ObjectiveTo evaluate the effect of bundle strategies on the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), in order to effectively prevent and control the severe situation of multiple drug-resistant bacteria in ICU.MethodsWe selected patients who admitted into the ICU from January 2016 to December 2017 as study subjects, and monitored 6 types of MDROs. Basic information was surveyed and collected from January to December 2016 (before intervention), while bundle strategies on MDROs were implemented from January to December 2017 (after intervention), including issusing isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, implementing hand hygiene, etc. Then we compared the MDRO detection rate, nosocomial infection rate, MDRO nosocomial infection rate, and compliance rates of interventions between the two periods.ResultsThe MDRO detection rate before intervention was 77.10%, and that after intervention was 49.12%, the difference between the two periods was statistically significant (χ2=69.834, P<0.001). The nosocomial infection rate of ICU decreased from 23.51% before intervention to 15.23% after intervention, the MDRO nosocomial infection rate decreased from 13.70% before intervention to 5.84% after intervention, and the differences between the two periods were statistically significant (χ2=8.594, P=0.003; χ2=13.722, P<0.001). The compliance rates of doctor’s isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, and hand hygiene, as well as the correct rate of hand hygiene after intervention (92.12%, 93.55%, 81.77%, 84.24%, 82.90%, 77.39%, and 96.37%) were significantly higher than those before intervention (31.94%, 52.00%, 23.43%, 48.18%, 67.16%, 59.46%, and 88.64%), and the differences were all statistically significant (P<0.001).ConclusionThe implementation of the above bundle strategies on the prevention and control of MDROs can decrease the MDRO detection rate and MDRO nosocomial infection rate.
ObjectiveTo confirm the effect of comprehensive prevention and care measures in reducing the incidence of multi-drug resistance in Intensive Care Unit (ICU) patients. MethodFrom March 1 to August 31 in 2014, we took routine measures to prevent multi-drug-resistant infections in ICU patients, and from September 1 in 2014 to February 28 in 2015, We added a series of comprehensive prevention measures to prevent multi-drug resistant infections including focus on isolation, temperature control of the ward, ward disinfection, quality improvement of basic care, standardized management and disinfection of equipments in ICU. Finally, we compared the detection rate of multi-drug resistant patients before and after the comprehensive nursing intervention. ResultsAfter taking comprehensive care interventions and a six-month monitoring, the detection rate of multi-resistant bacteria occurred in 11.87‰ of the patients. Compared with the previous six months, the detection rate dropped from 16.64‰ to 11.87‰ with a significant difference (χ2=6.346,P=0.012). ConclusionsComprehensive nursing intervention measures taken by the ICU department can effectively reduce multi-drug resistant infections in ICU patients.
Objective To investigate the value of bronchial mucosa biopsy and quantitative culture in the differential diagnosis of lower airway bacterial colonization and infection. Methods A prospective observational cohort survey onMDR Pseudomonas aeruginosa and Acinetobacter baumannii was carried out in intubed or tracheotomized patients with invasive ventilation in respiratory intensive care unite ( RICU) . A total of 50 ICU patients were followed for the detection of MDR pathogen colonization or infection from June 2008 to October 2009. All subjects were divided into an infection group and a colonization group according to the outcome of patients discharged fromthe RICU. Baseline information, APACHEⅡ scores, and CPIS scores were recorded on individual forms for each patient untill discharge or death. Bronchial mucosa biopsy was conducted on appropriate time to identify whether the patient was comfirmed as infection. Microbiological diagnosis was performed with quantitative culture. Results Fifty patients were enrolled in this study, of which infected in 23 cases and colonized in 27 cases. The time of invasive mechanical ventilation, length ofICU stay, catheter indwelling time, and the kinds of disease were significantly different between the two groups( P lt; 0. 05) . The kinds of using antibiotics before onset of multi-drug resistance of bacteria showed that cefoxitin/ cefmetazole and mezlocillin also had significant difference between the infection group and the colonization group. The results of dynamic CPIS score of the infection group showed that scores at each timepoint were higher than those in the colonization group. However, the results of t-test showed that there was higher score in the infection group than that in the colonization group on 14 days after intubation ( P lt;0. 05) . The bronchial mucosa biopsy showed that airway inflammation was detected in 19 cases in the infection group and 9 cases in colonization group. The positive rate in the infection and the colonization group were 55. 6% and 25. 0% , respectively assessed by traditional threshold of 103 cfu/mL for PSB in quantitative bacterial culture. In addition, there was more inflammatory cells in the patients with drug-resistant pathogens infection than that in the patients without nosocomial infection. The combination of bronchial mucosa biopsy and microorganism quantitative cultures had the highest sensitivity and specificity and the highest diagnostic accuracy. Conclusions Bronchial mucosa biopsy combining microorganism quantitative culture is feasible in identifying colonized or infected bacteria. Invasive mechanical ventilation time, length of ICU stay and the catheter indwelling time extending are risk factors for bacterial colonization.
ObjectiveTo analyze epidemic characteristics of multidrug-resistant organism (MDRO) in Neurosurgical Intensive Care Unit (NSICU), and to analyze the status of infection and colonization, in order to provide reference for constituting intervention measures. MethodsPatients who stayed in NSICU during January 2014 to April 2015 were actively monitored for the MDRO situation. ResultsA total of 218 MDRO pathogens were isolated from 159 patients, and 42 cases were healthcare-associated infections (HAI) among 159 patients. The Acinetobacter baumannii was the most common one in the isolated acinetobacter. Colonization rate was positively correlated with the incidence of HAI. From January to December, there was a significantly increase in the colonization rate, but not in the incidence of HAI. ConclusionThe main MDRO situation is colonization in NSICU. The obvious seasonal variation makes the HAI risk at different levels. So it is necessary that full-time and part-time HAI control staff be on alert, issue timely risk warning, and strengthen risk management. The Acinetobacter baumannii has become the number one target for HAI prevention and control in NSICU, so their apparent seasonal distribution is worthy of more attention, and strict implementation of HAI prevention and control measures should be carried out.
Objective To explore the clinical effect of failure mode and effect analysis (FMEA) combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU. Methods In January 2020, a risk assessment team was established in the Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, to analyze the possible risk points of MDRO infections in ICU from then on. FMEA was used to assess risks, and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections. The causes of the high-risk points were analyzed, and improvement measures were formulated to control the risks through PDCA cycle management model. The incidence of healthcare-associated MDRO infections in ICU, improvement of high-risk events, and satisfaction of doctors and nurses after the implementation of intervention measures (from January 2020 to June 2021) were retrospectively collected and compared with those before the implementation of intervention measures (from January 2018 to December 2019). Results Six high-risk factors were screened out, namely single measures of isolation, unqualified cleaning and disinfection of bed units, irrational use of antimicrobial agents, weak consciousness of isolation among newcomers of ICU, weak awareness of pathogen inspection, and untimely disinfection. The incidence of healthcare-associated MDRO infections was 2.71% (49/1800) before intervention and 1.71% (31/1808) after intervention, and the difference between the two periods was statistically significant (χ2=4.224, P=0.040). The pathogen submission rate was 56.67% (1020/1800) before intervention and 61.23% (1107/1808) after intervention, and the difference between the two periods was statistically significant (χ2=7.755, P=0.005). The satisfaction rate of doctors and nurses was 75.0% (30/40) before intervention and 95.0% (38/40) after intervention, and the difference between the two periods was statistically significant (χ2=6.275, P=0.012). Conclusions FMEA can effectively find out the weak points in the prevention and treatment of MDRO infections in ICU, while PDCA model can effectively formulate improvement measures for the weak points and control the risks. The combined application of the two modes provides a scientific and effective guarantee for the rational prevention and treatment of MDRO infections in ICU patients.
Objective To investigate the antibiotic resistance distribution and profiles of multidrug resistant bacteria in respiratory intensive care unit ( RICU) , and to analyze the related risk factors for multidrug resistant bacterial infections. Methods Pathogens from79 patients in RICU from April 2008 to May 2009 were analyzed retrospectively. Meanwhile the risk factors were analyzed by multi-factor logistic analysis among three groups of patients with non-multidrug, multidrug and pandrug-resistant bacterialinfection. Results The top three in 129 isolated pathogenic bacteria were Pseudomonas aeruginosa ( 24. 0% ) , Staphylococcus aureus( 22. 5% ) , and Acinetobacter baumannii( 15. 5% ) . The top three in 76 isolated multidrug-resistant bacteria were Staphylococcus aureus ( 38. 9% ) , Pseudomonas aeruginosa ( 25. 0% ) , and Acinetobacter baumannii( 19. 4% ) . And the two main strains in 29 isolated pandrug-resistant bacteria were Pseudomonas aeruginosa ( 48. 3% ) and Acinetobacter baumannii ( 44. 8% ) . Multi-factor logistic analysis revealed that the frequency of admition to RICU, the use of carbapenem antibiotics, the time of mechanical ventilation, the time of urethral catheterization, and complicated diabetes mellitus were independent risk factors for multidrug-resistant bacterial infection( all P lt; 0. 05) . Conclusions There is a high frequency of multidrug-resistant bacterial infection in RICU. Frequency of admition in RICU, use of carbapenem antibiotics, time of mechanical ventilation, time of urethral catheterization, and complicated diabetes mellitus were closely related withmultidrug-resistant bacterial infection.
目的 了解新生儿患者多重耐药菌社区感染的特点和定植情况，采取预防控制措施，防止在院内传播。 方法 对2011年9月－2012年8月所有新入院新生儿患者共801例进行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（ESBL）菌入院筛查，了解多重耐药菌社区感染的特点和定植情况。并将801例新生儿患者（观察组）医院感染发生率与2010年9月－2011年8月同期801 例新生儿患者（对照组）医院感染发生率进行比较。 结果 观察组发现MRSA和产ESBL菌共321例，检出率为40.1%。其中包括单纯MRSA 45例，占14.1%；产ESBL菌238例，占74.1%；MRSA+产ESBL菌38例，占11.8%。观察组医院感染发生率为2.0%，多重耐药菌医院感染构成比为12.5%；对照组医院感染发生率为5.1%，多重耐药菌医院感染构成比为53.6%；两组医院感染发生率和多重耐药菌医院感染构成比差异均有统计学意义（P＜0.01）。 结论 新生儿患者多重耐药菌定植情况严重，应引起高度重视，加强管理可防止在医院传播，减少医院感染发生。
Objective To investigate nosocomial infection rate in Intensive Care Unit (ICU), its risk factors and the pathogenic characteristics of multidrug-resistant bacteria through targeted monitoring, in order to provide scientific references for reducing nosocomial infection. Methods Targeted monitoring was performed on the patients who were admitted to the comprehensive ICU between July 2014 and June 2016. Results Nosocomial infection occurred in 312 of the 4 991 patients. The case infection rate was 6.25%, and case infection rate per day was 19.03‰. After the adjustment, the case infection rate per day was 6.77‰. The ventilator-associated pneumonia infection accounted for 30.78‰; catheter-related bloodstream infection occupied 0.30‰; and catheter-associated urinary tract infection accounted for 0.27‰. The respiratory tract was the major part of nosocomial infection, accounting for 90.38%. Gram-negative bacilli were the major bacteria accounting for 92.74%, in whichAcinetobacter baumannii accounted for 36.29%. Conclusions Through targeted monitoring to keep abreast of the current situation of nosocomial infection in ICU, management and interventions can be targeted. It is an important way to reduce nosocomial infection in ICU.
Objective To investigate the risk factors of multidrug-resistant organism (MDRO) infection in patients with car accident injuries in intensive care unit (ICU), providing clinical guidance for reducing MDRO infection in car accident patients. Methods The clinical data of patients with car accident injuries in Sichuan Provincial People’s Hospital between January 1st 2019 and February 28th 2023 were collected, and the relevant data were analyzed retrospectively to explore the risk factors of MDRO infection. Results A total of 141 patients with car accident injuries were collected, of whom 30 had MDRO infection. The proportions of males (P=0.012), indwelling catheters (P=0.005), mechanical ventilation (P=0.001), length of hospital stay (P<0.001), and total treatment costs (P<0.001) in the infection group were higher than those in the non-infection group. Multiple logistic regression analysis showed that male [odds ratio (OR)=3.797, 95% confidence interval (CI) (1.174, 12.275), P=0.026], mechanical ventilation [OR=4.596, 95%CI (1.538, 13.734), P=0.006], and length of hospital stay≥20 d [OR=1.014, 95%CI (1.001, 1.028), P=0.037] were independent risk factors for MDRO infection in car accident patients. Conclusions Male, mechanical ventilation, and increased length of hospital stay are independent risk factors for MDRO infection in car accident patients. For such patients, the prevention and control measures of hospital infection should be strictly implemented to reduce the risk of infection.