| Objective:Based on the Diagnosis Related Groups(DRGs),the high-risk departments with multi-drug resistance Organism infection that need to be mainly managed and the disease types were identified,the infection change trend and the implementation of prevention and control measures in the high-risk departments with multi-drug resistance Organism infection were analyzed,the causes affecting the multi-drug resistance Organism infection were scientifically analyzed,and the targeted improvement scheme was formulated,in order to achieve the purpose of reducing the incidence of multi-drug resistance Organism infection in the high-risk departments through accurate sensing and control.。Methods:1.The Case Mix Index(CMI),an ability index of DRGs to evaluate medical service performance,was used to adjust the incidence of multi-drug resistance Organism infection in different departments of a tertiary general hospital in 2021,identify the high-risk departments with multi-drug resistance Organism infection(CMI was the lowest,and the incidence of multi-drug resistance Organism infection was the highest),and investigate and analyze the implementation of multi-drug resistance Organism infection prevention and control measures in this department from 2018 to 2021.2.For the projects with poor implementation effect of prevention and control measures in this high-risk department for MDRO infection,the root cause analysis(RCA)was used to scientifically analyze the problems existing in the management of multi-drug resistance Organism infection in this department,and improvement plans were formulated for the key elements such as hand hygiene,clean and disinfect environment,contact isolation,and use of antibacterial drugs.3.The Hospital Infection Management Department and multiple disciplines jointly pushed forward the implementation of the improvement plan.The implementation was divided into the baseline investigation period(January–April 2022),the intervention implementation period(May–August 2022)and the effect evaluation period(September–December 2022).The change trends of each monitoring index in the three stages were analyzed and compared,including hand hygiene compliance rate,hand hygiene correct rate,cotton swab sample positive rate,ATP bioluminescence detection sampling qualified rate,fluorescence labeling clearance rate,contact isolation measures implementation rate,antibacterial drug utilization rate and antibacterial drug utilization intensity.4.A piecewise regression model was constructed based on interrupted time series(ITS)to analyze the MDRO detection situation and the changing trend of MDRO infection in the high-risk department of MDRO infection before and after the intervention,so as to evaluate whether the targeted improvement program was effective in reducing the risk of MDRO infection in the department.Results:1.MDRO high risk departments and prevention and control status quoThe difference in the incidence of multi-drug resistance Organism infection among different departments after CMI adjustment was statistically significant(X~2=42.284,P<0.05).The respiratory critical illness that had the lowest CMI(2.54)and the highest incidence of multi-drug resistance Organism infection(1.54%)was considered as the high-risk department.From 2018 to 2021,the implementation rate of doctors’24-h contact isolation orders in this department was 63.47%.The compliance rate of medical staff on hand hygiene ranged from 45%to 70%,and the correct rate of hand hygiene implementation ranged from 70%to 100%.Fourteen kinds of 79 strains of pathogenic bacteria were isolated from the patients’surrounding environment and the surface of medical staff with high-frequency contact with objects,of which,Gram-negative bacteria accounted for 65.82%.The utilization rate of antibacterial drugs showed an increasing trend(β=0.207,P<0.05).The utilization intensity of antibacterial drugs(AUD)was decreased,but the decreasing trend was not significant(β=-0.634,P>0.05).There was no correlation between AUD and the incidence of multi-drug resistance Organism infection(r=0.059.P=0.829).2.Root cause analysis resultsIt was found that there were many problems in high-risk departments for MDRO infection(respiratory critical illness)from the aspects of hand hygiene,environmental cleaning and disinfection,contact isolation measures,and antibacterial drug use,and the targeted improvement programs were formulated from the following aspects,including:attaching great importance to the prevention and control of MDRO infection,and implementing the infection prevention and control training system for all employees;The ATP fluorescence detection method and video surveillance were used to monitor the hand hygiene of medical staff,and the monitoring results were fed back to the department timely and regularly.Improve the cleaning and disinfection equipment,improve the terminal disinfection method,the use of ATP fluorescence detection method and fluorescence labeling method to carry out real-time evaluation of the environmental cleaning and disinfection effect of the cleaning work in place;Multi-disciplinary assistance for respiratory critical illness was provided to optimize patient treatment options and incorporate clinicians’antimicrobial use into performance appraisals.3.Change results of different monitoring indicators in the three periods before and after interventionDuring the baseline investigation,the compliance rate of hand hygiene was 53.44%,and the correct rate was 92.86%.Among 20 cotton swab samples sent for examination,19were positive in the test,with the positive rate of 95%;Of the 64 samples detected by ATP bioluminescence assay,11 were qualified,with the qualified rate of 17.19%;92 fluorescent marks and 32 removal marks,and the removal rate is 34.78%;The utilization rate of antibacterial drugs was 97.37%,and the utilization intensity of antibacterial drugs was 167.41 DDDs/100 person-days,respectively.During the implementation of intervention,the compliance rate and correct rate of hand hygiene were 54.65%and 93.65%,respectively.Among 30 cotton swab samples sent for examination,29 were positive in the test,with the positive rate of 96.67%;Among 64 samples detected by ATP bioluminescence assay,41 were qualified,with the qualified rate of 64.06%;92 fluorescent marks and 74 removal marks,and the removal rate is 80.43%;The utilization rate of antibacterial drugs was 98.70%,and the utilization intensity of antibacterial drugs was 163.58DDDs/100 person-days,respectively.In the effect evaluation stage,the compliance rate of hand hygiene was 57.75%,and the correct rate was 92.68%.Among 25 cotton swab samples sent for examination,13 were positive in the test,with the positive rate of 52%;Of the 64 samples detected by ATP bioluminescence assay,29 were qualified,with the qualified rate of 45.31%;92 fluorescent markers and 66 fluorescent markers were removed,and the removal rate was 71.74%.The utilization rate of antibacterial drugs was 91.97%,and the utilization intensity of antibacterial drugs was 139.83DDDs/100 person-days.The increasing trend of hand hygiene compliance rate in the three periods was statistically significant(Z=6.720,P<0.05),while the changing trend of hand hygiene correct rate was not statistically significant.The compliance rate and correct rate of hand hygiene before contacting patients in the three periods were the lowest in different hand hygiene opportunities,but they were increased in the intervention implementation period compared with those in the baseline investigation period.The positive rate of cotton swab samples and the change trend were statistically significant(Z=7.639,P<0.05).Common conditional pathogens are Enterococcus faecalis,Staphylococcus haemolyticus,Acinetobacter baumannii,etc.The change trend of the qualified rate of ATP bioluminescence test samples was statistically significant(Z=10.342,P<0.05).The change trend of the clearance rate of fluorescent markers in the working environment was statistically significant(Z=12.805,P<0.05).The implementation rates of contact isolation measures(Z=5.304,P<0.05),the correct use of isolation gown(Z=6.447,P<0.05),and the correct use of protective equipment(Z=6.775,P<0.05)were statistically significant.The downward trend of the utilization rate of antibacterial drugs was statistically significant(Z=9.030,P<0.05),while the downward trend of the utilization intensity of antibacterial drugs was not statistically significant(β=-3.613,P>0.05).4.ITS analysis resultsThe detectable rates of MDRO in the three periods were 80.85%,56.36%and 61.64%,respectively,and the downward trend was statistically significant(Z=10.967,P<0.05).The constructed stepwise regression model for MDRO detection rate was Y_t=0.352-0.046T_t+0.044X_t+0.050T_tX_t;The incidences of MDRO nosocomial infection in the three periods were 12.37%,9.69%,and 6.67%,respectively,and the downward trend was statistically significant(Z=3.976,P<0.05).The constructed stepwise regression model for the number of MDRO infection cases was Y_t=5.700+0.200T_t-0.167X_t-0.580T_tX_t;The results of the two models indicated that the MDRO detection rate and the incidence of MDRO infection cases had a downward trend after the targeted improvement program established by root cause analysis was implemented.Conclusion:DRGs standardized the disease diagnosis,complexity of diagnosis and treatment,and disease severity of cases in different departments,scientifically and objectively evaluated the incidence of MDRO infection in different departments by CMI,and accurately identified high-risk departments that needed key management.Through the investigation and analysis,it was found that there were many deficiencies in the implementation of prevention and control measures for MDRO infection,and continuous improvement was needed.The high incidence of MDRO infection in patients of high-risk departments for MDRO infection(respiratory critical illness)during the diagnosis and treatment is mostly related to the long duration of invasive mechanical ventilation and the use of antibacterial drugs.The application of RCA can accurately identify and master the key and difficult points in the management of respiratory critical MDRO infection.After the targeted improvement program was implemented,there was a significant change trend in each monitoring index for MDRO infection prevention and control,indicating that the intervention measures were effective,which effectively improved the implementation rate of MDRO infection prevention and control measures,and reduced the detection rate of MDRO infection and the incidence rate of MDRO infection cases to a certain extent.The application of DRGs performance evaluation index in MDRO infection management of will bring new thinking to MDRO infection management,break the thinking of"being dynamically controlled",proactively identify the weak points of MDRO infection prevention and control,and achieve meticulous management and accurate sensory control. |
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