摘要
目的评价应用精益A3模式促进多部门联动提高住院患者抗菌药物治疗前病原学送检率的效果。方法回顾性选取2023年1~3月和6~8月于海南省人民医院治疗性使用抗菌药物的22802例住院患者作为研究对象,以1~3月的12274例患者作为对照组,干预后6~8月份的10528例患者作为干预组。针对对照组病例病原学送检情况以精益A3模式进行背景描述、现状分析、设定目标并制定改进措施,2023年4月份后持续实施专项改进措施,干预后比较两组患者的病原学送检率、医院感染发病率、多重耐药菌检出情况和病原学标本构成等指标的差异。结果干预组患者抗菌药物治疗前病原学送检率、医院感染诊断相关病原学送检率、联合使用重点药物前病原学送检率分别为91.06%、95.72%、100.00%,明显高于对照组的28.69%、56.65%、95.73%,差异均有统计学意义(P<0.05);干预组患者的医院感染发病率为0.93%,明显优于对照组的1.13%,差异有统计学意义(P<0.05);干预组患者的耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率为57.83%,明显低于对照组的81.35%,差异有统计学意义(P<0.05),但两组患者的耐碳青霉烯类肠杆菌(CREC)检出率比较差异无统计学意义(P>0.05);干预组患者的耐碳青霉烯类肺炎克雷伯菌(CRKP)、耐碳青霉烯类铜绿假单胞菌(CRPA)、耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为50.69%、29.20%、43.31%,高于对照组的43.78%、18.34%和36.92%,但两组仅CRPA检出率比较差异有统计学意义(P<0.05);干预组患者的无菌性标本和血培养标本送检率分别为32.31%、28.47%,明显高于对照组的29.19%、24.91%,呼吸道标本送检率为28.39%,明显低于对照组的33.36%,差异均有统计学意义(P<0.05);干预组患者的单瓶血培养标本占比为39.01%,明显高于对照组的30.71%,差异有统计学意义(P<0.05);但干预组患者的单套血培养、≥两套血培养标本占比分别为34.60%、26.39%,明显低于对照组的36.64%、32.65%,差异均有统计学意义(P<0.05)。结论通过精益A3模式能优化病原学送检管理流程,能有效提高住院患者抗菌药物治疗前病原学送检率,为抗菌药物的合理应用奠定基础。
Objective To evaluate the effectiveness of the Lean A3 methodology in promoting multi-de-partment collaboration to improve the pathogen detection rate before antimicrobial therapy in hospitalized patients.Methods A retrospective study was conducted on 22802 hospitalized patients who received therapeutic antimicrobi-al agents at Hainan General Hospital from January to March and June to August,2023.Among them,12274 patients from January to March served as the control group,while 10528 patients from June to August(post-intervention)were assigned to the intervention group.The Lean A3 methodology was applied to analyze the baseline pathogen detection sta-tus in the control group,identify issues,set improvement goals,and develop targeted measures.Continuous interventions were implemented starting April 2023.Post-intervention comparisons were made between the two groups regarding pathogen detection rates,healthcare-associated infection(HAI)incidence,multidrug-resistant organism(MDRO)detec-tion rates,and specimen type distribution.Results The intervention group demonstrated significantly higher pathogen detection rates before antimicrobial therapy(91.06%vs 28.69%),for HAI diagnosis(95.72%vs 56.65%),and before com-bination therapy with key antimicrobials(100.00%vs 95.73%)compared to the control group(all P<0.05).The HAI inci-dence was lower in the intervention group(0.93%vs 1.13%,P<0.05).The detection rate of carbapenem-resistant Acineto-bacter baumannii(CRAB)significantly decreased(57.83%vs 81.35%,P<0.05),while no significant difference was ob-served for carbapenem-resistant Enterobacteriaceae(CREC),P>0.05.The intervention group showed higher detection rates for carbapenem-resistant Klebsiella pneumoniae(CRKP,50.69%vs 43.78%),carbapenem-resistant Pseudomonas ae-ruginosa(CRPA,29.20%vs 18.34%),and methicillin-resistant Staphylococcus aureus(MRSA,43.31%vs 36.92%),with only CRPA reaching statistical significance(P<0.05).The intervention group had higher rates of sterile specimen submis-sion(32.31%vs 29.19%)and blood cultures(28.47%vs 24.91%)but lower respiratory specimen submission(28.39%vs 33.36%),all P<0.05.Single-bottle blood cultures increased(39.01%vs 30.71%,P<0.05),while single-set(34.60%vs 36.64%)and≥two-set blood cultures(26.39%vs 32.65%)decreased(both P<0.05).Conclusion The Lean A3 method-ology optimizes pathogen detection workflows,effectively improving pre-therapy pathogen detection rates and provid-ing a foundation for rational antimicrobial use.
作者
廖敏
陈健
吴华
樊雯婧
李沛莹
吴彪
LIAO Min;CHEN Jian;WU Hua;FAN Wen-jing;LI Pei-ying;WU Biao(Department of Infection Management,Hainan General Hospital,Haikou 570311,Hainan,CHINA;Department of Clinical Laboratory,Hainan General Hospital,Haikou 570311,Hainan,CHINA;Wanling Wushi Branch of Qiongzhong Li and Miao Autonomous County Medical Community,Qiongzhong 572931,Hainan,CHINA;Hainan Public Health Clinical Center,Haikou 571129,Hainan,CHINA)
出处
《海南医学》
2025年第13期1907-1913,共7页
Hainan Medical Journal
基金
海南省卫生健康科技创新联合项目面上项目(编号:SQ2023WSJK0601)
国家卫生健康委医院管理研究所项目(编号:GJ02032337-14)
海南省疾控领域适宜技术推广项目(编号:HNJKSY202409、HNJKSY202407)。
关键词
精益A3模式
抗菌药物
病原学送检率
干预
效果评价
Lean A3 methodology
Antimicrobial agents
Pathogen detection rate
Intervention
Outcome evalu-ation
