【作者】 张丽；

【导师】 黄国富；

【作者基本信息】 南昌大学 ， 社会医学与卫生事业管理， 2023， 硕士

【摘要】 目的:通过对南昌市某三甲医院的多重耐药菌医院感染患者病例资料和医务人员多重耐药菌医院感染防控知识调查问卷进行分析,了解多重耐药菌医院感染现状,调查医务人员院感防控知识的知晓率,调查医务人员的院感防控积极性及院感防控行为的依从性;根据所研究医院的多重耐药菌医院感染现状和医务人员的防控现状,提出对策建议,为医院感染管理人员提供参考。方法:采用回顾性分析法收集南昌市某医院2017～2021年医院感染实时监测系统中的多重耐药菌防控报卡,将院感人员查阅核实的多重耐药菌防控报卡数据手动输入Excel软件中,对多重耐药菌医院感染现状进行描述统计。采用问卷调查法对医务人员进行多重耐药菌医院感染防控知识调查,对院感防控调查问卷数据进行统计描述和分析。结果:(1)多重耐药菌医院感染现状:样本医院自2017年1月1日至2021年12月31日以来,共有208411名住院患者,其中有1686名住院患者医院感染多重耐药菌,年均发生率为0.81%,多重耐药菌医院感染率在2017～2021年间呈上升趋势,从2017年的0.39%到2021年的1.36%。感染人群中多为高龄、住院时间较长的患者。多重耐药菌医院感染发生率较高的科室有重症医学科(51.22%)、脑外科(8.33%)、急诊科(5.45%)和老年医学科(3.27%)。发生多重耐药菌医院感染的部位主要分布在下呼吸道(35.29%)、肺部(20.64%)和泌尿道(9.49%)。医院的目标监测菌检出率最高的是鲍曼/溶血不动杆菌(81.93%)。(2)医务人员多重耐药菌医院感染防控知识调查现状:共回收557份问卷,其中有效问卷550份,有效率为98.74%。根据调查结果显示,被调查者中女性413人,男性137人;年龄占比最高的是31～40年龄段,占比46.50%;被调查者中外科人数占比最多,为44.2%;66%的被调查者是本科学历;从业年限以11～20年居多,占总体的28%;被调查者中护理人员占54.20%。分析结果显示,医务人员的性别、年龄、从业年限、学历、岗位、培训次数及科室领导的重视程度均对防控知识得分差异统计上有显著性差异(P<0.05);医务人员的岗位、职称、培训次数和领导重视程度对防控态度得分差异有显著差异(P<0.05);医务人员的性别、年龄、科室、从业年限、学历、岗位、职称、培训次数及科室领导的重视程度均对防控行为得分差异统计上有显著差异(P<0.05)。结论:(1)该院多重耐药菌医院感染发生率呈上升趋势,可能与高龄、住院时间长、科室有关。为降低感染发生率,应该加强主动监测和重点科室监测,尤其是对重点人群的监测,加强对重点科室和重点人群环境的消毒频次,做到早发现,早诊断,早采取消毒隔离措施,减少医源性交叉感染的发生。(2)医务人员院感防控问卷得分差异性别、年龄、从业年限、学历、岗位、培训次数及科室领导的重视程度有关。加强对医务人员多重耐药菌医院感染知识宣传培训,并就宣传培训内容进行考核。通过提高医务人员的防控意识积极性,增强医务人员的责任心,提高医务人员的防控行为依从性,更好的提高医疗质量,最大程度的保护患者安全,减少医疗资源的消耗。(3)加强细节监控和细化工作流程。成立多学科合作的院感管理小组,定期或不定期的对临床科室进行督查,尤其是对防控措施落实的细节进行监控,对检查的情况进行季度总结与改进完善。细化工作流程,加强医务人员的防控措施执行的落实程度。更多还原

【Abstract】 Objective:By analyzing the case data of patients with nosocomial infection of multi-drug-resistant bacteria in a third-class A hospital in Nanchang City and the questionnaire on the knowledge and practice of nosocomial infection prevention and control of multi-drug-resistant bacteria among medical staff,the current situation of nosocomial infection of multi-drug-resistant bacteria,the awareness rate of medical staff on nosocomial infection prevention and control knowledge,the enthusiasm and compliance of medical staff on nosocomial infection prevention and control behavior were understood.According to the current situation of multidrug-resistant bacteria nosocomial infection in the study hospital and the prevention and control status of medical staff,countermeasures and suggestions were put forward to provide reference for hospital infection management personnel.Methods:The multi-drug-resistant bacteria prevention and control report card of a hospital infection real-time monitoring system in Nanchang City from 2017 to 2021 was collected by retrospective analysis method,and the data of the multi-drug-resistant bacteria prevention and control report card verified by hospital infected personnel were manually input into Excel software,and the status of multi-drug-resistant bacteria nosocomial infection was described and analyzed.Questionnaire survey was used to investigate the knowledge of prevention and control of hospital infection of multi-drug resistant bacteria among medical staff,and the questionnaire data of prevention and control of hospital infection were statistically described and analyzed.Results:(1)Nosocomial infection of multi-drug resistant bacteria: From January 1,2017 to December 31,2021,a total of 208,411 inpatients were hospitalized in sample hospitals,among which 1686 inpatients were infected with multi-drug resistant bacteria in hospital,with an average annual incidence of 0.81%.The nosocomial infection rate of multi-drug resistant bacteria showed an increasing trend from 2017 to 2021.From 0.39 percent in 2017 to 1.36 percent in 2021.Most of the infected people were elderly patients with a long hospital stay.The departments with high incidence of multidrug-resistant bacteria in hospital were intensive care(51.22%),brain surgery(8.33%),emergency department(5.45%)and geriatric medicine(3.27%).The main nosocomial infection sites of multidrug-resistant bacteria were lower respiratory tract(35.29%),pneumonia(20.64%)and urinary tract(9.49%).Baumann/Acinetobacter hemolyticus had the highest detection rate in the hospital(81.93%).(2)Investigation on knowledge of nosocomial infection prevention and control of multi-drug-resistant bacteria among medical staff: A total of 557 questionnaires were collected,among which 550 were effective,with an effective rate of 98.74%.According to the survey results,413 women and 137 men were surveyed.The age group from 31 to 40 was the highest,accounting for 46.50%.Among the respondents,the number of surgery accounted for the most,44.2%;66% of respondents had a bachelor’s degree;Most of them have worked for 11～20 years,accounting for 28% of the total.Nursing staff accounted for 54.20% of the respondents.The results showed that gender,age,years of employment,education,post,training times and department leaders’ attention had statistically significant differences in the scores of prevention and control knowledge(P<0.05).There were significant differences in the scores of medical staff’s position,professional title,training times and leaders’ attention on prevention and control attitude(P<0.05).Gender,age,department,years of employment,education,post,title,training times and department leaders’ attention had statistically significant differences in the scores of prevention and control behaviors(P<0.05).Conclusion:(1)The nosocomial infection rate of multidrug-resistant bacteria in this hospital showed an increasing trend,which may be related to old age and long hospital stay.In order to reduce the incidence of infection,it is necessary to strengthen the active surveillance and monitoring of key departments,especially the monitoring of key populations,and strengthen the frequency of disinfection in the environment of key departments and key populations,so as to achieve early detection,early diagnosis,early adoption of disinfection and isolation measures,and reduce the occurrence of iatrogenic cross infection.(2)Differences in hospital infection prevention and control questionnaire scores of medical staff were related to gender,age,years of employment,education,post,training frequency and department leaders’ attention.Strengthen the publicity and training of multi-drug resistant bacteria nosocomial infection knowledge for medical staff,and evaluate the content of publicity and training.By improving the awareness of prevention and control enthusiasm of medical staff,enhancing the sense of responsibility of medical staff,improving the compliance of prevention and control behavior of medical staff,better improving the quality of medical treatment,protecting the safety of patients to the greatest extent,and reducing the consumption of medical resources.(3)Strengthen the detail monitoring and refine the work process.Establish a multidisciplinary management team to supervise clinical departments regularly or irregularly,especially to monitor the details of the implementation of prevention and control measures,and to summarize and improve the inspection situation quarterly.Work procedures should be refined to strengthen the implementation of prevention and control measures for medical personnel.更多还原