Miyachi Hayato, Furuya Hiroyuki, Umezawa Kazuo, Itoh Yumiko, Ohshima Toshio, Miyamoto Motoaki, Asai Satomi
Laboratory Medicine, Clinical Laboratory and Infection Control Office, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
Am J Infect Control. 2007 Mar;35(2):115-21. doi: 10.1016/j.ajic.2006.09.003.
Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful.
The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design.
Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations.
The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.
大型三级转诊医院目前控制耐甲氧西林金黄色葡萄球菌（MRSA）的方法并非普遍成功。
采用准实验设计，回顾性分析了1998年9月至2004年12月期间东海大学医院76个月内MRSA感染率的变化趋势及其与逐步实施预防策略的关系。
采用休哈特u图分析，实施包括病例和疫情报告反馈流程、感染控制团队和办公室以及MRSA预防指南等策略后，医院每月MRSA感染率并未降低。当组建了感染控制联络护士并使其活动全面展开后，2002年6月MRSA每月感染率的算术平均值从6.3%显著降至5.0%。同时，用指数加权移动平均图分析显示，2002年6月25个病房/科室中有15个的MRSA新发病例月均值也有所下降。与此同时，洗手液普通肥皂的月消耗量显著增加（17.3%）。此后，MRSA感染率在三年标准差范围内保持了两年的低水平。
医院MRSA感染率的持续降低可能与在持续执行手卫生合规等基本多学科方法的基础上引入感染控制联络护士系统有关。
