传统的感染控制措施被发现在减少MRSA感染率方面有效

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转中国医院感染管理网杨忠保老师的日志

Conventional Infection Control Measures Found Effective in Reducing MRSA Rates

03/20/2010

Scientists at the Virginia Commonwealth University Medical Center found a compliance with non-pathogen specific infection control practices such as hand hygiene, efforts to reduce device-related infections and chlorhexidine bathing, is successful for reducing rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA). The findings were presented at the Fifth Decennial International Conference on Healthcare-Associated Infections.

In an effort to reduce MRSA rates, some states have mandated active surveillance programs for patients admitted to hospitals.  However these programs remains controversial, with critics pointing to its expense, tying scarce infection prevention resources to one pathogen and the potential for adverse outcomes when patients who test positive are placed in isolation with reduced contact with healthcare personnel.  

Beginning in 2004, the medical center instituted a series of non-pathogen specific initiatives to reduce HAIs including an increasingly aggressive hand hygiene program, a central line bundle, a ventilator bundle and chlorhexidine bathing of all adult ICU patients and a recommendation for bare below the elbows, along with compliance monitoring and feedback via unit-specific posters.  Active surveillance cultures were not performed.

During this time, Michael Edmond, MD, MPH, MPA, and colleagues observed a 91 percent reduction in MRSA central line associated bloodstream infections, a 62 percent reduction in MRSA catheter-associated urinary tract infections and a 92 percent reduction in MRSA ventilator associated pneumonia.  These outcomes were observed in a 16-bed medical ICU, 18-bed surgical ICU and 14-bed neuroscience ICU.

Edmond cautioned this is an observational study using data from a single medical center and was observed in the ICU. Other healthcare facilities may have different results.   

"This study demonstrates that a broad focus on implementation of evidenced-based practices designed to reduce all healthcare-associated infections is effective at reducing MRSA infections, and will likely have a more beneficial impact on overall patient outcomes," said Neil Fishman, MD, president of SHEA.  These study findings are consistent with guidelines for infection prevention and control in healthcare settings.

The Society for Healthcare Epidemiology of America (SHEA), the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology (APIC), Inc. and the Infectious Diseases Society of America (IDSA) are convening the Fifth Decennial International Conference on Healthcare-Associated Infections 2010, the scientific event to set the agenda for preventing healthcare-associated infections for the next decade March 18-22, 2010 in Atlanta.



传统(常规)的感染控制措施被发现在减少MRSA感染率方面有效

二零一零年三月二十日

美国弗吉尼亚联邦大学医学中心的科学家找到了一个非特定病原体的感染控制措施，诸如遵守手部卫生，减少设备有关感染的努力和洗必泰沐浴，能成功降低医疗保健相关的耐甲氧西林金黄色葡萄球菌（MRSA）感染率。该项研究报告发表在第五届医疗保健相关感染十年国际会议上。

为降低MRSA发生率，一些国家还规定对入院病人实施积极的监测计划。然而，这些项目仍然存在争议，批评者指出其费用昂贵，将预防感染的稀缺资源用于某个病原体，而且将检验时呈阳性的病人隔离安置，使其与医护人员接触减少，存在潜在的不良后果。

从2004年开始，该医疗中心建立了一系列非病原体特异的具体措施，以减少HAIs，包括日益积极的手部卫生计划，中央静脉插管、机械通气的一揽子感染控制措施和给所有成人ICU病人用洗必泰洗澡，并建议医务人员肘部以下裸露，以及对遵守情况进行监测并反馈到具体部门。主动监测培养（ASC）没有执行。

在此期间，Michael Edmond, MD, MPH, MPA和同事发现，中央静脉导管相关血液MRSA感染降低91%，导管相关尿路MRSA感染减少62%， MRSA呼吸机相关性肺炎减少92%。这些成果是在16张病床的医疗病房，18张病床的外科ICU和14张病床的神经重症监护病房观测到的。

爱德蒙警告这是一个观察性的研究，使用的数据来自一个单纯的医学中心，并在加护病房观察。其他医疗机构可能有不同的结果。

“这项研究表明，实施基于循证医学的感控措施，旨在减少所有医疗保健相关感染的做法，可有效减少MRSA感染，并可能对所有患者的治疗效果产生更为有利的影响”，Neil Fishman, MD, SHEA主席说。这些研究结果同医疗机构感染预防和控制指南是一致的。

2010年3月18号至22号， 美国医疗保健机构流行病学学会（SHEA），疾病控制和预防中心（CDC）的感染控制及流行病学专业协会（APIC），有关公司和美国传染病学会（IDSA）正在亚特兰大召开2010年第五届医疗保健相关感染十年国际会议，为未来10年防止医疗保健相关感染确定议程。

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