Application of multi-disciplinary team mode in prevention and control of multidrug resistant organism infection in lung transplant recipients
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摘要:
目的 探讨多学科综合诊疗(MDT)模式在肺移植受者术后多重耐药菌(MDRO)感染防控中的实践效果。 方法 选择2019年至2022年的肺移植受者,从2020年1月开始成立MDT专家组,开展一系列防控措施,分析2020年至2022年MDRO防控措施落实率、环境物表MDRO检出率以及2019年至2022年肺移植受者MDRO检出率。 结果 医护人员总体MDRO防控措施落实率由2020年的64.9%上升至2022年的91.6%,呈逐年升高趋势(P<0.05)。监测环境物表MDRO检出率从2020年的28%下降到2022年的9%,呈逐年下降趋势(P<0.05)。肺移植受者MDRO检出率从2019年的66.7%降低至2022年的44.3%,呈逐年降低趋势(P<0.001)。 结论 通过MDT模式管理,提高了医务人员MDRO防控措施的执行力,有效降低了肺移植受者术后MDRO感染率和环境物表MDRO检出率,值得推广利用。 -
关键词:
- 肺移植 /
- 多重耐药菌 /
- 多学科综合诊疗 /
- 耐碳青霉烯类鲍曼不动杆菌 /
- 耐碳青霉烯类大肠埃希菌 /
- 耐碳青霉烯类肺炎克雷伯菌 /
- 耐甲氧西林金黄色葡萄球菌 /
- 耐碳青霉烯类铜绿假单胞菌
Abstract:Objective To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. Methods Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. Results The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (P<0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (P<0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (P<0.001). Conclusions MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application. -
Key words:
- Lung transplantation /
- Multidrug resistant organism /
- Multi-disciplinary team /
- Carbapenem-resistant acinetobacter baumannii /
- Carbapenem-resistant escherichia coli /
- Carbapenem-esistant Klebsiella pneumoniae /
- Methicillin-resistant Staphylococcus aureus /
- Carbapenem-resistant Pseudomonas aeruginosa
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表 1 2020年至2022年MDRO防控措施落实率情况
Table 1. Implementation rate of MDRO prevention and control measures from 2020 to 2022
防控措施 2020年 2021年 2022年 χ2检验 趋势检验 执行数/应执行数 执行率(%) 执行数/应执行数 执行率(%) 执行数/应执行数 执行率(%) χ2值 P值 Z值 P值 总防控措施 721/1 111 64.9 858/1 093 78.5 104 7/1 143 91.6 237.71 <0.001 −15.41 <0.001 医生核心防控措施① 285/460 62.0 348/439 79.3 419/463 90.5 108.43 <0.001 −10.33 <0.001 护士核心防控措施② 436/651 67.0 510/654 78.0 628/680 92.3 131.50 <0.001 −11.43 <0.001 注:①医生核心防护措施包括接触隔离医嘱及时开具、手卫生依从、近距离操作防控、查房诊疗操作顺序正确、抗菌药物合理使用。
②护士核心防控措施包括单间/床边隔离、患者专用物品和隔离标识配备、患者及家属宣教、床单元环境清洁消毒、医用织物和医疗废物正确处置、手卫生依从、近距离操作防控。表 2 2020年至2022年环境物表卫生学MDRO检出情况
Table 2. The detection of MDRO in environmental surface hygiene from 2020 to 2022
细菌名称 2020年 2021年 2022年 χ2检验 趋势检验 检出数/特定细菌数 检出率①(%) 检出数/特定细菌数 检出率①(%) 检出数/特定细菌数 检出率①(%) χ2值 P值 Z值 P值 MRSA 11/36 31 6/31 19 3/28 11 3.81 0.15 1.94 0.053 CRKP 5/35 14 2/15 13 0/9 1.43 0.49 0.70 0.485 CRAB 6/9 1/4 1/9 5.63 0.043 2.40 0.017 合计 22 28 9 18 4 9 6.41 0.04 2.57 0.01 注:①合计例数较少的(<10),不统计百分率。 表 3 2019年至2022年肺移植受者MDRO检出情况
Table 3. Detection of MDRO in lung transplant recipients from 2019 to 2022
细菌名称 2019年 2020年 2021年 2022年 χ2检验 趋势检验 检出数/特定细菌数 检出率(%) 检出数/特定细菌数 检出率(%) 检出数/特定细菌数 检出率(%) 检出数/特定细菌数 检出率(%) χ2值 P值 Z值 P值 CREC 4/11 36.4 3/17 17.6 3/15 20.0 2/25 8.0 4.3 0.230 1.87 0.062 CRKP 81/112 72.3 60/97 61.9 50/104 48.1 39/91 42.9 22.4 <0.001 4.67 <0.001 MRSA 16/30 53.3 11/31 35.5 13/40 32.5 9/38 23.7 6.7 0.084 2.46 0.014 CRAB 93/113 82.3 82/99 82.8 85/126 67.5 59/89 66.3 13.7 0.003 3.33 <0.001 CRPA 66/124 53.2 47/113 41.6 57/124 46.0 50/116 43.1 3.9 0.275 1.31 0.190 合计 260/390 66.7 203/357 56.9 208/409 50.9 159/359 44.3 46.4 <0.001 6.74 <0.001 -
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