Farrington M, Trundle C, Redpath C, Anderson L
Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital NHS Trust, Cambridge, UK.
J Hosp Infect. 2000 Oct;46(2):118-22. doi: 10.1053/jhin.2000.0808.
Nursing staff workload may influence hospital-acquired staphylococcal transmission. Closure of wards to new admissions is used in some institutions as part of methicillin-resistant Staphylococcus aureus (MRSA) outbreak control, and we postulated that it worked by reducing staff workload, allowing more time for good infection control practices. We have used the GRASPCopyright workload system to compare nursing workload during six MRSA outbreaks. Two outbreaks occurred while an aggressive control policy ('old'; 1994-1995) was in place, with a low threshold for ward closure. Control measures had been relaxed before the later four outbreaks, with wards remaining fully or partially open unless MRSA transmission proved intractable ('new'; 1995-1996). To standardize the analysis we compared GRASP and epidemiological data for periods while MRSA transmission was occurring on each ward ('during'), and four week periods 'before' and 'after'. Closing wards to admissions reduces staff workload towards a quality environment, although the nursing requirements of remaining patient rises. Workload pressures may rise during outbreaks if wards are not closed quickly and fully, and patients are not transferred to specialist isolation facilities. Changes in nursing workload need to be assessed during comparative studies of outbreak control measures and the GRASP(c) system appears to be a sensitive way to measure these.
护理人员的工作量可能会影响医院内葡萄球菌的传播。在一些机构中，作为耐甲氧西林金黄色葡萄球菌（MRSA）暴发控制措施的一部分，会对病房实行禁止接收新患者的措施。我们推测这样做的作用机制是通过减少工作人员的工作量，从而有更多时间来实施良好的感染控制措施。我们使用了GRASPCopyright工作量系统，对6次MRSA暴发期间的护理工作量进行了比较。在积极的控制策略（“旧策略”；1994 - 1995年）实施期间发生了2次暴发，当时病房关闭的门槛较低。在随后的4次暴发之前，控制措施有所放松，除非MRSA传播难以控制，病房会保持全部或部分开放状态（“新策略”；1995 - 1996年）。为了使分析标准化，我们比较了每个病房发生MRSA传播期间（“期间”）、以及“之前”和“之后”四周期间的GRASP数据和流行病学数据。禁止病房接收新患者可使工作人员的工作量朝着营造优质环境的方向减少，尽管剩余患者的护理需求会增加。如果病房没有迅速且完全关闭，并且患者没有被转移到专门的隔离设施中，那么在暴发期间工作量压力可能会增加。在对暴发控制措施进行比较研究时，需要评估护理工作量的变化，而GRASP(c)系统似乎是衡量这些变化的一种灵敏方法。
