Ebnöther Corina, Tanner Beate, Schmid Flavia, La Rocca Vittoria, Heinzer Ivo, Bregenzer Thomas
Division for Infection Control, Kantonsspital Aarau, Switzerland.
Infect Control Hosp Epidemiol. 2008 Jan;29(1):38-43. doi: 10.1086/524330.
To study the impact of a multimodal infection control program on the rate of nosocomial infections at a 550-bed tertiary care center.
Before and after the implementation of an infection control program, the rate of nosocomial infection was recorded in time-interval prevalence studies. Hand hygiene compliance was studied before and after the intervention. As a surrogate marker of compliance, the amount of alcohol-based hand rub consumed before the intervention was compared with the amount consumed after the intervention. The intervention included additional staff for infection control, repeated instructions for hand hygiene, new guidelines for preoperative antibiotic prophylaxis, and isolation of patients infected or colonized with multidrug-resistant bacteria.
The rate of nosocomial infection decreased from approximately 11.7% to 6.8% in 2 years. The rate of hand hygiene compliance increased by 20.0%; it was 59.0% before the intervention and increased to 79.0% afterward. These results correlate with data on the consumption of alcohol-based hand rub, but not with data on the use of antibiotics.
Within 2 years, a multimodal infection control program intervention such as this one may reduce the rate of nosocomial infection at a tertiary care center by more than one-third and improve both the quality of care and patient outcomes. It may also generate considerable savings. Therefore, such programs should be promoted not only by hospital epidemiologists but also by hospital administrators.
研究一项多模式感染控制计划对一家拥有550张床位的三级医疗中心医院感染率的影响。
在感染控制计划实施前后，通过时间间隔患病率研究记录医院感染率。在干预前后研究手卫生依从性。作为依从性的替代指标，将干预前消耗的含酒精洗手液量与干预后消耗的量进行比较。干预措施包括增加感染控制人员、对手卫生进行反复指导、制定术前抗生素预防新指南以及隔离感染或定植多重耐药菌的患者。
医院感染率在2年内从约11.7%降至6.8%。手卫生依从率提高了20.0%；干预前为59.0%，干预后升至79.0%。这些结果与含酒精洗手液的消耗量数据相关，但与抗生素使用数据无关。
在2年内，这样的多模式感染控制计划干预可能会使三级医疗中心的医院感染率降低三分之一以上，并改善医疗质量和患者预后。它还可能带来可观的节省。因此，此类计划不仅应由医院流行病学家推广，医院管理人员也应推广。
