Raboud Janet, Saskin Refik, Simor Andrew, Loeb Mark, Green Karen, Low Don E, McGeer Allison
Department of Public Health Sciences, University of Toronto, and University Health Network, Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2005 Jul;26(7):607-15. doi: 10.1086/502589.
To determine the impact of the screening test, nursing workload, handwashing rates, and dependence of handwashing on risk level of patient visit on methicillin-resistant Staphylococcus aureus (MRSA) transmission among hospitalized patients.
General medical ward.
Monte Carlo simulation was used to model MRSA transmission (median rate per 1,000 patient-days). Visits by healthcare workers (HCWs) to patients were simulated, and MRSA was assumed to be transmitted among patients via HCWs.
The transmission rate was reduced from 0.89 to 0.56 by the combination of increasing the sensitivity of the screening test from 80% to 99% and being able to report results in 1 day instead of 4 days. Reducing the patient-to-nurse ratio from 4.3 in the day and 6.8 at night to 3.8 and 5.7, respectively, reduced the number of nosocomial infections from 0.89 to 0.85; reducing the ratio to 1 and 1, respectively, further reduced the number of nosocomial infections to 0.32. Increases in handwashing rates by 0%, 10%, and 20% for high-risk visits yielded reductions in nosocomial infections similar to those yielded by increases in handwashing rates for all visits (0.89, 0.36, and 0.24, respectively). Screening all patients for MRSA at admission reduced the transmission rate to 0.81 per 1,000 patient-days from 1.37 if no patients were screened.
Within the ranges of parameters studied, the most effective strategies for reducing the rate of MRSA transmission were increasing the handwashing rates for visits involving contact with skin or bodily fluid and screening patients for MRSA at admission.
确定筛查试验、护理工作量、洗手率以及洗手对患者就诊风险水平的依赖性对住院患者耐甲氧西林金黄色葡萄球菌（MRSA）传播的影响。
普通内科病房。
采用蒙特卡洛模拟对MRSA传播（每1000患者日的中位数率）进行建模。模拟医护人员（HCWs）对患者的诊疗过程，并假设MRSA通过医护人员在患者之间传播。
将筛查试验的灵敏度从80%提高到99%，并能够在1天而非4天内报告结果，可使传播率从0.89降至0.56。将白天患者与护士的比例从4.3降至3.8，夜间从6.8降至5.7，可使医院感染数量从0.89降至0.85；分别降至1和1，可进一步将医院感染数量降至0.32。高风险就诊时洗手率分别提高0%、10%和20%，医院感染减少情况与所有就诊洗手率提高时相似（分别为0.89、0.36和0.24）。入院时对所有患者进行MRSA筛查，可使传播率从未筛查患者时的每1000患者日1.37降至0.81。
在所研究的参数范围内，降低MRSA传播率最有效的策略是提高涉及接触皮肤或体液的就诊时的洗手率以及入院时对患者进行MRSA筛查。
