Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms_West China Medical Journal

Authors：

SUN Rui ¹ ,  CHEN Liping ¹ , XIAO Yaxiong ² , WANG Mingqun ³ , LEI Xibing ¹ , TAN Muyang ¹ , TANG Yan ¹

1. Office of Hospital Infection Management, the First People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;
2. Department of Laboratory, the First People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;
3. Department of Pharmacy, the First People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;

Corresponding?author：

CHEN Liping, Email: 1837639492@qq.com

Keywords：

Multi-disciplinary team management mode; Management of multidrug-resistant organisms; Practice; Continuous improvement

DOI：

10.7507/1002-0179.201901150

Video：

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Objective To explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).Methods In 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.Results The detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ²=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ²=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.Conclusion The MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.

Citation： SUN Rui, CHEN Liping, XIAO Yaxiong, WANG Mingqun, LEI Xibing, TAN Muyang, TANG Yan. Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms. West China Medical Journal, 2019, 34(3): 256-261. doi: 10.7507/1002-0179.201901150 Copy

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10.	王媛媛, 孫穎, 林錦彥, 等. 多學科協作提高健康管理質量控制水平的研究. 中華健康管理學雜志, 2015, 9(4): 316-317.
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1. Günther F, Kaiser SJ, Fries T, et al. Susceptibility of multi-drug resistant clinical pathogens to a chlorhexidine formulation. J Prev Med Hyg, 2015, 56(4): E176-E179.
2. 中華人民共和國國家衛生健康委員會. 衛生部辦公廳關于加強多重耐藥菌醫院感染控制工作的通知(衛辦醫發〔2008〕130號). (2008-06-27) [2019-01-20]. http://www.nhfpc.gov.cn/zwgk/wtwj/201304/caa37dae8bde44bc9a42dd10aeb9ff43.shtml.
3. 顧忠民, 吳榮華. PCT 在 ICU 多重耐藥菌 MDR 的定植與感染鑒別中的應用. 中國醫藥科學, 2012, 2(11): 90-91.
4. Schuetz P, Albrich WC, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med, 2011, 9: 107.
5. 孫吉花, 于蘇國, 陳曉琳, 等. 多學科協作模式在醫院感染預防控制中的應用及管理. 中華醫院感染學雜志, 2010, 20(17): 2639-2641.
6. 魏瑛琪, 關純, 邱蔓, 等. 多學科協作與多部門聯動預防控制多藥耐藥菌醫院感染. 中華醫院感染學雜志, 2011, 21(12): 2595-2596.
7. 黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1): 1-9.
8. 中華人民共和國國家衛生和計劃生育委員會辦公廳. 國家衛生計生委辦公廳關于印發麻醉等 6 個專業質控指標(2015 年版)的通知. (2015-03-31) [2019-01-20]. http://www.nhfpc.gov.cn/yzygj/s3585/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
9. 葛芳, 黃麗晴, 毛美琴. 多重耐藥菌感染的危險因素與防控措施. 中國消毒學雜志, 2017, 34(3): 292-294.
10. 王媛媛, 孫穎, 林錦彥, 等. 多學科協作提高健康管理質量控制水平的研究. 中華健康管理學雜志, 2015, 9(4): 316-317.
11. 嵇曉紅, 劉春湘, 陳嫣紅, 等. 多學科協作模式在多重耐藥菌醫院感染控制中應用的效果觀察. 重慶醫學, 2013, 42(19): 2254-2256.
12. 雷曦兵, 黃薇, 陳麗萍, 等. 某三級甲等綜合醫院 2013 年–2015 年多重耐藥菌監測情況分析. 華西醫學, 2017, 32(3): 334-338.
13. 中華人民共和國國家衛生和計劃生育委員會合理用藥專家委員會, 全國細菌耐藥監測網. 2015 年全國細菌耐藥監測報告. 中國執業藥師, 2016, 13(3): 3-8.
14. 李耘, 呂媛, 薛峰, 等. 中國細菌耐藥監測研究 2013 至 2014 年非發酵革蘭陰性菌監測報告. 中華檢驗醫學雜志, 2016, 39(2): 130-138.
15. 肖淑珍, 徐桂婷, 方潔, 等. 鮑曼不動桿菌耐藥性與抗菌藥物使用情況的相關性分析. 中國感染與化療雜志, 2013, 13(6): 446-449.
16. 中華人民共和國國家衛生和計劃生育委員會. 抗菌藥物臨床應用管理辦法(衛生部令第 84 號). (2012-04-24) [2019-01-20]. http://www.moh.gov.cn/mohyzs/s3584/201205/54645.shtml.
17. 中華人民共和國國家衛生和計劃生育委員會辦公廳, 國家中醫藥管理局, 解放軍總后勤部衛生部藥品器材局. 關于印發抗菌藥物臨床應用指導原則(2015 年版)的通知. (2015-07-24)[2019-01-20]. http://www.gov.cn/xinwen/2015-08/27/content_2920799.htm.
18. 中華人民共和國國家衛生和計劃生育委員會辦公廳. 國家衛生計生委辦公廳關于進一步加強抗菌藥物臨床應用管理遏制細菌耐藥的通知(國衛辦醫發〔2017〕10 號). (2017-02-27)[2019-01-20]. http://www.nhfpc.gov.cn/yzygj/s7659/201703/d2f580480cef4ab1b976542b550f36cf.shtml.
19. 雷曦兵, 陳麗萍, 肖亞雄, 等. 某三級甲等醫院實施多重耐藥防控干預效果研究. 華西醫學, 2016, 31(3): 406-413.

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Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms

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