Objective To discuss the effect of monitoring-training-planning (MTP) intervention model on the prevention and control of catheter–associated urinary tract infection (CAUTI) in Intensive Care Unit (ICU). Methods Patients with indwelling catheter from departments with ICU (ICU, ICU of the Department of Neurosurgery, ICU of the Department of Neurologic Medicine) between 2014 and 2015 were included in this study. Based on the inclusion criteria, target monitoring indicators were set in accordance with Hospital Infection Monitoring Norms. A total of 493 patients with indwelling catheters from January to December 2014 were subjected to target surveillance, and were used as baseline for the study. A total of 529 patients with indwelling catheters from January to December 2015 were treated with MTP intervention. The occurrence of indwelling catheter–associated urinary tract infections in the intensive care unit was compared before and after intervention. Results The incidence of indwelling catheter-associated urinary tract infections before and after MTP intervention were different, and the difference was statistically significant (P<0.05). Conclusion MTP intervention model can effectively prevent and reduce indwelling catheter-associated urinary tract infections in ICU.
Objective To investigate the detection of multidrug-resistant organisms (MDRO) by targeted monitoring in a tertiary hospital, and to understand the distribution of MDRO. Methods We retrospectively analyzed the detection and distribution of methicillin-resistantStaphylococcus aureus (MRSA), carbon black alkeneAcinetobacter baumannii (CRABA), carbapenem-resistantPseudomonas aeruginosa (CRPAE), vancomycin-resistantEnterococci (VRE) and carbapenem-resistantEnterobacter (CRE) in clinical samples collected from 2013 to 2015. Results A total of 990 multidrug-resistant bacteria strains were isolated from 2013 to 2015, of which 445 were MRSA (44.95%), 328 were CRABA (33.13%), 99 were CRPAE (10.00%), 12 were VRE (1.21%), and 106 were CRE (10.71%). They were mainly distributed in the Department of Burn, Comprehensive ICU, Department of Neurosurgery, Department of Respiratory Medicine and Department of Orthopedic Surgery. The detection rates of multidrug-resistant organisms of 2013-2015 were 10.85% (352/3 244), 9.20% (304/3 303), and 7.11% (334/4 699) respectively, which reduced year by year with significant difference (χ2= 34.42,P< 0.001). The detection rates of CRPAE, CRE and VRE all reduced with significant differences (P< 0.05). Conclusions The detection rate of multidrug-resistant organisms under targeted monitoring shows an obvious downward trend. MRSA and CRABA are still the major MDROs, which show no obvious change. The detection rates of CRPAE, VRE and CRE show obvious downward trend. Department of Burn, Comprehensive ICU, Department of Neurosurgery, Department of Respiratory Medicine and Department of Orthopedic Surgery have the highest risks of MDRO. In the future, we should strengthen the monitoring of high-risk departments, and focus on the reasonable choice of special antimicrobial agents to avoid special MDROs.
ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.
ObjectiveTo understand the economic burden of disinfection supply to medical institutions in Yibin City, and explore the feasibility of establishing a regional centralized management model of disinfection supply center in Yibin City.MethodsFrom April to May 2018, 263 medical institutions in the eight counties and two districts of Yibin City were investigated by means of mobile phone application-designed questionnaire, to obtain the information of cost accounting and economic burden of disinfection supply.ResultsThere were 263 medical institutions involved in the survey, in which 61 (23.19%) had set up the central sterile supply department (CSSD), including 43 public hospitals and 18 private hospitals; 202 medical institutions were without CSSD, which were mainly secondary hospitals [195 (74.14%), including 120 public hospitals and 75 private hospitals]. The higher the hospital level was, the larger the average area of the CSSD was; the difference was statistically significant (χ2=40.009, P<0.001). The higher the hospital level was, the more full-time personnel were employed, and the difference was statistically significant (χ2=31.862, P<0.001), and the care staff were the majority (66.23%). The cost burden of CSSD was more than 1 million yuan in the tertiary hospitals, which was 100 000 yuan or above in 61.90% of the secondary hospitals, and was below 100 000 yuan in hospitals below secondary level. The higher the hospital level was, the higher the total cost burden became; the difference was statistically significant (χ2=37.995, P<0.001). ConclusionIn view of the heavy economic burden of CSSD in medical institutions and the unbalanced setting up of medical institutions below secondary level, the establishment of a regional CSSD centralized management model is a new direction, new trend, and new model for future development, which is conducive to improving the quality of disinfection and sterilization, reducing medical care costs, making rational use of health resources, effectively preventing hospital infections, and ensuring the medical safety.