Another success story for horizontal infection control strategies--which one?*.
Another success story for horizontal infection control strategies--which one?*.
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横向感染控制策略的另一个成功案例——哪一个？*。
DOI：
10.1097/ccm.0000000000000566
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发表时间：
2014
影响因子：
8.8
通讯作者：
Popovich,KyleJ
中科院分区：
文献类型：
--
作者：
Popovich,KyleJ
重症监护医学 www. ccm杂志。 org 2293 我们不知道每个组件的合规性如何，因此很难知道应建议采取哪种感染控制措施才能获得他们观察到的显着结果。作者在研究进行了几年后开展了手部卫生宣传活动，表明对某些策略的遵守情况可能有所不同，并且可能需要频繁监测和强化，以确保某些感染控制措施的成功。该研究的另一个局限性是缺乏控制变量（例如，外科 ICU 外 MRSA 感染的流行率），此前曾报道这些变量可以提高准实验研究的科学严谨性 (14)。作者报告说，他们医院的其他 ICU 也观察到 MRSA 感染率有所下降，这可能是由于这些其他科室实施了感染控制策略。纳入内部控制变量将强化以下论点：外科 ICU 中观察到的 MRSA 感染率下降可归因于所概述的干预措施。最后，了解外科 ICU 是否观察到除 MRSA 以外的病原体引起的感染率有所下降，从而支持横向感染控制方法的更广泛影响，这将是很有价值的。尽管如此，尽管存在这些限制，5 年 MRSA BSI 为零仍令人印象深刻。其他国家研究也同样观察到自 2005 年以来医院相关 MRSA 感染有所下降 (15, 16)。这些国家趋势部分归因于对 HAI 的认识提高以及全国 ICU 中各种干预措施的实施，例如当前研究中包含的干预措施 (15)。正如 Traa 等人 (7) 所建议的，成本效益分析对于未来实施多成分感染控制干预措施具有重要意义。这项研究丰富了文献，因为它证明了在不使用主动监测培养物的情况下显着减少医院相关 MRSA 感染（包括 BSI）的能力。通过实施多种横向感染控制策略（针对 MRSA 以外的病原体的干预措施），外科 ICU 已连续 5 年实现了零医院相关 MRSA BSI。这项研究还表明，鼻内莫匹罗星可能不是旨在减少 MRSA 引起的 HAI 的感染控制计划的必要组成部分。 Traa 等人 (7) 的研究得出的主要结论是，只要坚持不懈并保持警惕，医院感染的减少是可能的。尽管应根据上述局限性来看待这项研究，但零 MRSA BSI 仍然是零 MRSA BSI。
Critical Care Medicine www. ccmjournal. org 2293 we do not know what the compliance was for each of the various components, making it challenging to know which infection control measure should be recommended to attain the dramatic results they observed. The authors instituted a refresher hand hygiene campaign several years into the study, suggesting that compliance with certain strategies may have been variable and that frequent monitoring and reinforcement may be needed to ensure the success of certain infection control measures.An additional limitation of the study is the lack of control variables (eg, the prevalence of MRSA infectious outside the surgical ICU), which have been previously reported to increase the scientific rigor of quasi-experimental studies (14). The authors report that other ICUs at their hospital also observed a decrease in the prevalence of MRSA infections, presumably due to implementation of infection control strategies in these other units. Including internal control variables would have strengthened the argument that the observed declines in the prevalence of MRSA infections in the surgical ICU were attributable to the outlined interventions. Finally, it would have been valuable to know if the surgical ICU observed reductions in the prevalence of infections due to pathogens other than MRSA, supporting the broader impact of horizontal infection control approaches. Nonetheless, despite these limitations, zero MRSA BSI for 5 years is impressive. Other national studies have similarly observed declines in hospital-associated MRSA infections since 2005 (15, 16). These national trends have in part been attributed to improved recognition of HAIs as well as implementation in ICUs across the country of various interventions such as those included in the current study (15). As Traa et al (7) suggest, a cost-benefit analysis would be of value to inform future implementation of multicomponent infection control interventions. This study adds to the literature as it documents the ability to significantly decrease hospital-associated MRSA infections, including BSIs, without the use of active surveillance cultures. By implementing several horizontal infection control strategies—interventions that target pathogens beyond MRSA—the surgical ICU had 5 years of zero hospital-associated MRSA BSIs. This study also suggests that intranasal mupirocin may not be a necessary component of an infection control program aimed at reducing HAIs due to MRSA. The major take home message of the study by Traa et al (7) is that reductions in HAIs are possible, with perseverance and vigilance. Although this study should be viewed in light of the mentioned limitations, zero MRSA BSIs are still zero MRSA BSIs.