独立清洁单元消毒模式在重症监护病房医院感染防控中的应用研究

发布时间：2018-01-13 11:46

本文关键词：独立清洁单元消毒模式在重症监护病房医院感染防控中的应用研究　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对ICU环境物体表面的清洁消毒质量以及医院感染现状进行调查,了解目前ICU医院感染及其风险环节、MDRO感染(或定植)与传播、环境清洁消毒模式等方面较为突出的问题,以循证医学为依据,改进ICU环境清洁消毒与管理措施,在ICU实施独立清洁单元模式,并采用新的环境清洁消毒效果监测方法,探讨新型环境清洁消毒模式在ICU医院感染防控中的作用。以期提高环境清洁消毒质量,降低医院感染率,保障ICU人员安全,为卫生行政部门制订行业规范标准提供依据。方法:2016年1月-2016年12月在ICU实施独立清洁单元消毒模式的综合干预措施,包括:培训ICU医务人员,尤其是保洁工人,掌握新的环境清洁消毒模式;重视并增加手高频接触物表的清洁消毒频次,使用清洁、消毒、去污一步完成的一次性医用消毒湿巾擦拭消毒手高频接触物表;全部采用超细纤维材质的抹布和可拆卸式拖地巾;加强手卫生管理,提高手卫生依从性;专用洗衣机处置用后的抹布、地巾,使用机械清洗-热力消毒-机械烘干一步完成,使洁具AO值大于600;难清洁消毒的物表实施屏障覆盖保护,减少污染及传播,如可浸泡清洗消毒的键盘、鼠标等;采用物表采样细菌培养计菌落数、荧光标记和目标菌监测相结合的方法,监测和评价环境清洁消毒质量;做好生活区高频接触物体表面的清洁与消毒。对比干预前后物表采样、荧光标记、目标菌监测、手卫生依从性、医院感染率。采用卡方检验,采用SPSS 18.0进行统计分析。P0.05为差异有统计学意义。结果:通过细菌培养计数菌落数、荧光标记及目标菌监测消毒效果评价方法,得出独立清洁单元消毒方法干预后,菌落计数合格率由干预前56.79%提高到86.47%,目标菌MDR-Ab检出率由干预前30.86%下降至6.03%,荧光标记清除率由干预前41.00%提高至80.17%,手卫生依从性由干预前66.06%提高至82.83%,ICU医院感染率由8.59%下降至6.52%,P0.05,差异有统计学意义。结论:遵循独立清洁单元的清洁消毒模式实施集束化的环境物表清洁消毒措施,可有效提高环境物表请洁消毒质量,降低多重耐药菌的检出率,控制医院感染发生率,提高医务人员手卫生的依从性。说明实施独立清洁单元消毒模式能有效预防与控制ICU医院感染。
[Abstract]:Objective: to investigate the quality of cleaning and disinfection on the surface of ICU environmental objects and the present situation of nosocomial infection in order to understand the nosocomial infection and its risk link of ICU infection (or colonization). On the basis of evidence-based medicine, the environmental cleaning disinfection and management measures of ICU were improved, and the independent cleaning unit model was implemented in ICU. In order to improve the quality of environmental cleaning and disinfection and reduce the nosocomial infection rate, a new environmental cleaning and disinfection monitoring method was used to explore the role of new environmental cleaning and disinfection mode in the prevention and control of ICU nosocomial infection. Ensure the safety of ICU personnel. Methods: from January 2016 to December 2016, comprehensive intervention measures of independent cleaning unit disinfection model were carried out in ICU. Including: training ICU medical personnel, especially cleaning workers, to master the new environmental cleaning and disinfection mode; Attach importance to and increase the frequency of cleaning and disinfection of hand high frequency contact table, use clean, sterilize, decontamination one step complete disposable medical disinfectant wet towel wipe disinfection hand high frequency contact table; All adopt the dishcloth of superfine fiber material and detachable type floor towel; Strengthening hand hygiene management and improving hand hygiene compliance; Special washing machine after disposal of wipes, floor towels, using mechanical cleaning-thermal disinfection-mechanical drying one step to complete, so that the AO value of sanitary ware greater than 600; Difficult to clean and disinfect the surface to implement barrier coverage protection, reduce pollution and spread, such as immersion cleaning disinfection keyboard, mouse and so on; The quality of environmental cleaning and disinfection was monitored and evaluated by the methods of surface sampling bacterial culture count, fluorescence labeling and target bacteria monitoring. Cleaning and disinfecting the surfaces of objects exposed to high frequency in living area were done well. Surface sampling, fluorescent labeling, monitoring of target bacteria, hand hygiene compliance and nosocomial infection rate were compared before and after intervention. Chi-square test was used. Using SPSS 18.0 statistical analysis. P0.05 as the difference was statistically significant. Results: count the number of bacteria by bacterial culture, fluorescent labeling and target bacteria monitoring disinfection evaluation method. The results showed that the qualified rate of colony count increased from 56.79% to 86.47% after the intervention of independent cleaning unit disinfection method. The detection rate of target bacteria MDR-Ab decreased from 30.86% to 6.03 and the fluorescence labeling clearance rate increased from 41.00% to 80.17% before intervention. Hand hygiene compliance increased from 66.06% before intervention to 82.83 ICU nosocomial infection rate decreased from 8.59% to 6.52 (P0.05). Conclusion: following the cleaning and disinfection mode of independent cleaning unit can effectively improve the quality of environmental surface cleaning and disinfection by implementing cluster cleaning and disinfection measures. To reduce the detection rate of multidrug resistant bacteria, to control the incidence of nosocomial infection, and to improve the compliance of medical staff in hand hygiene, it is concluded that the implementation of independent cleaning unit disinfection mode can effectively prevent and control ICU nosocomial infection.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

【参考文献】