估计由于MRSA预防政策的变化,设施MRSA感染率的变化
Karim Khader1,2, Candace Haroldsen1,2, Vanessa Stevens1,2
1Informatics, Decision Enhancement, and Analytical Sciences (IDEAS) 2.0 Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
概括
接触预防措施 (CP) 和积极监测 (AS) 对抗甲素黄金葡萄球菌 (MRSA) 预防医疗相关感染 (HAI) 的有效性尚不清楚. 在调整了基线负担后,流行病的干扰并不一致地将实践变化与MRSAHAI增加联系起来.
科学领域:
- 预防和控制感染的预防和控制.
- 医疗流行病学 医疗流行病学
- 抗微生物耐药性 抗微生物耐药性
背景情况:
- 接触预防措施 (CP) 和主动监视 (AS) 在急症护理环境中预防耐甲金色葡萄球菌 (MRSA) 的有效性尚不确定.
- 一些研究表明,CP可以减少MRSA的传播,而另一些研究则显示益处有限.
- COVID-19大流行扰乱了标准的MRSA预防实践,提供了一个独特的机会来评估它们对MRSA医疗相关感染 (HAI) 的影响.
研究的目的:
- 评估MRSA预防实践变化的影响 (AS,殖民者的CP,感染者的CP) 在COVID-19大流行期间对MRSAHAI的影响.
- 评估这些做法的停止和恢复与退伍军人事务 (VA) 急症医院MRSA HAI率之间的关联.
主要方法:
- 从2020年7月到2022年6月,对121家VA急症医院进行了一项研究.
- 设施实践通过国家调查进行评估,患者级数据确定了MRSA HAI.
- 统计模型 (Poisson,负二项式,混合效应的Poisson回归) 用于估计关联,根据基线MRSA负担和其他因素进行调整.
主要成果:
- 在905,164例入院患者中,发现了1,708例MRSAHAI事件.
- 许多设施暂时暂停了预防实践,但后来恢复了.
- 虽然更简单的模型表明在停止治疗后MRSA的发病率更高,但在调整后的混合效应模型中,这些关联并不显著.
结论:
- 当考虑基线负担时,在大流行期间停止MRSA预防实践与HAI增加并不一致.
- 调查结果强调了在感染控制评估中,设施特定因素和建模假设的重要性.
- 没有测量到与流行病相关的做法可能影响了传播,强调需要灵活的,基于证据的感染预防政策.
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