摘要
目的利用多药耐药菌(MDROs)隔离医嘱信息化预警和屏障技术,以提高医护人员隔离医嘱执行的及时性,并评估其对MDROs医院感染的影响效果。方法选取广州中医药大学深圳医院住院患者检出的耐碳青霉烯类肠杆菌科细菌(CRE)、耐碳青霉烯类鲍氏不动杆菌(CRAB)、耐碳青霉烯类铜绿假单胞菌(CRPA)、耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)和产超广谱β-内酰胺酶(ESBLs)肠杆菌为研究对象,2019年1月-2019年7月设为干预前组,2019年8月-2020年4月为干预组,对这些耐药菌采取危急值管理,在电子医嘱、护理医嘱、影像信息(PACS)系统中实现隔离医嘱信息预警和技术屏障,观察干预措施前后隔离医嘱医生和护士执行时间是否缩短,以及对MDROs医院感染的干预效果。结果实施信息化预警和技术屏障后医生开立隔离医嘱的时间由平均1 323 min,缩短至平均238 min(P<0.05);护士执行隔离医嘱的时间从平均31 min,缩短至平均13 min(P<0.05);CRE的感染和感染例次率均从0.04%降至0.01%,CRAB的感染率0.18%下降至0.05%、感染例次率从0.21%下降至0.05%,ESBLs感染例次率从0.33%下降至0.23%,差异均具有统计学意义(P<0.05)。CRE、CRAB医院感染和感染例次率与医生开立隔离医嘱的时间有正相关性(P<0.05)。结论MDROs隔离医嘱信息化预警和技术屏障有助于提高医护人员隔离医嘱执行的及时性,对预防CRE、CRAB等耐药菌医院感染具有一定的积极作用。
OBJECTIVE To improve the timeliness of orders by using the electronic pre-warning and barrier technology of isolated doctor’s orders, and evaluate its impact on multidrug-resistant organisms(MDROs) nosocomial infection. METHODS The carbapenem-resistant Enterobacteriaceae(CRE), carbapenem-resistant Acinetobacter baumannii(CRAB), carbapenem-resistant Pseudomonas aeruginosa(CRPA), methicillin-resistant Staphylococcus aureus(MRSA), vancomycin-resistant Enterococci(VRE) and extended-spectrum β-lactamases(ESBLs)-producing Enterobacter strains that were isolated from the hospitalized patients of Shenzhen Hospital of Guangzhou University of Traditional Chinese Medicine were enrolled in the study. The time period from Jan 2019 to Jul 2019 was assigned as the pre-intervention group, while the time period from Aug 2019 to Apr 2020 was assigned as the intervention group. The critical value management was carried out for the drug-resistant strains, the information pre-warning and technology barrier of isolation orders was achieved in electronic medical order, nursing medical order and Picture Archiving and Communication Systems(PACS). The time periods of the doctors’ and nurses’ executing the isolation orders were observed before and after the intervention measures were taken, and the intervention effects on MDROs nosocomial infection were observed. RESULTS After the implementation of pre-warning and barrier measures for isolation orders, the time for doctors issuing isolation orders was shortened from 1323 minutes to 238 minutes(P<0.05).The time for nurses to execute isolation orders was shortened from 31 minutes to 13 minutes(P<0.05). The infection and infection case rate of CRE all decreased from 0.04% to 0.01%,the infection rate of CRAB decreased from 0.18% to 0.05%, the infection case rate of CRAB decreased from 0.21% to 0.05%,the infection case rate of ESBLs decreased from 0.33% to 0.23%,the differences were significant(P<0.05),there was a positive correlation of the nosocomial infection rate and infection case rate of CRE and CRAB with the shortening of doctor’s isolation order time(P<0.05). CONCLUSION The electronic pre-warning and technical barrier of MDROs help to improve timeliness of doctors and nurses to implement isolated doctor’s orders, and it would play a positive role in the prevention of nosocomial infection caused by CRE, CRAB.
作者
胡继华
莫莉
梁冠民
HU Ji-hua;MO Li;LIANG Guan-min(Shenzhen Hospital,Guangzhou University of Chinese Medicine,Guangdong,Shenzhen 518032,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第22期3512-3516,共5页
Chinese Journal of Nosocomiology
基金
深圳市福田区卫生公益性科研基金资助项目(FTWS2019070)。
关键词
多药耐药菌
隔离医嘱
信息化预警
信息化屏障技术
医院感染
Multidrug-resistant organisms
Isolated doctor’s orders
Electronic pre-warning
Electronic barrier technology
Nosocomial infection
作者简介
胡继华(1965-),男,本科,主任医师,研究方向:复杂感染性疾病的诊治与预防。
