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环境服务对医疗相关艰难梭菌减少的影响。

Environmental services impact on healthcare-associated Clostridium difficile reduction.

机构信息

Department of Infection Prevention, Clark Regional Medical Center and Bourbon Community Hospital, Winchester, KY.

Bourbon Community Hospital, Paris, KY.

出版信息

Am J Infect Control. 2019 Apr;47(4):400-405.e1. doi: 10.1016/j.ajic.2018.09.016. Epub 2018 Dec 14.

Abstract

BACKGROUND

Healthcare-associated Clostridium difficile infection (CDI) can result from organisms found on hospital environmental surfaces. Without proper cleaning of hospital environmental surfaces, cross-contamination can occur, resulting in a healthcare-associated infection. In 2011, an environmental services (EVS) model was developed in Hospital A that resulted in a reduction in healthcare-associated CDI. The purpose of this study was to determine if implementing Hospital A's EVS model in Hospital B would decrease healthcare-associated CDI incidence.

METHODS

A quasi-experimental design was used. The study was conducted in Hospital B, a 53-bed acute care community-based hospital, between January 2013 and December 2017. A retrospective review of all CDI LabID A/B toxin enzyme immunoassay events was performed using the National Healthcare Safety Network surveillance definitions. The data were calculated based on incidence rates per 1,000 patient days and the National Healthcare Safety Network standard infection ratio formula. No new disinfectants, antibiotic restrictions, or new isolation techniques were instituted during this time period.

RESULTS

There was a 100% reduction in healthcare-associated CDI in Hospital B from 2013's baseline rate of 0.48 per 1,000 patient days to 0.00 per 1,000 patient days (0.48, 0.00, P = 0.020).

CONCLUSIONS

This study highlights the importance of EVS education and accountability as well as recognition of the role played by EVS in reducing healthcare-associated CDI within healthcare facilities.

摘要

背景

医院环境表面存在的微生物可导致医源性艰难梭菌感染(CDI)。如果不对医院环境表面进行适当的清洁,就可能发生交叉污染,进而导致医源性感染。2011 年,A 医院制定了环境服务(EVS)模式,使医源性 CDI 有所减少。本研究旨在确定在 B 医院实施 A 医院的 EVS 模式是否会降低医源性 CDI 的发生率。

方法

采用准实验设计。该研究在 B 医院进行,B 医院是一家拥有 53 张病床的急性护理社区医院,时间跨度为 2013 年 1 月至 2017 年 12 月。使用国家医疗保健安全网络(NHSN)监测定义对所有 CDI LabID A/B 毒素酶免疫测定事件进行回顾性回顾。根据每千名患者天数的发病率和 NHSN 标准感染率公式计算数据。在此期间,没有引入新的消毒剂、抗生素限制或新的隔离技术。

结果

B 医院医源性 CDI 发生率从 2013 年的基线率 0.48/千患者天降至 0.00/千患者天,降幅达 100%(0.48,0.00,P=0.020)。

结论

本研究强调了 EVS 教育和问责制的重要性,以及 EVS 在减少医疗机构内医源性 CDI 方面所起的作用。

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