Antimicrobial stewardship (AMS) is an important means to control bacterial resistance. The unique situation of intensive care unit (ICU) poses a challenge to AMS. This article reviews the literature on AMS in the ICU at home and abroad in recent years, and summarizes the related measures of AMS. Effective AMS measures in the ICU include setting up a multidisciplinary AMS team, using rapid microbial diagnosis technology to shorten the time of diagnosis, using non-culture methods to assess the necessity of antimicrobial therapy for patients with suspected sepsis, and evaluating the effectiveness of antimicrobial therapy as early as possible and optimizing it. These initiatives aim to increase the rational use of antimicrobials in ICU, reduce the risk of multidrug-resistant infections, and improve patients’ condition.
Objective To explore the clinical effect of failure mode and effect analysis (FMEA) combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU. Methods In January 2020, a risk assessment team was established in the Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, to analyze the possible risk points of MDRO infections in ICU from then on. FMEA was used to assess risks, and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections. The causes of the high-risk points were analyzed, and improvement measures were formulated to control the risks through PDCA cycle management model. The incidence of healthcare-associated MDRO infections in ICU, improvement of high-risk events, and satisfaction of doctors and nurses after the implementation of intervention measures (from January 2020 to June 2021) were retrospectively collected and compared with those before the implementation of intervention measures (from January 2018 to December 2019). Results Six high-risk factors were screened out, namely single measures of isolation, unqualified cleaning and disinfection of bed units, irrational use of antimicrobial agents, weak consciousness of isolation among newcomers of ICU, weak awareness of pathogen inspection, and untimely disinfection. The incidence of healthcare-associated MDRO infections was 2.71% (49/1800) before intervention and 1.71% (31/1808) after intervention, and the difference between the two periods was statistically significant (χ2=4.224, P=0.040). The pathogen submission rate was 56.67% (1020/1800) before intervention and 61.23% (1107/1808) after intervention, and the difference between the two periods was statistically significant (χ2=7.755, P=0.005). The satisfaction rate of doctors and nurses was 75.0% (30/40) before intervention and 95.0% (38/40) after intervention, and the difference between the two periods was statistically significant (χ2=6.275, P=0.012). Conclusions FMEA can effectively find out the weak points in the prevention and treatment of MDRO infections in ICU, while PDCA model can effectively formulate improvement measures for the weak points and control the risks. The combined application of the two modes provides a scientific and effective guarantee for the rational prevention and treatment of MDRO infections in ICU patients.
ObjectiveTo optimize procedures of going out for examination for patients with multidrug-resistant organism, strengthen prevention and control management of nosocomial infection, and prevent nosocomial infection.MethodsPatients with multidrug-resistant organism who went out for examination were selected from April to November 2018. April to July 2018 (before implementation) was process construction stage, and August to November 2018 (after implementation) was process optimization implementation stage. In April 2018, process and management system of going out for multidrug-resistant organism patients were formulated, training of transporters was strengthened, and measures such as checklist identification, accompany patients for examination, patient handover, isolation and protection, and disinfection of materials were implemented, to realize the infection prevention and control management in the whole process of going out for multidrug-resistant organism patients. We compared relevant indicators before and after implementation.ResultsA total of 262 cases times of patients with multidrug-resistant organism were included, including 134 cases times before implementation and 128 cases times after implementation. Compared with before implementation, the hand hygiene, wearing gloves, disinfection of inspection instruments and articles, patient transfer, isolation measures in waiting process (special elevator, isolation after waiting for inspection, arrange inspection time reasonably), education and training after implementation improved(P<0.05). Before and after implementation, the Methicillin resistant staphylococcus aureus detection rate difference was statistically significant (P<0.05).ConclusionsThe optimization of procedures of examination for patients with multidrug-resistant organism can increase implementation rate of indirect indicators such as hand hygiene, disinfection of inspection instruments and articles, isolation and protection, education and training in the prevention and control of multidrug-resistant organism in nosocomial infection. And it is important for the prevention and control of multi-disciplinary collaboration of multidrug-resistant organism.
Objective To explore the source and distribution of patients with multidrug resistant organisms (MDROs) acquired (infections/colonizations) outside the hospital and to provide a reference for guiding proactive interventions for nosocomial transmission of MDROs. Methods Bacterial culture results and clinical data of patients newly admitted to Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospita1 were retrospectively investigated between January 1st 2022 and December 31st 2023. The types of MDROs infections/colonizations, patient sources, and triple distributions of patients with nosocomial acquisition of MDROs were analyzed. Results A total of 293 patients with 308 infections/colonizations were investigated in the extranocomial infection of MDROs, 198110 newly admitted patients during the same period, and the total case rate of extranocomial infection of MDROs was 0.155% (308/198110). Among them, the case rate of extranocomial infection of methicillin-resistant Staphylococcus aureus (0.062%) and carbapenem resistant Acinetobacter baumannii (0.044%) were higher than those of other types of bacteria. The case rate of extranocomial infection of MDROs was statistically significant in terms of the distribution of the route of admission, gender of the patient, age of the patient, department of admission, and time of admission (P<0.001); The distribution of patients with extranocomial infection of various types of MDROs was correlated with admission route, patient age, and admission department (P<0.001), and the associations with patient gender and admission time were not statistically significant (P>0.05). Conclusions The total case rate of extranocomial infection of MDROs in the institution was at a relatively low level, and conducting large-scale active screening has certain limitations. Active screening factors should be considered in a comprehensive manner to capture differences in epidemiological characteristics of patients with extranocomial infection of MDROs, and targeted prevention and intervention should be carried out to achieve a reduction in infections from MDROs in hospitals.
Objective To evaluate the effect of ECRS management model on the quality of prevention and control of hospital infection with multidrug-resistant organisms (MDROs). Methods The data related to the prevention and control of MDROs in the First Hospital of Nanchang in 2020 and 2021 were retrospectively collected. The hospital implemented routine MDRO infection prevention and control management in accordance with the Expert Consensus on the Prevention and Control of Multi-drug Resistant Bacteria Nosocomial Infection in 2020. On this basis, the hospital applied the four principles of the ECRS method to cancel, combine, rearrange and simplify the MDRO infection prevention and control management. The detection rate of MDROs on object surfaces, the incidence rate of hospital infection of MDROs, the compliance rate of hand hygiene, the implementation rate of contact isolation prevention and control measures, and the pass rate of MDRO infection prevention and control education assessment were analyzed and compared between the two years. Results The detection rate of MDROs on the surfaces in 2021 was lower than that in 2020 (9.39% vs. 31.63%). The hospital-acquired MDRO infection rate in 2021 was lower than that in 2020 (1.18% vs. 1.46%). The hand hygiene compliance rates of medical staff, workers and caregivers in 2021 were higher than those in 2020 (90.99% vs. 78.63%, 73.51% vs. 45.96%, 70.96% vs. 33.71%). The implementation rate of contact isolation prevention and control measures in 2021 was higher than that in 2020 (93.31% vs. 70.79%). The qualified rates of MDRO infection prevention and control education in medical personnel, workers and caregivers in 2021 were higher than those in 2020 (96.57% vs. 81.31%, 76.47% vs. 47.95%, 73.17% vs. 34.19%). All the differences above were statistically significant (P<0.05). Conclusion ECRS management mode can improve the execution and prevention level of MDRO hospital infection prevention and control, and reduce the incidence of MDRO hospital infection.
Liver transplantation is a most curative treatment for end-stage liver diseases. However, postoperative infection, especially the multi-drug resistant organisms infection, could contribute to the mortality after liver transplantation. Therefore, how to identify and prevent multi-drug resistant bacterial infection is the key to achieve improved postoperative outcomes after liver transplantation. The team of West China Hospital of Sichuan University, in collaboration with multiple Chinese medical centers, draw on the mature experiences of advanced countries in the field of transplantation jointly formulated the “Multicenter expert consensus on prevention and treatment of infections caused by multi-drug resistant organisms after liver transplantation”. The consensus had been developed around aspects such as epidemiological characteristics, antimicrobial uses, and prevention measurements of multi-drug resistant bacterial infection after liver transplantation.
ObjectiveTo evaluate the efficiency of hydrogen peroxide vapor (HPV) in disinfecting multidrug-resistant organisms (MDROs).MethodsWe searched Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database for before-after studies or case-control studies or cohort studies evaluating efficiency of HPV and published from January 2010 to December 2020 (the time range was from January 2000 to December 2020 in the snowball searching). RevMan 5.4 and R 4.0.2 softwares were used for meta-analysis.ResultsA total of 9 studies were included, consisting of 8 before-after studies and 1 cohort study. Six studies evaluated positive rate of environmental samplings, meta-analysis revealed that HPV combined with manual cleaning disinfected the environment efficiently [relative risk (RR)=0.03, 95% confidence interval (CI) (0.01, 0.08), P< 0.000 01] and HPV was more efficient than manual cleaning [RR=0.04, 95%CI (0.02, 0.10), P< 0.000 01]. Three studies evaluated the hospital-acquired MDROs colonization/infection rates, and the results of the 3 studies were consistent, revealing that HPV could reduce hospital-acquired MDROs colonization/infection rates.ConclusionHPV is efficient in reducing MDROs contaminated surfaces and hospital-acquired infection rate.
Objective To investigate the changes of multidrug-resistant organisms (MDROs) in the First People’s Hospital of Longquanyi District of Chengdu around its overall relocation. Methods The First People’s Hospital of Longquanyi District of Chengdu was overall relocated on December 31st, 2016. The detection rates of MDROs and the changes in nosocomial infections before the relocation (from 2015 to 2016) and after the relocation (from 2017 to 2020) were retrospectively analyzed. Results A total of 83634 qualified specimens were submitted for inspection, 8945 strains of pathogenic bacteria were detected, and the detection rate of pathogenic bacteria was 10.70%, showing an increasing trend in yearly detection rates of pathogenic bacteria (χ2trend=8.722, P=0.003); among them, 1551 MDRO strains were detected, and the detection rate of MDROs was 17.34%, showing an increasing trend in yearly detection rates of MDROs (χ2trend=11.140, P=0.001). The detection rate of pathogenic bacteria before relocation was lower than that after relocation, and the difference was statistically significant (9.64% vs. 11.08%; χ2=35.408, P<0.001); there was no significant difference in the detection rate of MDROs before and after relocation (16.32% vs. 17.66%; χ2=2.050, P=0.152). From 2015 to 2020, the detection rates of pathogenic bacteria from sputum+throat swab specimens (χ2trend=81.764, P<0.001) and secretion+pus specimens (χ2trend=56.311, P<0.001) showed increasing trends, while the detection rates of pathogenic bacteria from blood specimens (χ2trend=110.400, P<0.001), urine specimens (χ2trend=11.919, P=0.001), and sterile body fluid specimens (χ2trend=20.158, P<0.001) showed decreasing trends. The MDRO detection rates of Escherichia coli (χ2trend=21.742, P<0.001), Staphylococcus aureus (χ2trend=47.049, P<0.001), and Pseudomonas aeruginosa (χ2trend=66.625, P<0.001) showed increasing trends, while the MDRO detection rates of Klebsiella pneumoniae (χ2trend=2.929, P=0.087) and Acinetobacter baumannii (χ2trend=0.498, P=0.481) showed no statistically linear trend, but the MDRO detection rate of Acinetobacter baumannii dropped significantly in 2017. In the targeted monitored MDROs, the proportions of nosocomial infections in methicillin-resistant Staphylococcus aureus (χ2trend=4.581, P=0.032), carbapenem-resistant Enterobacteriaceae (χ2trend=8.031, P=0.005), and carbapenem-resistant Pseudomonas aeruginosa (χ2trend=6.692, P=0.010) showed decreasing trends; there was no statistically linear trend in the proportion of nosocomial infections in carbapenem-resistant Acinetobacter baumannii (χ2trend=0.597, P=0.440); only one strain of vancomycin-resistant Enterococcus was detected in 2017, and no nosocomial infection occurred. Conclusions The overall detection rate of pathogenic bacteria and MDROs in this tertiary general hospital around relocation showed increasing trends year by year. The detection rate of pathogenic bacteria after relocation was higher than that before relocation, but the detection rate of MDROs after relocation did not differ from that before relocation. The proportion of nosocomial infections among the targeted monitored MDROs decreased.
ObjectiveTo analyze epidemic characteristics of multidrug-resistant organism (MDRO) in Neurosurgical Intensive Care Unit (NSICU), and to analyze the status of infection and colonization, in order to provide reference for constituting intervention measures. MethodsPatients who stayed in NSICU during January 2014 to April 2015 were actively monitored for the MDRO situation. ResultsA total of 218 MDRO pathogens were isolated from 159 patients, and 42 cases were healthcare-associated infections (HAI) among 159 patients. The Acinetobacter baumannii was the most common one in the isolated acinetobacter. Colonization rate was positively correlated with the incidence of HAI. From January to December, there was a significantly increase in the colonization rate, but not in the incidence of HAI. ConclusionThe main MDRO situation is colonization in NSICU. The obvious seasonal variation makes the HAI risk at different levels. So it is necessary that full-time and part-time HAI control staff be on alert, issue timely risk warning, and strengthen risk management. The Acinetobacter baumannii has become the number one target for HAI prevention and control in NSICU, so their apparent seasonal distribution is worthy of more attention, and strict implementation of HAI prevention and control measures should be carried out.
ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.