预防与医疗保健相关的MRSA细菌病:了解问题的根源
Michael A Borg1,2, David Suda1, Ermira Tartari1
1University of Malta, Msida, Malta.
Antimicrobial stewardship & healthcare epidemiology : ASHE
|December 29, 2023
概括
实施连续干预措施,包括手部卫生运动和改进的设备管理,显著减少了近90%的与医疗保健相关的甲素耐药黄金葡萄球菌细菌症 (HA-MRSA-B). 这些策略对于在医院控制MRSA感染至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 医院流行病学 医院流行病学
- 公共卫生干预 公共卫生干预
背景情况:
- 医疗相关感染 (HAI) 是由抗甲素黄金葡萄球菌 (MRSA) 引起的,这对全球健康构成了重大挑战.
- 甲素耐药黄金杆菌菌 (MRSA-B) 在全球范围内对医院环境中的发病率和死亡率做出了重大贡献.
研究的目的:
- 评估一项旨在减少医疗相关MRSA细菌病 (HA-MRSA-B) 发生率的准实验性,顺序性干预策略的有效性.
- 评估不同的干预措施,包括促进手部卫生,根源原因分析和入院查,对HA-MRSA-B率的影响.
主要方法:
- 马耳他Mater Dei医院采用了一种连续的准实验性设计,分阶段实施干预措施:手部卫生运动 (2008年),HA-MRSA-B病例的根本原因分析 (2011年) 和普遍的MRSA入院查 (2014年).
- 变化点分析被用来统计评估每个干预措施对HA-MRSA-B发病率随时间推移的影响.
- 收集和分析了有关酒精消耗和MRSA细菌病源的数据.
主要成果:
- 随着手部卫生运动的推广,饮酒量显著增加,消费者对手部进行摩擦. 根源原因分析发现,在83%的HA-MRSA-B病例中,血管内装置是主要的风险因素.
- 在RCA发现的基础上,针对血管内器件管理的有针对性的干预措施导致HA-MRSA-B率的最实质性降低.
- 干预措施的连续实施,包括普遍的MRSA入院查,导致HA-MRSA-B发病率总体减少近90%,从2008年至2019年间的1.72至0.18个病例/10,000个病床日.
- 在静脉注射器械干预后,也观察到对甲基西林敏感黄金葡萄球菌 (MSSA) 细菌病率的同时降低.
结论:
- 即使在高度特有的环境中,也可以通过精心策划的,特定于环境的干预措施来实现HA-MRSA-B的显著减少.
- 结合增强的手部卫生,彻底的根本原因分析,有针对性的设备管理和入院查的多方面方法有效控制MRSA细菌性血症.
- 根据当地环境和文化量身定制的行为改变干预措施对于成功实施和感染控制战略的持续影响至关重要.
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