本文關(guān)鍵詞：獨立清潔單元消毒模式在重癥監(jiān)護(hù)病房醫(yī)院感染防控中的應(yīng)用研究　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 重癥監(jiān)護(hù)室 獨立清潔單元 高頻接觸物體表面 清潔與消毒 醫(yī)院感染

【摘要】：目的:通過對ICU環(huán)境物體表面的清潔消毒質(zhì)量以及醫(yī)院感染現(xiàn)狀進(jìn)行調(diào)查,了解目前ICU醫(yī)院感染及其風(fēng)險環(huán)節(jié)、MDRO感染(或定植)與傳播、環(huán)境清潔消毒模式等方面較為突出的問題,以循證醫(yī)學(xué)為依據(jù),改進(jìn)ICU環(huán)境清潔消毒與管理措施,在ICU實施獨立清潔單元模式,并采用新的環(huán)境清潔消毒效果監(jiān)測方法,探討新型環(huán)境清潔消毒模式在ICU醫(yī)院感染防控中的作用。以期提高環(huán)境清潔消毒質(zhì)量,降低醫(yī)院感染率,保障ICU人員安全,為衛(wèi)生行政部門制訂行業(yè)規(guī)范標(biāo)準(zhǔn)提供依據(jù)。方法:2016年1月-2016年12月在ICU實施獨立清潔單元消毒模式的綜合干預(yù)措施,包括:培訓(xùn)ICU醫(yī)務(wù)人員,尤其是保潔工人,掌握新的環(huán)境清潔消毒模式;重視并增加手高頻接觸物表的清潔消毒頻次,使用清潔、消毒、去污一步完成的一次性醫(yī)用消毒濕巾擦拭消毒手高頻接觸物表;全部采用超細(xì)纖維材質(zhì)的抹布和可拆卸式拖地巾;加強手衛(wèi)生管理,提高手衛(wèi)生依從性;專用洗衣機處置用后的抹布、地巾,使用機械清洗-熱力消毒-機械烘干一步完成,使?jié)嵕逜O值大于600;難清潔消毒的物表實施屏障覆蓋保護(hù),減少污染及傳播,如可浸泡清洗消毒的鍵盤、鼠標(biāo)等;采用物表采樣細(xì)菌培養(yǎng)計菌落數(shù)、熒光標(biāo)記和目標(biāo)菌監(jiān)測相結(jié)合的方法,監(jiān)測和評價環(huán)境清潔消毒質(zhì)量;做好生活區(qū)高頻接觸物體表面的清潔與消毒。對比干預(yù)前后物表采樣、熒光標(biāo)記、目標(biāo)菌監(jiān)測、手衛(wèi)生依從性、醫(yī)院感染率。采用卡方檢驗,采用SPSS 18.0進(jìn)行統(tǒng)計分析。P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:通過細(xì)菌培養(yǎng)計數(shù)菌落數(shù)、熒光標(biāo)記及目標(biāo)菌監(jiān)測消毒效果評價方法,得出獨立清潔單元消毒方法干預(yù)后,菌落計數(shù)合格率由干預(yù)前56.79%提高到86.47%,目標(biāo)菌MDR-Ab檢出率由干預(yù)前30.86%下降至6.03%,熒光標(biāo)記清除率由干預(yù)前41.00%提高至80.17%,手衛(wèi)生依從性由干預(yù)前66.06%提高至82.83%,ICU醫(yī)院感染率由8.59%下降至6.52%,P0.05,差異有統(tǒng)計學(xué)意義。結(jié)論:遵循獨立清潔單元的清潔消毒模式實施集束化的環(huán)境物表清潔消毒措施,可有效提高環(huán)境物表請潔消毒質(zhì)量,降低多重耐藥菌的檢出率,控制醫(yī)院感染發(fā)生率,提高醫(yī)務(wù)人員手衛(wèi)生的依從性。說明實施獨立清潔單元消毒模式能有效預(yù)防與控制ICU醫(yī)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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R47

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