汽化过氧化氢对降低病房多重耐药菌风险的研究-译文

slj19910811

An Evaluation of EnvironmentalDecontamination With Hydrogen Peroxide Vapor for Reducing the Risk of Patient Acquisition of Multidrug-Resistant Organisms

Background. Admission to a room previously occupied by a patient with certain multidrug-resistant organisms(MDROs) increases the risk of acquisition. Traditional cleaning strategies do not remove all environmental MDROs.We evaluated the environmental and clinical impact of hydrogen peroxide vapor (HPV) room disinfection.
Methods. We performed a 30-month prospective cohort intervention study on 6 high-risk units in a 994-bed tertiary care hospital. Following a 12-month preintervention phase, HPV was implemented on 3 units to decontaminate the rooms of patients known to be infected or colonized with epidemiologically important MDROs, following their discharge. Monthly environmental samples for MDROs were collected on all study units for 3 preintervention and 6 intervention months. The risk of MDRO acquisition in patients admitted to rooms decontaminated using HPV was compared with rooms disinfected using standard methods.
Results. The prior room occupant was known to be infected or colonized with an MDRO in 22% of 6350 admissions. Patients admitted to rooms decontaminated using HPV were 64% less likely to acquire any MDRO (incidence rate ratio [IRR], 0.36; 95% confidence interval [CI], .19–.70; P < .001) and 80% less likely to acquire VRE (IRR, 0.20;95% CI, .08–.52; P < .001) after adjusting for other factors. The risk of acquiring Clostridium difficile, methicillinresistant Staphylococcus aureus, and multidrug-resistant gram-negative rods individually was reduced, but not significantly.
The proportion of rooms environmentally contaminated with MDROs was reduced significantly on the HPV units (relative risk, 0.65, P = .03), but not on non-HPV units. Conclusions. HPV decontamination reduced environmental contamination and the risk of acquiring MDROs compared with standard cleaning protocols.

背景：被一个携带特定多重耐药菌感染的患者先前进入病房增加了探测的风险。传统的清洗方法不能清除环境中的所有多重耐药菌。我们评估了过氧化氢蒸汽房间灭菌的环境和临床效果。

方法：我们在一个拥有994个床位的三级护理医院对6个高风险单位进行了为期30个月的前瞻性干预研究。

经过12个月的干预前阶段，对属于流行病学上重要的多重耐药菌感染的或已经潜伏感染的患者出院后房间三个单元实施过氧化氢蒸汽灭菌。

结果：现住病房感染或者潜伏感染的患者为6350的22%，患者进入用HPV灭菌过的房间64%不可能感染任何的多重耐药菌（发病率，0.36,95%的置信区间P<0.001）以及调整其它参数之后80%不会感染耐万古霉素肠球菌（发病率0.02，95%置信区间，P<0.001）。感染艰难梭状芽胞杆菌、耐甲氧西林金黄色葡萄球菌以及多药耐药革兰阴性杆菌的风险降低，但不是很显著。在过氧化氢蒸汽灭菌的单元，多重耐药菌污染的房间比例明显降低（相对风险0.65，p=0.03），但是在非HPV单元却没有这种情况。

结论：相比于标准的清洗流程，HPV灭菌可以减少环境污染和感染多重耐药菌的风险。

最近医院有采购这种设备的需求，找了一些国外的文献询证，分享给各位老师看看，新技术 多多学习

感控雏鹰

似乎某次培训听倪晓平主任讲过这样的技术哦，非常不错，就是不知道成本如何

slj19910811

感控雏鹰 发表于 2016-12-21 16:10
似乎某次培训听倪晓平主任讲过这样的技术哦，非常不错，就是不知道成本如何

据说价格有点贵，一次性投入成本较高，不是三甲医院的 估计买不起

感控雏鹰

slj19910811 发表于 2016-12-21 16:28
据说价格有点贵，一次性投入成本较高，不是三甲医院的 估计买不起

其实，就算是三甲也很少买吧，医院都会考虑成本的，我们还没开始考虑这种器械呢，不过价钱合适效果好的话在ICU等重点科室倒是可以推广使用的