Study on prevention and control effect of carbapenem resistant Gram-negative bacilli in geriatric ward based on transparent supervision model_West China Medical Journal

Authors：

ZUO Yan ¹ , LIU Jing ² ,  CHEN Yanan ²

1. Department of Nursing Management, the First People’s Hospital of Lianyungang, Lianyungang, Jiangsu 222061, P. R. China;
2. Department of Infection Management, the First People’s Hospital of Lianyungang, Lianyungang, Jiangsu 222061, P. R. China;

Corresponding author：

CHEN Yanan, Email: 297769987@qq.com

Keywords：

Old age; transparent supervision; carbapenem resistant Gram-negative bacilli; effect

DOI：

10.7507/1002-0179.202401013

Video：

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Objective To explore the prevention and control effect of carbapenem resistant Gram-negative bacillus (CRO) in geriatric ward based on transparent supervision model. Methods Patients admitted to the geriatric ward in the First People’s Hospital of Lianyungang between January 2018 and December 2022 were selected. A transparent regulatory model for CRO was established and implemented in 2019, including the establishment of a regulatory group, the development of cluster prevention and control measures, the implementation of transparent reminder, publicity, supervision and assessment and other management measures. We evaluated the effectiveness by comparing the detection rate and infection rate of CRO before and after the intervention. Results A total of 15015 patients were monitored, and a total of 418 strains of CRO were detected. The incidence rate of noso-comial infection was decreasing year by year（χ²=26.666, P<0.001), and the etiological submission rate of hospitalized patients before antimicrobial treatment had been increasing year by year（χ²=280.320, P<0.001). The detection rate of CRO infection had been decreasing year by year, but the difference was not statistically significant (P>0.05), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia infection (P=0.030). The detection rate of CRO had been decreasing year by year (χ²=33.593, P<0.001), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia (χ²=23.663, P<0.001) and carbapenem resistant Pseudomonas aeruginosa (χ²=14.527, P=0.006).Conclusions By establishing and promoting transparent supervision mode in the geriatric ward, the detection rate and infection rate of drug-resistant bacteria can be significantly reduced, and the prevention and control effect of CRO in the elderly patients in the ward can be effectively improved to ensure the safety of elderly patients.

Citation： ZUO Yan, LIU Jing, CHEN Yanan. Study on prevention and control effect of carbapenem resistant Gram-negative bacilli in geriatric ward based on transparent supervision model. West China Medical Journal, 2024, 39(3): 387-391. doi: 10.7507/1002-0179.202401013 Copy

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24.	Gómez-Zorrilla S, Camoez M, Tubau F, et al. Prospective observational study of prior rectal colonization status as a predictor for subsequent development of Pseudomonas aeruginosa clinical infections. Antimicrob Agents Chemother, 2015, 59(9): 5213-5219.
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1. Guidelines for the prevention and control of carbapenem-resistant enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017.
2. 许川, 赖晓全, 徐敏, 等. 多学科协作管理模式提高住院患者抗菌药物治疗前病原学送检率的应用效果. 中华医院感染学杂志, 2023, 33(21): 3321-3326.
3. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
4. 胡付品, 郭燕, 朱德妹, 等. 2021 年 CHINET 中国细菌耐药监测. 中国感染与化疗杂志, 2022, 22(5): 521-530.
5. 乔甫, 宗志勇. 世界卫生组织《医疗机构耐碳青霉烯的肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌防控指南》介绍. 华西医学, 2018, 33(3): 259-263.
6. 殷希, 杜鑫, 杨诗汝, 等. 美英两国医疗领域透明监管制度对我国合理用药监管的启示. 医学与社会, 2014, 27(9): 11-14.
7. 郑晓菲, 张新平, 赖晓全, 等. 基于德尔菲法的医院感染公开指标研究. 中国医院管理, 2016, 36(5): 59-61.
8. 梁艳芳, 赖晓全, 谭莉. 透明监管在医院感染管理中的应用研究. 中华医院感染学杂志, 2020, 30(1): 135-140.
9. 黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 2015, 14(1): 1-9.
10. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 8(5): 314-320.
11. 杨欣雨, 王惠, 吕宇, 等. 2018-2022 年四川省医院医院感染现况调查. 中华医院感染学杂志, 2023, 33(21): 3201-3206.
12. Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
13. 吴安华. 医院感染控制当前面临的严峻挑战及对策. 华西医学, 2019, 34(3): 227-232.
14. 李颖, 许文, 戈伟, 等. 提高多重耐药菌防控措施执行力对降低多重耐药菌医院感染的影响. 中国感染控制杂志, 2017, 16(2): 126-129.
15. Rosenthal MB. Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med, 2007, 357(16): 1573-1575.
16. Hansen S, Schwab F, Zingg W, et al. Process and outcome indicators for infection control and prevention in European acute care hospitals in 2011 to 2012 – results of the PROHIBIT study. Euro Surveill, 2018, 23(21): 1700513.
17. 刘卫平, 海云婷, 郭天慧, 等. 老年患者医院感染现状调查及病原菌耐药分析. 中华医院感染学杂志, 2018, 28(11): 1645-1649.
18. 臧凤, 张永祥, 刘波, 等. 重症监护病房老年患者多药耐药菌的感染分布与来源分析. 中华医院感染学杂志, 2020, 30(6): 866-871.
19. 陈惠刚, 李桂艳, 马微. 老年下呼吸道感染铜绿假单胞菌的病原学特征分析. 中国病原生物学杂志, 2024, 19(1): 74-78.
20. Chu VT, Tsitsiklis A, Mick E, et al. The antibiotic resistance reservoir of the lung microbiome expands with age. Res Sq, 2023: rs. 3. rs-3283415.
21. 尹丹萍, 徐茂云, 朱田田, 等. 某医院老年患者多重耐药菌感染临床分布特点. 中国消毒学杂志, 2023, 40(8): 585-587.
22. 全国细菌耐药监测网. 全国细菌耐药监测网 2014—2019 年老年患者常见临床分离细菌耐药性监测报告. 中国感染控制杂志, 2021, 20(2): 112-123.
23. 刘娜, 王娜娜, 纪冰, 等. 2012—2021 年住院老年患者感染病原菌分布及耐药趋势. 山东大学学报(医学版), 2023, 61(6): 29-40, 46.
24. Gómez-Zorrilla S, Camoez M, Tubau F, et al. Prospective observational study of prior rectal colonization status as a predictor for subsequent development of Pseudomonas aeruginosa clinical infections. Antimicrob Agents Chemother, 2015, 59(9): 5213-5219.
25. Le Guern R, Grandjean T, Stabler S, et al. Gut colonisation with multidrug-resistant Klebsiella pneumoniae worsens Pseudomonas aeruginosa lung infection. Nat Commun, 2023, 14(1): 78.
26. Madden GR, Sifri CD. Antimicrobial resistance to agents used for Staphylococcus aureus decolonization: is there a reason for concern? Curr Infect Dis Rep, 2018, 20(8): 26.
27. Song X, Soghier L, Floyd TT, et al. Reassessing the need for active surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the neonatal intensive care population. Infect Control Hosp Epidemiol, 2018, 39(12): 1436-1441.

West China Medical Journal

Study on prevention and control effect of carbapenem resistant Gram-negative bacilli in geriatric ward based on transparent supervision model

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