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多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用

仇桑桑, 许琴芬, 黄琴红, 等. 多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024008
引用本文: 仇桑桑, 许琴芬, 黄琴红, 等. 多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024008
Qiu Sangsang, Xu Qinfen, Huang Qinhong, et al. Application of multi-disciplinary team mode in prevention and control of multidrug resistant organism infection in lung transplant recipients[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024008
Citation: Qiu Sangsang, Xu Qinfen, Huang Qinhong, et al. Application of multi-disciplinary team mode in prevention and control of multidrug resistant organism infection in lung transplant recipients[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024008

多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用

doi: 10.3969/j.issn.1674-7445.2024008
基金项目: 江苏省科技重点研发计划社会发展项目(BE2022697);江苏省医院协会医院管理创新研究课题(JSYGY3-2023-326);无锡市卫生健康委青年项目(Q202003)
详细信息
    作者简介:
    通讯作者:

    许琴芬(ORCID 0009-0004-6168-3834),主任护师,研究方向为医院感染管理,Email:840800600@qq.com

  • 中图分类号: R617, R37

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。

     

  • 图  1  MDT对肺移植受者MDRO感染防控管理技术路线图

    Figure  1.  Roadmap of MDT for MDRO infection prevention and control management in lung transplant recipients

    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 P Z P
    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 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 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。
    下载: 导出CSV

    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(%) 检出数/特定细菌数 检出率(%) 检出数/特定细菌数 检出率(%) χ2 P Z P
    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。
    下载: 导出CSV

    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 P Z值 P
    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
    下载: 导出CSV
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  • 收稿日期:  2024-01-05
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