感控認證可以降低MRSA比率


  【24drs.com】根據發表於3月美國感染控制期刊的研究,就加州當地的醫院而言,如果醫院感控主任獲得委員會認證,則其抗methicillin金黃色葡萄球菌(MRSA)血液感染率顯著較低。
  
  紐約市哥倫比亞大學護理學院Monika Pogorzelska博士等人,在2010年4-6月調查了加州的醫院,當時是加州強制感染率報告生效、且加州開始要求針對MRSA篩檢後一年多。
  
  研究者與感控專業人員暨流行病學協會(APIC)邀請了331所非專科急診照護醫院參與,203所(61%)完成部份調查;這篇由加州藍盾基金會資助的研究,目標是探討強制報告對於感染預防和院內感染的影響。
  
  研究者調查了相關的照護特徵結構,例如病床數與教學狀態,照護過程如病患住院和預定隔離時的篩檢,以及結果方面,2010年第一季的MRSA和抗vancomycin腸菌(VRE)之血液感染(BSI)率,和難治梭狀芽孢桿菌感染率。他們也調查感控主任是否獲得感控與流行病學委員會(CBIC)認證、是否為美國健康照護流行病協會或APIC會員。
  
  203所回應醫院中,180所(54%)回答了多重抗藥性有機體(MDRO)的問題,91所醫院提供了MRSA BSI比率(平均值為:0.43 MRSA BSI/1000中心導管使用天數)與VRE BSI (平均值為:0.21 VRE BSI/1000中心導管使用天數)。至於C difficile,105所醫院提供了感染率(中位數為:0.41例感染/1000住院天數)。
  
  略超過半數醫院(51.2%)報告指出,感控主任有獲得委員會認證,大部分醫院(89.7%)報告指出,該主任是其中一個協會的會員。
  
  有感控委員會認證主任的醫院,MRSA BSI比率顯著低於感控主任沒有委員會認證的醫院(發生率比率[IRR]為0.32;P = .02)。同樣地,參加健康照護促進活動之醫院的MRSA BSI比率顯著低於沒有參與的醫院(IRR,0.30;P = .01)。
  
  控制照護特徵等因素的多變項分析中,為所有因MRSA住院之病患篩檢的醫院,IRR是未如此執行之醫院的10.2倍。反之,為新住院病患進行MRSA篩檢的醫院,MRSA BSI比率顯著低於沒有此策略的醫院(IRR,0.03;P = .01)。
  
  研究者寫道,在我們的研究中,有獲得感控認證的感控主任是降低MRSA BSI比率的重要獨立因子,作者們認為,這些差異可能是採用實證實務或更好的組織品質或支持的結果。
  
  幾乎所有醫院(97.2%)報告指出,他們在住院時蒐集了監測型培養分析MDRO,大部分是來自護理之家(77.8%)、加護病房(72.8%)、透析室(63.3%)或30天內再度住院者(75.6%),此外,36所醫院(20%)報告指出,除了生產之外,所有住院者都搜集監測性培養。
  
  約29%的醫院報告指出,住院時為所有病患篩檢MRSA,但是其中多數(87.3%)表示針對護理之家(96.0%)、加護病房(86.8%)、透析者(76.8%)、與再住院者(89.4%)。少數醫院指出,住院時針對VRE (6.7%)或C difficile (3.9%)篩檢,可能是因為加州法規僅針對MRSA。
  
  多數醫院指出,有相關規定限制與MRSA (93.3%)、VRE (65%)或C difficile (83.9%)等陽性病患接觸,不過,大部分用來偵測MRSA採用的是標準式培養,在1-3天內可獲得結果。
  
  研究者寫道,因為僅少數醫院表示對等待結果的病患使用推定隔離或接觸預防措施,只有在培養結果陽性時才進行隔離,住院時篩檢的實用性大打折扣。
  
  研究確認,87%的加州醫院有篩檢MRSA政策,高於之前的研究結果,不過,在報告與篩檢要求、機構與醫院政策執行等之間有所差異。
  
  作者們寫道,結果可能有取樣偏差,因為感控程度高且院內感染率低的醫院,可能更會參加這次研究,此外,另一個限制是缺乏所有醫院的資料。
  
  不過,研究者結論表示,這篇研究強調,感控認證是院內相關感染率的重要預測因子,也顯示出,繼續將重點放在對MRSA感染控制部門的政策制定,可能對國家規範有所影響。
  
  根據CBIC,全球超過4,900人獲得感控認證。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6784&x_classno=0&x_chkdelpoint=Y
  

Infection Control Certification May Lower MRSA Rates

By Larry Hand
Medscape Medical News

April 10, 2012 — California hospitals appear to have significantly lower rates of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection if their infection control directors are board-certified, according to a study published in the March issue of the American Journal of Infection Control.

Monika Pogorzelska, PhD, MD, from the Columbia University School of Nursing in New York City, and colleagues surveyed California hospitals between April and June 2010, which was more than a year after California mandatory reporting of infection rates went into effect and after California required targeted MRSA screening.

Of 331 nonspecialty acute care hospitals invited to participate by the researchers and the Association for Professionals in Infection Control (APIC) and Epidemiology, 203 (61%) completed some part of the survey. The objective of the study, funded by the Blue Shield of California Foundation, was to investigate the effect of mandatory reporting on the role of infection preventionists and healthcare-acquired infections.

The researchers asked about structure of care characteristics such as bed size and teaching status, processes of care such as screening of patients on admission and presumptive isolation, and outcomes, including the MRSA and vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) rates and Clostridium difficile infection rates for the first quarter of 2010. They also asked whether the infection control directors were certified by the Certification Board of Infection Control and Epidemiology (CBIC) and were members of either the Society for Healthcare Epidemiology of America or APIC.

Of the 203 respondents, 180 (54%) answered questions in the multidrug-resistant organisms (MDRO) section, and 91 hospitals provided rates for MRSA BSI (mean, 0.43 MRSA BSI/1000 central line-days) and VRE BSI (mean, 0.21 VRE BSI/1000 central line-days). For C difficile, 105 hospitals provided infection rates (median, 0.41 infections/1000 inpatient days).

Slightly more than half of the hospitals (51.2%) reported that the infection control director was board-certified, and most hospitals (89.7%) reported that the director was a member of 1 of the associations.

Hospitals that had a board-certified infection control director had significantly lower MRSA BSI rates compared with hospitals that did not have a board-certified infection control director (incidence rate ratios [IRR], 0.32; P = .02). Similarly, hospitals that participated in an Institute for Healthcare Improvement campaign had significantly lower MRSA BSI rates than those that did not participate (IRR, 0.30; P = .01).

In multivariate analyses that controlled for structure of care characteristics, hospitals that screened all patients at admission for MRSA had an IRR 10.2 times higher than hospitals that did not have this policy. Conversely, hospitals with policies to target MRSA screening for new admissions had significantly lower MRSA BSI rates compared with hospitals without the policy (IRR, 0.03; P = .01).

"In our study, having an infection control director who was certified in infection control was a significant independent predictor of lower MRSA BSI rates," the researchers write. The authors suggest the difference may be a result of the adoption of evidence-based practices or of better organizational quality or support.

Almost all hospitals (97.2%) reported that they collected some type of surveillance culture at admission for MDRO, mostly from transfers from nursing homes (77.8%), intensive care units (72.8%), dialysis (63.3%), or readmissions within 30 days (75.6%). In addition, 36 hospitals (20%) reported collecting surveillance cultures from all admissions except labor and delivery.

About 29% of hospitals reported screening all patients for MRSA on admission, but many more (87.3%) reported targeted screening such as for nursing home (96.0%), intensive care (86.8%), dialysis (76.8%), and readmitted (89.4%) patients. Few hospitals reported targeted screening on admission for VRE (6.7%) or C difficile (3.9%), possibly because the California regulations focus only on MRSA.

Most hospitals reported having policies to limit contact with patients positive for MRSA (93.3%), VRE (65%), or C difficile (83.9%). However, the method used most often to detect MRSA was standard culture, with results available only after 1 to 3 days.

"[B]ecause few hospitals report the use of presumptive isolation or contact precautions for patients with pending results and institute isolation only when culture results are positive, the usefulness of screening at admission is greatly diminished," the researchers write.

The study confirmed that 87% of the California hospitals had policies in place to screen for MRSA, which is a higher rate than shown in previous research. However, a lag exists between reporting and screening requirements and institution and hospital policy implementation.

The authors write that results may have a selection bias because "hospitals with high intensity of infection control processes and low [healthcare-associated infection] rates may have been more likely to participate in this study." In addition, lack of data from all hospitals may be a limitation.

Nevertheless, the researchers conclude, "This study highlights the importance of infection control certification as an important predictor of [healthcare-associated infection] rates. It also demonstrates the continued focus placed on MRSA as evidenced by policies instituted by infection control departments, potentially in response to state mandates."

More than 4900 people hold certification in infection control worldwide, according to CBIC.

The authors have disclosed no relevant financial relationships.

Am J Infect Control. 2012;40:96-101.

    
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