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MRSA感染预防指南概要（APIC）
医院感染即病人在医疗保健机构获得的感染。耐甲氧西林金黄色葡萄球菌（ MRSA）是医院感染中最常见的多重耐药菌。MRSA感染，使病人的发病率、死亡率和住院费用增加而引起广泛关注。
美国CDC统计报告，1972年，金黄色葡萄球菌的医院感染中MRSA感染只占20%，现在MRSA感染占到60%以上。该MRSA感染的死亡率估计比SA高2.5倍。
对55个研究报告进行分析后的结论是，治疗一般的医院感染，费用为13973美元，而治疗MRSA的医院感染为35367美元。
MRSA构成的威胁，再怎么强调也不过分。针对此，APIC组织感染控制专家，在循证的基础上，制定了该干预计划，以防止MRSA的医院内传播。
MRSA感染传播预防计划
一、MRSA感染的风险评估
感染控制小组整理医院既往收集的MRSA流行病学监测数据，为MRSA感染的监测做准备。
二、MRSA的监视计划
根据风险评估和微生物实验室的MRSA检验结果，制定一个监视计划，确定具体的目标，行动/干预措施，并定期评价反馈。
三、手卫生
落实手卫生工作。经常洗手或使用含酒精手消与手套。凡是可能接触病人的人都纳入管理。如医护人员、工人、陪护等。
四、接触预防措施
一旦证实病人被MRSA感染或定植，或者设备，用品和病人的环境检出MRSA污染。立刻把MRSA感染病人置单人房和使用手套及防护衣等其他预防措施，以避免MRSA传播到其他病人或环境中。
五、环境和设备的清洁卫生
由于MRSA能够在体外存活长达56天之久，病历夹，桌面与布窗帘都是常见的定植部位。教育环境保洁人员执行正确的清洗程序非常关键。
六、开展目标监测
医院应对所有住院病人或MRSA感染/定植高危人群进行目标监测。高危人群包括：长期监护病人、经常住院病人、透析患者、运动员？？、兽医？？、ICU留置过的病人、静脉给药患者。
迅速甄别MRSA感染病人，实施隔离与干预措施，防止扩散。其中包括：隔离、接触预防、消除定植、及时治疗，以进一步减少MRSA的传播。
要成功的控制MRSA感染，时间是关键因素。因为快速检测技术为尽早采取预防措施和及时治疗提供了帮助，可以减少传染源和并发症的危险。
七、改变医院文化
APIC建议，要成功的实施该防控计划，医院必须认识到，医院获得性MRSA感染或定植首先是一个文化问题的探讨。医院必须在这个层面理解和加以正视。
Summary of MRSA Prevention Guidelines from the Association for Professionals inInfection Control and Epidemiology (APIC)
Healthcare-Associated Infections (HAIs) are infections that patients acquire while under the care of a healthcare institution. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common HAI and a multi-drug resistant organism. MRSA infections increase patient morbidity, mortality and hospital costs. Of note:
In 1972, MRSA accounted for only two percent of all Staphylococcus aureus HAIs reported to the Centers for Disease Control and Prevention (CDC). Today, MRSA accounts for more than 60 percent of Staphylococcus aureus infections.
The MRSA death rate has been estimated to be more than 2.5 times higher than infections from Staphylococcus aureus that are susceptible to methicillin
An analysis of 55 studies concluded that the cost of a MRSA HAI was $35,367 compared with $13,973 for a HAI. The threat posed by MRSA cannot be overstated. Responding to this crisis faced by U.S. hospitals, the Association for Professionals in Infection Control and Epidemiology (APIC), an international organization representing more than 11,000 infection control experts, released an institutional guide of evidence-based, step-by-step instructions for developing and implementing a
program to eliminate MRSA transmission in a hospital.
This summarizes components APIC recommends in a MRSA-transmission prevention program:
MRSA risk assessment
o Using past and current hospital surveillance data, this provides the infection control team with
epidemiological MRSA data that directs development of a plan for MRSA surveillance,
prevention and control.
MRSA surveillance program
o The surveillance program is based on risk assessment data, and outlines specific goals,
actions/interventions, and evaluations. These include a consistent and comprehensive retrieval
system for lab culture reports, collaborating with Microbiology Laboratory staff regarding
specifics of MRSA testing, and communicating MRSA surveillance results to healthcare
providers.
Hand hygiene
o Proper hand hygiene, involving gloves and frequent hand-washing or alcohol-based hand rubs, must include all levels of healthcare providers and other workers having patient contact.
Contact precautions
o Implemented once patients are confirmed to be colonized or infected with MRSA; extends to
contaminated equipment, supplies and the patient’s environment. These include placing MRSApatients in private rooms and the use of gloves and gowns and other precautions to avoid
transfer of microorganisms to other patients or environments.
Proper environmental and equipment cleaning and decontamination
o Educating environmental and housekeeping staff on proper cleaning procedures is critical
because MRSA can survive outside the human body for up to 56 days on patient charts,
tabletops and cloth curtains.
Targeted active surveillance cultures (ASC)
o Depending on the hospital, this approach may involve testing of patients at high-risk for MRSA
colonization or infection, or all patients being admitted to a hospital (ie, universal ASC). “Highrisk”
groups include:
Long-term care residents
Patients with recent or frequent hospitalizations
Dialysis patients
Athletes
Veterinarians
Those with a history of incarceration
History of IV drug use
o Prompt identification of MRSA colonized patients and initiation of proper interventions preventing
MRSA-associated infections, including
Isolation
Contact precautions
Decolonization, and treatment to minimize further MRSA transmission
o Timing is a critical factor in successful infection control because rapid detection allows sooner
implementation of proper precautions and treatment, minimizing risks of complications and
transmission.
Cultural transformation
o Hospital-acquired MRSA infection or colonization is first and foremost a cultural problem of the
hospital and must be addressed at that level. To accomplish a successful program, APIC
recommends encouraging participation and support from all staff at all levels and tapping into the
staff’s knowledge concerning the hospital culture.
o When change comes from within an organization, as when staff members create solutions,
cultural change is appropriate and lasting. Identification of staff with distinctive practices, that
allow them to discover better solutions than their peers, will lead to better solutions for improving
the program.
Involving hospital administration
o Leadership support from hospital administration is crucial to any MRSA prevention program.
APIC recommends presenting success stories from other institutions to hospital leadership to
strengthen the case for requested interventions and resources, as well as providing hospital
leadership with:
Barriers or inadequate processes contributing to MRSA transmission risk
Prevalence and incidence rates of MRSA
Identification of any increasing trends
Current financial burden of facility’s hospital-associated infection
Relevant published data
o Cost is one of the most common problems in efforts to prevent and control MRSA. Reasons
given by administration include:
Additional supplies required for isolating patients (gowns, gloves)
Additional costs associated with isolating patients
Additional expenses from high-priced antibiotics
o It is important to demonstrate to administrators that costs of the intervention can indeed be less than the cost of not adopting a MRSA control program.
[ 本帖最后由 胡杨 于 2008-3-7 17:09 编辑 ]
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发表于 2008-3-7 13:32:00
发表于 2008-3-7 13:32:01
