規范ICU多重耐藥菌感染病人接觸隔離的循證護理實踐

Standardize contact isolation of patients infected with multidrug-resistant bacteria in ICU：an evidence-based nursing practice

JING Yao，LIU Dan，JIANG Zhuojuan，PENG FeiShanghai Changzheng Hospital，Shanghai 200003 ChinaCorresponding Author PENG Fei，E-mail：675025715@qq.com

Abstract Objective：To improve the contact isolation management level and best evidence implementation ability of medical staff in intensive care units （ICUs） and reduce the incidence of multidrug-resistant bacteria hospital infection in ICUs.

Methods：Evidence-based nursing methods were used to obtain the best evidence， and the review indicators for contact isolation management of patients with multidrug-resistant bacteria were formulated and used for continuous quality improvement in clinical practice. The incidence of multidrug-resistant bacteria hospital infection in ICUs before and after the application of evidence and the knowledge and implementation of medical staff on contact isolation of patients with multidrug-resistant bacteria were compared. Results：A total of 21 quality review indicators were formulated in this study. After applying the best evidence， the theoretical knowledge score of multidrug-resistant bacteria contact isolation of ICU medical staff increased from （73.49±6.50） points to （92.88±6.27） points. The compliance with contact isolation measures was greatly improved， and the implementation rate of 13 review indicators increased to more than 88%， with statistically significant differences （Plt;0.05）. The infection rate of multidrug-resistant bacteria hospital in ICU decreased from 3.2% to 1.9%.Conclusions：Applying the best evidence based on evidence in clinical practice will help promote the implementation of contact isolation control measures for patients infected with multidrug-resistant bacteria in the ICU， improve the theoretical knowledge and practical level of medical staff， and reduce the incidence of multidrug-resistant bacteria hospital infection in the ICU.

Keywords multidrug-resistant bacteria;contact isolation;evidence-based nursing;intensive care unit

摘要 目的：提高重癥監護病房（ICU）醫護人員接觸隔離管理水平及最佳證據執行能力，降低ICU多重耐藥菌醫院感染發生率。方法：運用循證護理方法獲取最佳證據，制定多重耐藥菌感染病人接觸隔離管理審查指標并用于臨床進行持續質量改進，比較證據應用前后ICU多重耐藥菌醫院感染發生率、醫護人員對多重耐藥菌感染病人接觸隔離相關知識知曉情況及執行情況。結果：本研究形成21條質量審查指標，應用最佳證據后，ICU醫護人員多重耐藥菌接觸隔離理論知識評分由（73.49±6.50）分提高到（92.88±6.27）分；接觸隔離措施依從性大幅提升，13條審查指標執行率提升至88%以上，差異均有統計學意義（Plt;0.05），ICU多重耐藥菌醫院感染率從3.2%降低至1.9%。結論：將基于循證的最佳證據應用于臨床，有助于推進ICU多重耐藥菌感染病人接觸隔離管控措施落實，提升醫護人員理論知識及實踐水平，降低ICU多重耐藥菌醫院感染發生率。

關鍵詞 多重耐藥菌;接觸隔離;循證護理;重癥監護病房

doi：10.12102/j.issn.2095-8668.2024.13.007

多重耐藥菌（multidrug-resistant organisms，MDRO）主要是指對臨床應用的3類或3類以上抗菌藥物同時耐藥的細菌［1］。2018年世界衛生組織全球抗微生物藥物耐藥性監測系統顯示，22個國家均存在細菌耐藥情況，多重耐藥已經成為全球共同面臨的公共衛生問題［2］。MDRO感染導致的感染性休克、重癥監護病房（intensive care unit，ICU）入院、器官衰竭和病死率較非MDRO感染者更高［3-7］，給治療、護理及醫院感染預防與控制帶來了極大的挑戰［8］，嚴重影響醫療質量和病人安全［9］。ICU病人通常免疫力低下，年齡較大且基礎疾病嚴重，是醫院感染的高發群體［10-12］。……