Wang Ying, Zhang Xin-Ping, Lai Xiao-Quan, Wang Xue-Mei
Naning Drum Tower Hospital Affiated to Nanjing University Medical School, Nanjing, 210008, China.
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Curr Med Sci. 2023 Feb;43(1):198-205. doi: 10.1007/s11596-023-2709-6. Epub 2023 Mar 3.
Contact precautions, especially the initiation of isolation, are important measures to prevent and control multidrug-resistant organisms (MDROs). However, the implementation in clinical practice remains weak. This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection, and determine the factors that affect the implementation of isolation measures.
A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1, 2018. The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected. Then, the issuance of isolation orders was retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation.
The overall issuance rate of isolation orders was 61.21%, which increased from 33.12% to 75.88% (P<0.001) after the implementation of the multidisciplinary collaborative intervention. The intervention (P<0.001, OR=0.166) was a promoting factor for the issuance of isolation orders, in addition to the length of stay (P=0.004, OR=0.991), department (P=0.004), and microorganism (P=0.038).
The isolation implementation remains far lower than policy standards. Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors, thereby promoting the standardized management of MDROs, and providing reference for further improving the quality of hospital infection management.
接触预防措施，尤其是隔离的启动，是预防和控制多重耐药菌（MDROs）的重要措施。然而，在临床实践中的实施情况仍然薄弱。本研究旨在分析多学科协作干预对多重耐药菌感染隔离实施的影响，并确定影响隔离措施实施的因素。
2018年11月1日，在中国中部一家教学型三级医院进行了一项与隔离相关的多学科协作干预。收集了干预前后10个月内1338例多重耐药菌感染和定植患者的信息。然后，对隔离医嘱的下达情况进行回顾性分析。进行单因素分析和多因素logistic回归分析，以分析影响隔离实施的因素。
隔离医嘱的总体下达率为61.21%，实施多学科协作干预后从33.12%提高到75.88%（P<0.001）。除住院时间（P=0.004，OR=0.991）、科室（P=0.004）和微生物种类（P=0.038）外，干预措施（P<0.001，OR=0.166）是隔离医嘱下达的促进因素。
隔离措施的实施仍远低于政策标准。多学科协作干预可有效提高医生对隔离措施的依从性，从而促进多重耐药菌的规范化管理，并为进一步提高医院感染管理质量提供参考。
