手卫生和环境卫生到底那个更重要？

石桥wshh1975

谷子 发表于 2014-6-15 17:05
非常好的资料，关于手卫生与环境卫生哪个更重要一直是感控界争论的热点，其实把他们作为一个Bundles来进 ...

Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants.
Datta R1, Platt R, Yokoe DS, Huang SS.
Author information
Abstract
BACKGROUND:
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40% increased risk of acquisition, presumably through environmental contamination. Subsequently, a cleaning intervention was shown to reduce MRSA and VRE room contamination. We now evaluate the effect of this intervention on the risk of acquiring MRSA and VRE from prior room occupants.
METHODS:
We conducted a retrospective cohort study of patients admitted to 10 intensive care units at a 750-bed academic medical center during the enhanced cleaning intervention (from September 1, 2006, through April 30, 2008; n = 9449) vs baseline (from September 1, 2003, through April 30, 2005; n = 8203) periods. The intervention consisted of targeted feedback using a black-light marker, cleaning cloths saturated with disinfectant via bucket immersion, and increased education regarding the importance of repeated bucket immersion during cleaning. Intensive care units included medical, cardiac, burn/trauma, general surgery, cardiac surgery, thoracic surgery, and neurosurgery units. We calculated the number of room stays involving the potential for MRSA and VRE acquisition and then assessed the frequency at which eligible patients were exposed to rooms in which the prior occupants had MRSA-positive or VRE-positive status.
RESULTS:
Acquisition of MRSA and VRE was lowered from 3.0% to 1.5% for MRSA and from 3.0% to 2.2% for VRE (P < .001 for both). Patients in rooms previously occupied by MRSA carriers had an increased risk of acquisition during the baseline (3.9% vs 2.9%, P = .03) but not the intervention (1.5% vs 1.5%, P = .79) period. In contrast, patients in rooms previously occupied by VRE carriers had an increased risk of acquisition during the baseline (4.5% vs 2.8%, P = .001) and intervention (3.5% vs 2.0%, P < .001) periods.
CONCLUSIONS:
Enhanced intensive care unit cleaning using the intervention methods may reduce MRSA and VRE transmission. It may also eliminate the risk of MRSA acquisition due to an MRSA-positive prior room occupant.

月光依旧

石桥wshh1975 发表于 2014-5-26 17:22
从辩证法和矛盾论的角度来看，矛盾双方会转变的。当环境卫生和手卫生都处于低水平时，说哪个更重要意义不大 ...

老师这样的总结更准确。感谢老师分享！

医大一院

谢谢分享，挺不错的，学习了新的知识。