization was adopted according to the infection risk and patients'conditions.Chi-square test was used to compare the infection results of patients in the two wards with the distribution of MDRO infection strains,so as to verify the effect of different prevention and control strategies.Results:A total of 737 GICU patients were monitored in this study,and 85 cases occurred MDRO infection during the study period.Among them,286 patients were monitored in Ward A,and 66 were infected by MDRO,with an infection rate of 23.1%.There were 451 monitored patients in ward B,and 19 cases were infected by MDRO.The infection rate in Ward B was 4.2%,which was lower than that in ward A(P<0.001).The results of MDRO strain infection showed that there were differences in the distribution of infected strains between the two Ward.The infection rates of CR-AB,CR-PA and MASR in Ward B were lower than that in Ward A,and there was no difference in the comorbidities of patients in the two Ward.This indicates that the MDRO control result in Ward B is better than that in Ward A.Conclusion:The comprehensive prevention and control strategy of infection risk prediction and active intervention is beneficial to reduce the incidence of healthcare associated infection caused by MDRO in GICU patients.