耐甲氧西林金黄色葡萄球菌感染控制的长期结果及改善方法与问题解决

T. Ayabe, M. Tomita, I. Takajo, Yukishi Nakayama, Ryo Maeda, M. Okumura, Kunihide Nakamura
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摘要

背景:耐甲氧西林金黄色葡萄球菌(MRSA)导致住院时间延长,费用增加,患者预后较差。本研究的目的是:1)调查我院外科病房MRSA爆发和预防的短期结果;2)评估7年感染控制经验的长期结果;3)报告采用行业问题解决方法进行质量改进干预对根除新发MRSA患者的有效性。方法:对2009年4月至2019年10月我院外科病房感染控制及预防措施改善情况进行回顾性分析。测量了用于手部卫生的每日酒精使用量(ml/患者/天),并调查了每月MRAS新患者的发生率。我们采用行业问题解决方法作为感染控制的改善措施,根除外科病房发生的一种新的耐甲氧西林金黄色葡萄球菌。结果:用于手部卫生的酒精使用量的增加与MRSA新发患者数量的减少呈负相关。在长期结果中,酒精使用量逐渐减少,偶尔观察到MRSA患者;这些事实表明,保持严格的感染控制是困难的。通过使用问题解决方法,2018年6月至2018年12月连续7个月无新发MRSA患者。然而,一旦用于手部卫生的酒精用量降至40 ml/患者/天以下,则检测到3例新的MRSA患者。研究显示,为了手部卫生而减少的酒精使用量与MRSA新患者数量的增加呈负相关。结论:日常监测和测量手卫生酒精使用量,了解当前MRSA新发患者数量将成为有意义的工具。通过用解决问题的方法进行改善,将有助于多专业团队可视化感染控制质量改进的过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-Term Outcome of Infection Control for Methicillin-Resistant Staphylococcus aureus and Kaizen Approach with Problem-Solving
Background: Methicillin-resistant Staphylococcus aureus (MRSA) results in longer hospitalization, increased expenses, and poorer patient prognosis. The aim of this study is 1) to investigate the short-term outcome of MRSA outbreak and the prevention in our surgical ward, and 2) to evaluate the long-term outcome of a 7-year experience of infection control, and 3) to report the effectiveness of intervention of quality improvement by industry problem-solving method for the eradication of a new occurrence of MRSA patients. Methods: Between April 2009 and October 2019, we retrospectively studied the improvement activity for infection control and preventative measures in our surgical ward. The daily alcohol use for hand hygiene was measured (ml/patient/day) and the monthly number of occurrences of new MRAS patients was investigated. We used the industry problem-solving method as the Kaizen of infection control for the eradication of a new Methicillin-resistant Staphylococcus aureus occurrence in the surgical ward. Results: There was an inverse correlation between the increased amount of alcohol use for hand hygiene and the decreased number of new MRSA patients. In the long-term outcome, the amount of alcohol use has gradually decreased and the MRSA patients have been occasionally observed; these facts should display the difficulty to maintain a strict infection control. By the use of the problem-solving method, there continued for 7 months no new MRSA patients between June 2018 and December 2018. However, once the amount of alcohol use for hand hygiene decreased below 40 ml/patient/day, three new MRSA patients were detected. It displayed an inverse correlation between the decreased amount of alcohol use for hand hygiene and the increased number of new MRSA patients. Conclusion: The daily monitoring and measuring of the amount of alcohol use for hand hygiene and to know the current number of new occurrence of MRSA patients will become a meaningful tool. By performing the Kaizen with a problem-solving method, it will contribute to the multi-professional team to visualize the process of quality improvement for infection control.
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