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在一家少于 400 张床位的二级教学医院和一家社区医院停止接触预防措施对多重耐药菌的影响:一项为期 3 个月的试点研究。

The impact of discontinuing contact precautions for multidrug resistant organisms at a less than 400-bed level II teaching hospital and a community hospital: A 3-month pilot study.

机构信息

Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA.

Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA.

出版信息

Am J Infect Control. 2020 Mar;48(3):333-336. doi: 10.1016/j.ajic.2019.08.012. Epub 2019 Sep 10.

Abstract

BACKGROUND

The impact of discontinuing contact precautions (CPs) for patients with select multidrug-resistant organisms on bacteremia infection rates was evaluated in this quality improvement project.

METHODS

The removal of use of CPs, with increased focus on standard precautions, for all patients with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization/infection was piloted via a quality improvement project over a 3-month period.

RESULTS

CP was discontinued in December 2018. Comparing 3 months pre- and postchange, the overall incidence density rate decreased for hospital-onset (HO) laboratory-identified (LabID) MRSA bacteremia (0.07 vs 0.02; P = .52), whereas HO LabID VRE bacteremia rates remained the same (0.00 vs 0.00). Overall estimated financial savings, including personal protective equipment ($15,375) and staff time ($17,165), was $32,540 for the project period, with annualized estimated savings of $130,160.

CONCLUSIONS

In this pilot study evaluating the discontinuance of CPs, there was no evidence of an increase in HO MRSA or VRE LabID bacteremia incidence density rates. This practice change may be safely implemented at similar health care facilities.

摘要

背景

本质量改进项目评估了停止对某些多重耐药菌患者实施接触预防措施(CPs)对菌血症感染率的影响。

方法

通过质量改进项目,对所有耐甲氧西林金黄色葡萄球菌(MRSA)或万古霉素耐药肠球菌(VRE)定植/感染患者停用 CPs,并更加注重标准预防措施,为期 3 个月。

结果

CP 于 2018 年 12 月停止使用。与改变前的 3 个月相比,医院获得性(HO)实验室鉴定(LabID)MRSA 菌血症的总发生率密度降低(0.07 比 0.02;P=0.52),而 HO LabID VRE 菌血症率保持不变(0.00 比 0.00)。项目期间的总估计节省费用包括个人防护设备(15375 美元)和员工时间(17165 美元)为 32540 美元,年化估计节省 130160 美元。

结论

在这项评估停止使用 CPs 的试点研究中,HO MRSA 或 VRE LabID 菌血症发生率密度没有增加的证据。这种做法的改变可以在类似的医疗机构中安全实施。

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