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使用碳青霉烯类耐药鲍曼不动杆菌控制长达二十年的地方病疫情:一系列干预措施的电子传播

Control of a two-decade endemic situation with carbapenem-resistant Acinetobacter baumannii: electronic dissemination of a bundle of interventions.

作者信息

Munoz-Price L Silvia, Carling Philip, Cleary Timothy, Fajardo-Aquino Yovanit, DePascale Dennise, Jimenez Adriana, Hughes Michael, Namias Nicholas, Pizano Louis, Kett Daniel H, Arheart Kristopher

机构信息

Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL; Jackson Health System, Miami, FL.

Boston University, Boston, MA.

出版信息

Am J Infect Control. 2014 May;42(5):466-71. doi: 10.1016/j.ajic.2013.12.024.

Abstract

BACKGROUND

Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions.

METHODS

This was a quasiexperimental study performed at a 1,500-bed, public, teaching hospital. From January 2011 to March 2012, weekly electronic communications were sent to the hospital leadership and intensive care units (ICUs). These communications aimed to describe, interpret, and package the findings of the previous week's active surveillance cultures, environmental cultures, environmental disinfection, and hand cultures. Additionally, action plans based on these findings were shared with recipients.

RESULTS

During 42 months and 1,103,900 patient-days, we detected 438 new acquisitions of carbapenem-resistant A baumannii. Hospital wide, the rate of acquisition decreased from 5.13 ± 0.39 to 1.93 ± 0.23 per 10,000 patient-days, during the baseline and postintervention periods, respectively (P < .0001). This effect was also observed in the medical and trauma ICUs, with decreased rates from 67.15 ± 10.56 to 17.4 ± 4.6 (P < .0001) and from 55.9 ± 8.95 to 14.71 ± 4.45 (P = .0004), respectively.

CONCLUSION

Weekly and systematic dissemination of the findings of a bundle of interventions was successful in decreasing the rates of carbapenem-resistant A baumannii across a large public hospital.

摘要

背景

尽管采取了一系列干预措施,我们机构耐碳青霉烯类鲍曼不动杆菌仍处于高流行状态。我们旨在描述随后实施的每周一系列干预措施结果的电子传播所产生的影响。

方法

这是一项在一家拥有1500张床位的公立教学医院进行的准实验性研究。2011年1月至2012年3月,每周向医院领导和重症监护病房(ICU)发送电子通讯。这些通讯旨在描述、解读并整合前一周主动监测培养、环境培养、环境消毒和手部培养的结果。此外,还与接收者分享基于这些结果的行动计划。

结果

在42个月和1103900个患者日期间,我们检测到438例新的耐碳青霉烯类鲍曼不动杆菌感染病例。在全院范围内,每10000个患者日的感染率在基线期和干预后期分别从5.13±0.39降至1.93±0.23(P<.0001)。在医疗和创伤ICU也观察到了这种效果,感染率分别从67.15±10.56降至17.4±4.6(P<.0001)和从55.9±8.95降至14.71±4.45(P=.0004)。

结论

每周系统地传播一系列干预措施的结果成功降低了大型公立医院耐碳青霉烯类鲍曼不动杆菌的感染率。

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