文摘大家译：接触和飞沫预防对发生院内耐甲氧西林金黄色葡萄球菌感染的效果

潮水

Infect Control Hosp Epidemiol 2007;28:1261-1266
Impact of Contact and Droplet Precautions on the Incidence of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection
Ed Mangini, RN, MPH, CIC; Sorana Segal-Maurer, MD; Janice Burns, RN, CIC; Annette Avicolli, PharmD; Carl Urban, PhD; Noriel Mariano, MS; Louise Grenner, BA; Carl Rosenberg, PhD; James J. Rahal, MD

OBJECTIVE.     To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.

DESIGN.     Before-after study.

SETTING.     A 439-bed, university-affiliated community hospital.

METHODS.     To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, "non-ICU areas"), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed.

RESULTS.     The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P = .03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P = .43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P = .02).

CONCLUSION.     The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.

青暮

近这篇文章一直没人翻译～我就先抛砖引玉一下吧～～献丑了～～
目的：评估接触和飞沫预防对减少医院获得性耐甲氧西林金黄色葡萄球菌（MRSA）感染的效果。
计划：前后对照研究。
设定对象：一所439张床位的某大学附属社区医院。
方法：
      对临床培养的金黄色葡萄球菌进行监测，由医院临床微生物实验室对其进行处理以鉴定MRSA定植或感染住院病人。接着，我们查阅所有检出MRSA病人的病例。将接受标准护理的各个病区的医院获得性MRSA感染率制成表。一个基准期以后，在所有重症监护区（ICUs）施行接触和飞沫预防。ICUs内医院获得性MRSA感染率的减少使非ICU病人监护区（后称“非ICU区”）也施行了接触预防。中断飞沫的预防。对不同干预期的医院获得性MRSA感染率进行比较分析。
结果：
      在内科ICU和外科ICU，医院获得性MRSA感染的合并率为每1000个住院日有10.0例感染。而在其他ICU则为每1000个住院日有0.7例感染。在施行飞沫和接触预防之后，MICU和SICU内MRSA感染的合并率减少至每1000个住院日有4.3例（95%置信区间，0.17-0.97；p=.03）。但在其他ICUs医院获得性MRSA感染率无显著变化。在中断飞沫的预防施行以后，MICU和SICU内其合并率进一步下级至每1000个住院日有2.5例。但这个发现无显著意义（p=.43）。另外，在其他医院获得性MRSA感染发生率高的非ICU，施行接触预防前其发生率为1.3例/1000住院日。施行预防后比率下降到0.9例/1000住院日（95%置信区间，0.47-0.94；p=.02）。
结论：
      接触预防的实施能显著减低医院获得性MRSA的感染率，在ICUs内中断飞沫的预防措施可导致感染率进一步降低。进一步的研究，评价具体的感染控制策略是必要的。

莲雾

究证明接触预防对减低医院获得性MRSA感染率的重要性。