Black Stephanie R, Weaver Kingsley N, Weinstein Robert A, Hayden Mary K, Lin Michael Y, Lavin Mary Alice, Gerber Susan I
1Communicable Disease Program,Chicago Department of Public Health,Chicago,Illinois.
2Division of Infectious Diseases,Cook County Health and Hospitals System,Chicago,Illinois.
Infect Control Hosp Epidemiol. 2015 Apr;36(4):381-6. doi: 10.1017/ice.2014.78.
Multidrug-resistant organisms (MDROs) are an increasing burden among healthcare facilities. We assessed facility-level perceived importance of and responses to various MDROs.
A pilot survey to assess staffing, knowledge, and the perceived importance of and response to various multidrug resistant organisms (MDROs)
Acute care and long-term healthcare facilities
In 2012, a survey was distributed to infection preventionists at ~300 healthcare facilities. Pathogens assessed were Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant (defined as bacterial resistance to ≥3 antibiotic classes) Pseudomonas, and extended-spectrum β-lactamase-producing Escherichia coli.
A total of 74 unique facilities responded, including 44 skilled nursing facilities (SNFs) and 30 acute care facilities (ACFs). While ACFs consistently isolated patients with active infections or colonization due to these MDROs, SNFs had more variable responses. SNFs had more multi-occupancy rooms and reported less specialized training in infection control and prevention than did ACFs. Of all facilities with multi-occupancy rooms, 86% employed a cohorting practice for patients, compared with 50% of those without multi-occupancy rooms; 20% of ACFs and 7% of SNFs cohorted staff while caring for patients with the same MDRO. MRSA and C. difficile were identified as important pathogens in ACFs and SNFs, while CRE importance was unknown or was considered important in <50% of SNFs.
We identified stark differences in human resources, knowledge, policy, and practice between ACFs and SNFs. For regional control of emerging MDROs like CRE, there is an opportunity for public health officials to provide targeted education and interventions. Education campaigns must account for differences in audience resources and baseline knowledge.
多重耐药菌（MDROs）在医疗机构中的负担日益加重。我们评估了医疗机构层面对于各种MDROs的重要性认知及应对措施。
一项试点调查，旨在评估人员配备、知识水平以及对各种多重耐药菌（MDROs）的重要性认知和应对措施。
急性护理和长期医疗保健机构
2012年，向约300家医疗机构的感染预防人员发放了调查问卷。评估的病原体包括艰难梭菌、耐碳青霉烯类肠杆菌科细菌（CRE）、耐碳青霉烯类不动杆菌、耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌、多重耐药（定义为对≥3类抗生素耐药）铜绿假单胞菌以及产超广谱β-内酰胺酶的大肠埃希菌。
共有74家不同的机构做出回应，包括44家专业护理机构（SNFs）和30家急性护理机构（ACFs）。虽然ACFs持续隔离因这些MDROs导致有活动性感染或定植的患者，但SNFs的应对措施则更为多样。SNFs的多人病房更多，且报告称在感染控制和预防方面接受的专业培训比ACFs少。在所有设有多人病房的机构中, 86%对患者采用了分组护理做法，而在没有多人病房的机构中这一比例为50%；20%的ACFs和7%的SNFs在护理感染同一种MDRO的患者时对工作人员进行了分组。MRSA和艰难梭菌在ACFs和SNFs中被确定为重要病原体，而CRE的重要性在SNFs中尚不清楚或只有不到50%的机构认为其重要。
我们发现ACFs和SNFs在人力资源、知识水平、政策和实践方面存在明显差异。对于像CRE这样新出现的MDROs进行区域控制，公共卫生官员有机会提供有针对性的教育和干预措施。教育活动必须考虑到受众资源和基线知识的差异。
