Harrington Glenys, Watson Kerrie, Bailey Michael, Land Gillian, Borrell Susan, Houston Leanne, Kehoe Rosaleen, Bass Pauline, Cockroft Emma, Marshall Caroline, Mijch Anne, Spelman Denis
Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Melbourne, Victoria, Australia.
Infect Control Hosp Epidemiol. 2007 Jul;28(7):837-44. doi: 10.1086/518844. Epub 2007 May 31.
To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA).
Longitudinal observational study before and after interventions.
The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).
A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.
Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.
The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P=.047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P<.001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.
A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.
评估一系列干预措施对耐甲氧西林金黄色葡萄球菌（MRSA）发病率的影响。
干预前后的纵向观察性研究。
阿尔弗雷德医院是一家拥有350张床位的三级转诊医院，设有一个35张床位的重症监护病房（ICU）。
一系列干预措施，包括在重症监护病房引入抗菌洗手液以及一项全院范围的MRSA监测反馈计划，该计划使用统计过程控制图但不进行主动监测培养。
2003年1月至2006年5月期间实施了一系列干预措施。比较了干预前和干预期间重症监护病房及全院范围内新感染或定植MRSA的患者发病率和比率，以及MRSA菌血症发作情况。采用分段回归分析计算干预期间全院范围内新感染MRSA患者数量和MRSA菌血症发作次数的减少百分比。
干预期间，重症监护病房新感染MRSA的患者比率为每100例患者入院中有6.7例，而干预前为每100例患者入院中有9.3例（P = 0.047）。干预期间全院新感染MRSA的患者比率为每100例患者入院中有1.7例，而干预前为每100例患者入院中有3.0例（P < 0.001）。通过分段回归分析，新感染MRSA患者比率减少百分比的最大估计值和保守估计值分别为79.5%和42.0%，MRSA菌血症发作次数减少百分比的最大估计值和保守估计值分别为87.4%和39.0%。
已证明使用最少的资源和有限的干预措施可使新感染或定植MRSA的患者数量持续减少。
