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Article(id=1241329575402197142, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411387, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732032000000, receivedDateStr=2024-11-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633564, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633564, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633564, creator=13701087609, updateTime=1773885633564, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2471, endPage=2476, ext={EN=ArticleExt(id=1241329575741935790, articleId=1241329575402197142, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Development and validation of an evaluation index system for multidrug-resistant organism infection prevention and control in hospitals, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To establish a comprehensive evaluation index system for multidrug-resistant organism (MDRO) infection prevention and control in hospitals, and conduct empirical research to analyze current management status and propose improvement strategies.

Methods

The evaluation system was developed through literature review, Delphi expert consultation, and analytic hierarchy process (AHP). A questionnaire survey was conducted to assess current MDRO prevention and control practices.

Results

Both Delphi rounds achieved 100% response rates, with expert authority coefficients (Cr) of 0.9736 and 0.9794 respectively. Kendall’s W values were 0.520 (χ2=645.23, P<0.01) and 0.537 (χ2=593.525, P<0.01) for successive rounds. The system demonstrated good reliability (Cronbach’s α=0.757) and validity (I-CVI=0.833-1.000, S-CVI/UA=0.938,S-CVI/Ave=0.990), comprising 3 first-level, 15 second-level, and 48 third-level indicators. Empirical data revealed suboptimal implementation: MDRO patient reporting rate (23.71%), isolation rate (59.79%), PPE utilization (14.95%), and hand hygiene compliance (53.09%). ICUs showed significantly higher MDRO infection rates (1.88‰, χ2=39.130, P<0.01), detection rates (25.58%, χ2=103.308, P<0.01), and identification rates (16.76%, χ2=1629.737, P<0.01) than other departments.

Conclusion

The developed evaluation system is scientifically sound and practical. Current MDRO prevention measures require substantial improvement, necessitating targeted interventions and precision management strategies.

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目的

构建一套医院多重耐药菌（MDRO）感染防控评价指标体系，为评价和改进MDRO感染防控工作提供参考依据和评价工具。并开展临床实证研究，分析医院MDRO防控工作的管理现状，为其改进和提高MDRO感染防控工作提出策略和建议。

方法

采用文献分析、德尔菲专家咨询法和层次分析法（AHP），建立MDRO感染防控评价指标体系。采用问卷调查的方法，对医院MDRO感染防控现状开展临床实证研究。

结果

两轮专家咨询问卷回收率均为100%，专家意见权威系数（Cr）分别为0.973 6、0.979 4。第一轮专家肯德尔和谐系数为0.520（χ2=645.23，P<0.01），第二轮专家肯德尔和谐系数为0.537（χ2=593.525，P<0.01），差异均有统计学意义。信度指数Cronbach α为0.757，效度指数I-CVI为0.833～1.000，S-CVI/UA=0.938，S-CVI/Ave=0.990。构建的指标体系包括3个一级指标、15个二级指标和48个三级指标。MDRO患者报告率为23.71%、隔离率59.79%、医护人员个人防护用品使用率为14.95%、手卫生依存性为53.09%。ICU多重耐药菌千日医院感染例次率为1.88‰（χ2=39.130，P<0.01）、MDRO检出率为25.58%（χ2=103.308，P<0.01）、发现率为16.76%（χ2=1 629.737，P<0.01），均高于其它科室，差异有统计学意义。

结论

构建的医院MDRO感染防控评价指标体系科学、可行。医院MDRO各项感染防控措施的执行情况不容乐观，医院应针对存在的问题和短板制定干预措施，做好精细化管理和精准感控。

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石丽丽，E-mail:
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石丽丽（1983—），女，硕士，副主任医师，研究方向：医院感染预防与控制

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Evaluation index system and weights of hospital MDRO infection prevention and control

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标原始权重二级指标组合权重组合权重
A感染防控体系0.311 9A1管理机制0.249 5A1.1建立MDRO防控联席会议制度和协作机制0.099 1
A1.2 MDRO管理纳入医疗质量考核体系0.040 5
A1.3定期发布MDRO监测数据0.014 6
A1.4建立MDRO应急处置小组0.029 5
A1.5制定MDRO感控制度、流程0.065 9
A2建筑设计0.062 4A2.1设置隔离病房0.045 1
A2.2隔离病房面积符合标准0.010 9
A2.3设置独立污物间0.006 4
B日常感控管理0.490 5B1监测与报告0.077 4B1.1建立监测与报告体系0.015 3
B1.2开展细菌耐药性监测0.037 9
B1.3 24h内MDRO报告率0.024 1
B2主动筛查与去定植0.009 4B2.1 MDRO的主动筛查率0.007 5
B2.2 MDRO去定植率0.001 9
B3患者隔离0.052 9B3.1 24h内开立接触隔离医嘱执行率0.012 1
B3.2 MDRO患者隔离率0.017 9
B3.3 MDRO患者的分组护理执行率0.003 6
B3.4 MDRO分时段诊疗执行率0.005 9
B3.5张贴隔离标识执行率0.002 6
B3.6 MDRO患者陪护人数0.001 9
B3.7 MDRO患者解除隔离前标本采样率0.008 8
B4接触预防0.077 4B4.1个人防护用品配备0.011 1
B4.2个人防护用品使用率0.022 1
B4.3 MDRO患者诊疗用品专人使用率0.022 1
B4.4复用的诊疗器械每次使用后清洗消毒执行率0.022 1
B5手卫生0.077 4B5.1手卫生设施配备0.024 8
B5.2手卫生依从率0.043 1
B5.3手卫生正确率0.009 5
B6患者转运0.012 2B6.1转科记录注明MDRO检出情况执行率0.008 1
B6.2 MDRO患者转运或外出检查提前告知接收科室执行率0.004 1
B7环境清洁消毒0.052 9B7.1环境卫生学消毒效果监测合格率0.007 6
B7.2日常清洁与消毒执行率0.020 3
B7.3终末消毒执行率0.020 3
B7.4清洁工具分区使用0.004 6
B8医疗废物管理0.017 0B8.1医疗废物正确分类0.005 7
B8.2医疗废物交接登记0.002 4
B8.3 MDRO患者的生活垃圾按照医疗废物正确处置率0.008 9
B9抗菌药物管理0.047 0B9.1建立抗菌药物管理团队0.009 3
B9.2抗菌药物使用强度0.019 8
B9.3抗菌药物治疗前病原学送检率0.003 8
B9.4联合使用重点药物前病原学送检率0.014 1
B10教育培训0.038 4B10.1培训参与率0.025 6
B10.2医务人员对MDRO检出情况知晓率0.012 8
B11监督管理与评价0.028 6B11.1日常督查频次0.019 1
B11.2建立MDRO防控质量评价机制0.009 5
C感染防控效果0.197 6C1医院感染发生指标0.158 1C1.1 MDRO医院感染发生率0.079 0
C1.2 MDRO千日医院感染例次发病率0.079 0
C2 MDRO监测相关指标0.039 5C2.1 MDRO检出率0.026 3
C2.2 MDRO发现率0.013 2
), ArticleFig(id=1241329766737957729, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575402197142, language=CN, label=表1, caption=

医院多重耐药菌感染防控评价指标体系及权重

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标原始权重二级指标组合权重组合权重
A感染防控体系0.311 9A1管理机制0.249 5A1.1建立MDRO防控联席会议制度和协作机制0.099 1
A1.2 MDRO管理纳入医疗质量考核体系0.040 5
A1.3定期发布MDRO监测数据0.014 6
A1.4建立MDRO应急处置小组0.029 5
A1.5制定MDRO感控制度、流程0.065 9
A2建筑设计0.062 4A2.1设置隔离病房0.045 1
A2.2隔离病房面积符合标准0.010 9
A2.3设置独立污物间0.006 4
B日常感控管理0.490 5B1监测与报告0.077 4B1.1建立监测与报告体系0.015 3
B1.2开展细菌耐药性监测0.037 9
B1.3 24h内MDRO报告率0.024 1
B2主动筛查与去定植0.009 4B2.1 MDRO的主动筛查率0.007 5
B2.2 MDRO去定植率0.001 9
B3患者隔离0.052 9B3.1 24h内开立接触隔离医嘱执行率0.012 1
B3.2 MDRO患者隔离率0.017 9
B3.3 MDRO患者的分组护理执行率0.003 6
B3.4 MDRO分时段诊疗执行率0.005 9
B3.5张贴隔离标识执行率0.002 6
B3.6 MDRO患者陪护人数0.001 9
B3.7 MDRO患者解除隔离前标本采样率0.008 8
B4接触预防0.077 4B4.1个人防护用品配备0.011 1
B4.2个人防护用品使用率0.022 1
B4.3 MDRO患者诊疗用品专人使用率0.022 1
B4.4复用的诊疗器械每次使用后清洗消毒执行率0.022 1
B5手卫生0.077 4B5.1手卫生设施配备0.024 8
B5.2手卫生依从率0.043 1
B5.3手卫生正确率0.009 5
B6患者转运0.012 2B6.1转科记录注明MDRO检出情况执行率0.008 1
B6.2 MDRO患者转运或外出检查提前告知接收科室执行率0.004 1
B7环境清洁消毒0.052 9B7.1环境卫生学消毒效果监测合格率0.007 6
B7.2日常清洁与消毒执行率0.020 3
B7.3终末消毒执行率0.020 3
B7.4清洁工具分区使用0.004 6
B8医疗废物管理0.017 0B8.1医疗废物正确分类0.005 7
B8.2医疗废物交接登记0.002 4
B8.3 MDRO患者的生活垃圾按照医疗废物正确处置率0.008 9
B9抗菌药物管理0.047 0B9.1建立抗菌药物管理团队0.009 3
B9.2抗菌药物使用强度0.019 8
B9.3抗菌药物治疗前病原学送检率0.003 8
B9.4联合使用重点药物前病原学送检率0.014 1
B10教育培训0.038 4B10.1培训参与率0.025 6
B10.2医务人员对MDRO检出情况知晓率0.012 8
B11监督管理与评价0.028 6B11.1日常督查频次0.019 1
B11.2建立MDRO防控质量评价机制0.009 5
C感染防控效果0.197 6C1医院感染发生指标0.158 1C1.1 MDRO医院感染发生率0.079 0
C1.2 MDRO千日医院感染例次发病率0.079 0
C2 MDRO监测相关指标0.039 5C2.1 MDRO检出率0.026 3
C2.2 MDRO发现率0.013 2
), ArticleFig(id=1241329766817649513, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575402197142, language=EN, label=Table 2, caption=

Implementation of MDRO sensing and control measures

, figureFileSmall=null, figureFileBig=null, tableContent=
感控措施全院合计(n=194)骨外科系统(n=58)内科系统(n=47)ICU(n=89)
措施执行患者数执行率（%）措施执行患者数执行率（%）措施执行患者数执行率（%）措施执行患者数执行率（%）
开立接触隔离医嘱12262.892746.552451.067179.78
24h内报告4623.711525.861123.402022.47
主动筛查13670.103763.793165.966876.40
隔离11659.792644.832144.686977.53
分组护理6332.472543.102655.321213.48
分时段诊疗5126.291525.861429.792224.72
张贴隔离标识8644.332543.102348.943842.70
患者解除隔离前采样2613.4023.45%510.641921.35
医护人员使用防护用品2914.9535.1736.382325.84
患者诊疗用品专人专用9347.942644.832348.944449.44
复用的诊疗器械每次使用后清洗消毒9448.453051.722348.944146.07
转运或外出检查提前告知接收科室84.1235.1724.2633.37
日常清洁与消毒8945.883967.242961.704752.81
终末消毒11056.703458.623063.834651.69
患者的生活垃圾按照医疗废物正确处置11458.762543.102246.816775.28
手卫生依从率10353.093458.622859.574146.07
手卫生正确率5957.281750.001760.712560.98
), ArticleFig(id=1241329766951867249, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575402197142, language=CN, label=表2, caption=

MDRO感控措施执行情况

, figureFileSmall=null, figureFileBig=null, tableContent=
感控措施全院合计(n=194)骨外科系统(n=58)内科系统(n=47)ICU(n=89)
措施执行患者数执行率（%）措施执行患者数执行率（%）措施执行患者数执行率（%）措施执行患者数执行率（%）
开立接触隔离医嘱12262.892746.552451.067179.78
24h内报告4623.711525.861123.402022.47
主动筛查13670.103763.793165.966876.40
隔离11659.792644.832144.686977.53
分组护理6332.472543.102655.321213.48
分时段诊疗5126.291525.861429.792224.72
张贴隔离标识8644.332543.102348.943842.70
患者解除隔离前采样2613.4023.45%510.641921.35
医护人员使用防护用品2914.9535.1736.382325.84
患者诊疗用品专人专用9347.942644.832348.944449.44
复用的诊疗器械每次使用后清洗消毒9448.453051.722348.944146.07
转运或外出检查提前告知接收科室84.1235.1724.2633.37
日常清洁与消毒8945.883967.242961.704752.81
终末消毒11056.703458.623063.834651.69
患者的生活垃圾按照医疗废物正确处置11458.762543.102246.816775.28
手卫生依从率10353.093458.622859.574146.07
手卫生正确率5957.281750.001760.712560.98
), ArticleFig(id=1241329767031559034, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575402197142, language=EN, label=Table 3, caption=

Effectiveness of nosocomial infection prevention and control in MDRO

, figureFileSmall=null, figureFileBig=null, tableContent=
科室分类MDRO医院感染例次率（%，感染例次/同期住院人数）MDRO千日医院感染例次率（‰，感染例次/同期住院天数）MDRO检出率（%，MDRO检出数/病原菌检出数）MDRO发现率（%，MDRO检出数/同期住院人数）
ICU0.97(7/722)1.88(7/3 722)25.58(121/473)16.76(121/722)
骨外科系统0.02(2/11 231)0.22(2/101 617)21.79(124/569)1.10(121/11 231)
内科系统0.04(5/12 395)0.04(5/119 216)5.19(35/674)0.28(35/12 395)
χ2值31.38039.130103.3081 629.737
P值0.0000.0000.0000.000
), ArticleFig(id=1241329767161582464, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575402197142, language=CN, label=表3, caption=

MDRO院内感染防控效果

, figureFileSmall=null, figureFileBig=null, tableContent=
科室分类MDRO医院感染例次率（%，感染例次/同期住院人数）MDRO千日医院感染例次率（‰，感染例次/同期住院天数）MDRO检出率（%，MDRO检出数/病原菌检出数）MDRO发现率（%，MDRO检出数/同期住院人数）
ICU0.97(7/722)1.88(7/3 722)25.58(121/473)16.76(121/722)
骨外科系统0.02(2/11 231)0.22(2/101 617)21.79(124/569)1.10(121/11 231)
内科系统0.04(5/12 395)0.04(5/119 216)5.19(35/674)0.28(35/12 395)
χ2值31.38039.130103.3081 629.737
P值0.0000.0000.0000.000
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医院多重耐药菌感染防控评价指标体系的构建与实证研究
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石丽丽 , 牛永祝 , 张秀娟 , 张春兰 , 李潇
现代预防医学 | 疾病预防控制 2025,52(13): 2471-2476
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现代预防医学 | 疾病预防控制 2025, 52(13): 2471-2476
医院多重耐药菌感染防控评价指标体系的构建与实证研究
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石丽丽 , 牛永祝, 张秀娟, 张春兰, 李潇
作者信息
  • 甘肃省中医院公共卫生与医院感染管理处，甘肃 兰州 730050

    • 石丽丽（1983—），女，硕士，副主任医师，研究方向：医院感染预防与控制

通讯作者:

石丽丽，E-mail:
Development and validation of an evaluation index system for multidrug-resistant organism infection prevention and control in hospitals
Li-li SHI , Yong-zhu NIU, Xiu-juan ZHANG, Chun-lan ZHANG, Xiao LI
Affiliations
  • Department of Public Health and Healthcare-associated Infection Management, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu 730050, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202411387
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摘要
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目的

构建一套医院多重耐药菌（MDRO）感染防控评价指标体系，为评价和改进MDRO感染防控工作提供参考依据和评价工具。并开展临床实证研究，分析医院MDRO防控工作的管理现状，为其改进和提高MDRO感染防控工作提出策略和建议。

方法

采用文献分析、德尔菲专家咨询法和层次分析法（AHP），建立MDRO感染防控评价指标体系。采用问卷调查的方法，对医院MDRO感染防控现状开展临床实证研究。

结果

两轮专家咨询问卷回收率均为100%，专家意见权威系数（Cr）分别为0.973 6、0.979 4。第一轮专家肯德尔和谐系数为0.520（χ2=645.23，P<0.01），第二轮专家肯德尔和谐系数为0.537（χ2=593.525，P<0.01），差异均有统计学意义。信度指数Cronbach α为0.757，效度指数I-CVI为0.833～1.000，S-CVI/UA=0.938，S-CVI/Ave=0.990。构建的指标体系包括3个一级指标、15个二级指标和48个三级指标。MDRO患者报告率为23.71%、隔离率59.79%、医护人员个人防护用品使用率为14.95%、手卫生依存性为53.09%。ICU多重耐药菌千日医院感染例次率为1.88‰（χ2=39.130，P<0.01）、MDRO检出率为25.58%（χ2=103.308，P<0.01）、发现率为16.76%（χ2=1 629.737，P<0.01），均高于其它科室，差异有统计学意义。

结论

构建的医院MDRO感染防控评价指标体系科学、可行。医院MDRO各项感染防控措施的执行情况不容乐观，医院应针对存在的问题和短板制定干预措施，做好精细化管理和精准感控。

多重耐药菌  /  评价指标体系  /  实证研究  /  德尔菲法  /  层次分析法
Objective

To establish a comprehensive evaluation index system for multidrug-resistant organism (MDRO) infection prevention and control in hospitals, and conduct empirical research to analyze current management status and propose improvement strategies.

Methods

The evaluation system was developed through literature review, Delphi expert consultation, and analytic hierarchy process (AHP). A questionnaire survey was conducted to assess current MDRO prevention and control practices.

Results

Both Delphi rounds achieved 100% response rates, with expert authority coefficients (Cr) of 0.9736 and 0.9794 respectively. Kendall’s W values were 0.520 (χ2=645.23, P<0.01) and 0.537 (χ2=593.525, P<0.01) for successive rounds. The system demonstrated good reliability (Cronbach’s α=0.757) and validity (I-CVI=0.833-1.000, S-CVI/UA=0.938,S-CVI/Ave=0.990), comprising 3 first-level, 15 second-level, and 48 third-level indicators. Empirical data revealed suboptimal implementation: MDRO patient reporting rate (23.71%), isolation rate (59.79%), PPE utilization (14.95%), and hand hygiene compliance (53.09%). ICUs showed significantly higher MDRO infection rates (1.88‰, χ2=39.130, P<0.01), detection rates (25.58%, χ2=103.308, P<0.01), and identification rates (16.76%, χ2=1629.737, P<0.01) than other departments.

Conclusion

The developed evaluation system is scientifically sound and practical. Current MDRO prevention measures require substantial improvement, necessitating targeted interventions and precision management strategies.

Multidrug-resistant organisms  /  Evaluation index system  /  Empirical research  /  Delphi method  /  Analytic hierarchy process
石丽丽, 牛永祝, 张秀娟, 张春兰, 李潇. 医院多重耐药菌感染防控评价指标体系的构建与实证研究. 现代预防医学, 2025 , 52 (13) : 2471 -2476 . DOI: 10.20043/j.cnki.MPM.202411387
Li-li SHI, Yong-zhu NIU, Xiu-juan ZHANG, Chun-lan ZHANG, Xiao LI. Development and validation of an evaluation index system for multidrug-resistant organism infection prevention and control in hospitals[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2471 -2476 . DOI: 10.20043/j.cnki.MPM.202411387
正文
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随着全球范围内抗菌药物的广泛使用，多重耐药菌（multidrug-resistant organism，MDRO）的问题已成为全球重大公共卫生威胁[1]。据美国疾病预防控制中心调查数据显示[2]，多重耐药的鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌引起的感染十分严峻，多重耐药的鲍曼不动杆菌引起感染的占比高达58.3%。鉴于这一严峻形势，美国政府已将MDRO医院感染的防控工作提升至国家战略层面。欧洲地区面临MDRO引发的医院感染问题极为严重，尤其MRSA的感染率高达21%[3]。2023年中国细菌耐药监测网关于中国细菌耐药监测报告显示[4]，我国多重耐药菌感染形势异常严峻，其中MRSA检出率高达29.6%，鲍曼不动杆菌对美罗培南耐药率由2005年的31%攀升至2023的73.7%。肺炎克雷伯菌对碳青霉烯类的耐药率由2005年的2.9%攀升到2023年的26%，细菌耐药菌率呈现急速上升的趋势。造成MDRO医院感染居高不下的主要因素是对MDRO患者的各项感染防控措施执行力度不足[2]。因此，有效预防和控制MDRO在医院内传播，保障医疗质量安全，已成为院感防控工作中急需解决的重点和难点[5]。鉴于此，WHO等国际组织以及我国已制定了MDRO综合防控措施[6-7]。
然而，我国医疗体系存在“侧重应对，忽视预防”的状况[8]，MDRO问题并未得到有效缓解。现今仍缺乏一套对MDRO感染防控能力及防控措施评价的指标体系。目前，国内外关于MDRO感染防控评价指标体系的研究未见报道，本研究旨在建立一套科学、实用、可行的医院MDRO感染防控评价指标体系，为评价和改进MDRO感染防控工作提供评价工具。并开展临床实证研究，分析医院多重耐药菌防控工作的管理现状与不足，为其改进MDRO感染防控工作提出策略和建议。
1　资料与方法
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1.1　构建指标体系
1.1.1　初步建立指标体系框架
成立由五人组成的课题研究小组，查阅国内外相关文献及标准、规范等，筛选出各级指标，采用小组讨论法，初步形成指标体系框架，包括3个一级指标，15个二级指标和56个三级指标。
1.1.2　德尔菲专家咨询
采用德尔菲专家咨询法[9]，咨询专家选择15～30名专家为宜[10]。为避免专家选择不当导致结果偏倚，制定专家遴选标准：（1）在三甲医院从事医院感染防控相关工作；（2）在院感专业领域具有较高的学术水平和权威性；（3）副高及以上职称或10年以上院感工作经验的中级以上职称；（4）本科及以上学历；（5）自愿参加，并能及时完成问卷咨询。本研究最终遴选17名来自不同医院的专家作为咨询对象。基于已构建的指标体系框架，设计专家咨询问卷。共进行两轮咨询，通过邮箱发放和回收问卷。采用Likert 5级评分法[11]对指标的重要性进行量化评分，两轮专家咨询结束后，结合专家修订意见，最终确定各级指标，并分析专家积极系数、权威程度（Cr）和肯德尔和谐系数（Kendall W）[12]。
1.1.3　确定各级指标权重
采用层次分析法(AHP)[13]计算各级指标的权重，通过Saaty1-9标度法[14]构建判断矩阵，利用概率乘法确定其组合权重[15]。对每个判断矩阵进行一致性检验，当一致性比率（CR）<0.1，认为该矩阵一致性较好[16]。
1.2　临床实证研究
1.2.1　MDRO监测范围及调查对象
选取某所三甲综合性医院作为实证研究对象，调查科室包括骨外科系统、内科系统、ICU系统，共41个科室。选择临床检出的耐甲氧西林金黄色葡萄球菌(Methicillin-resistant staphylococcus aureus,MRSA）、耐碳青霉烯肠杆菌(Carbapenem-resistant Enterobacteriaceae,CRE）、耐碳青霉烯鲍曼不动杆菌(Carbapenem-resistant acinetobacter bau-mannii,CRAB）、耐碳青霉烯铜绿假单胞菌(Carbapenem-resistant pseudomonas aeruginosa,CRPA）、耐万古霉素肠球菌(Vancomycin-resistant enterococcus,VRE）纳入监测范围[17]。以2024年1月1日—6月30日检出以上MDRO的患者及该科室医务人员作为调查对象。
1.2.2　调查方法
根据构建的指标体系制定《医院MDRO感染防控现状调查表》，将指标进行标准化或量化，通过现场检查、访谈等方式对MDRO患者防控情况开展调查，防控效果指标通过医院感染监控平台获取。
1.3　统计分析
数据采用SPSS 22.0软件分析，计量资料用（）描述，计数资料用［n（%）］描述，组间比较采用χ2检验，检验水准α=0.05。应用yaaph 10.1软件进行层次分析，计算指标权重。专家咨询结果的可靠性采用内部一致性信度检验，用克朗巴赫系数（Cronbach α）表示[18]，专家咨询结果有效性通过效度检验进行验证，根据评分计算条目水平的内容效度指数（I-CVI）、全体一致量表水平的内容效度指数（S-CVI/UA）、平均量表水平的内容效度指数（S-CVI/Ave），当专家人数>6时，I-CVI>0.78，S-CVI/ UA>0.80，S-CVI/Ave>0.90认为内容效度较好[19]。
2　结果
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2.1　专家基本情况
专家平均年龄为（42.71±5.25）岁，平均工作年限（18.71±6.86）年，副高及以上职称占14人(82.35%)，学历均为本科及以上学历。两轮专家咨询问卷回收率均为100%，专家意见权威程度Cr分别为0.973 6、0.979 4，Cr≥0.70表明专家的专业判断力显著，函询结果具有极高的可靠性。第一轮专家肯德尔和谐系数为0.520（χ2=645.23，P<0.01），第二轮专家肯德尔和谐系数为0.537（χ2=593.525，P<0.01），差异均有统计学意义，说明专家意见的一致性良好，误差控制较好，结果可信[12]。内部一致性总体信度指数Cronbach α为0.757，且各维度的Cronbach α系数均大于0.7，表明研究信度较高，研究结果有较高的准确度和可靠性[18]。指标体系条目内容效度(I-CVI)为0.833～1.000，S-CVI/UA= 0.938，S-CVI/Ave= 0.990，表明研究内容效度较好，研究结果有较高的有效性[19]。
2.2　指标体系权重和一致性检验
最终形成的评价指标体系及各级指标权重见表1，一级指标判断矩阵的CR值为0.051 7，二级指标判断矩阵的CR值为0～0.023 4，三级指标判断矩阵的CR值为0～0.051 7，均<0.1。
2.3　MDRO感控措施执行情况
共调查194例MDRO患者，MDRO患者报告率为23.71%，隔离率为59.79%，医护人员个人防护用品使用率为14.95%，手卫生依存性为53.09%，各项措施执行率见表2。
2.4　MDRO感染防控效果
ICU多重耐药菌医院感染例次率（0.97%）、MDRO千日医院感染例次率（1.88‰），MDRO检出率（25.58%）和发现率（16.76%）均高于其它科室，差异均有统计学意义（P<0.01）。见表3。
3　讨论
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3.1　构建的指标体系科学、客观、适用性强
该体系以国家标准与指南为框架，筛选可量化、标准化的客观指标，降低了主观指标比重，部分指标可通过医院感染监控平台获取数据，来源可靠，使得结果更具客观性，可真实反映医疗机构MDRO防控能力及措施执行情况。各级指标贯穿MDRO防控全过程，能够全面评价院科两级MDRO防控现状。临床实证表明，该体系灵活性强，适用于不同科室及机构，契合了MDRO临床管理要求，故指标体系具有良好的临床适用性。
3.2　指标体系内容有效、可信
两轮专家函询问卷回收率高，反映专家参与积极性较高，专家权威系数Cr≥0.7，表明专家的专业判断力显著，函询结果可靠。专家意见协调系数差异均有统计学意义（P<0.01），说明专家意见误差控制较好，结果可信[12]。各级指标判断矩阵的一致性比率CR值均<0.1，说明指标体系在逻辑上一致性良好，各指标权重分配合理[16]。内部一致性总体信度指数和各维度Cronbach α均大于0.7，表明研究结果有较高的准确度和可靠性[18]。指标体系内容效度较好，表明研究结果有较高的有效性[19]。
3.3　医院MDRO感控措施的落实有待加强
MDRO报告隔离及分组护理执行力不足。本研究显示，医生对MDRO报告率仅为23.71%，患者隔离率为59.79%，开立接触隔离医嘱执行率仅为62.89%，低于王雪玉等人[20-21]的报道。有研究表明，主管医生及时开立接触隔离医嘱，能积极推进下一步防控措施的执行，对预防MDRO的传播起到正向作用[21]。本研究MDRO分组护理的执行率为32.47%，分时段诊疗的执行率仅26.29%，远未达到指南要求的MDRO患者独立护理与分时段最后处理的标准[1,7]。本研究揭示了医务人员对MDRO的防控意识不足，防控措施执行力度不强，因此，医院应强化医护人员对MDRO感染控制培训，增强其防控意识，提高对MDRO患者实施报告、隔离和分组护理等相关措施的执行率。
医务人员个人防护与手卫生依从性差。本研究显示，仅14.95%的医护人员在接触MDRO患者时使用了个人防护用品，手卫生依从率为53.09%、正确率为57.28%，低于王雪玉[20]的研究报道，反映出医务人员个人防护意识薄弱与手卫生依存性不足。个人防护用品是保障医务人员安全的重要工具，在降低自身感染风险方面发挥着关键作用[22]，并能够有效阻断感染传播途径，防止病原体扩散[23]。手卫生是防控MDRO传播的关键措施[24]，可显著降低CRO感染率及定植风险[25]。随机采样发现，医务人员的手部有大肠埃希菌、CRAB、MRSA等致病菌被检出[20]。马里医学中心的研究表明，不规范的手卫生是MDRO传播的主要载体，进而增加MDRO感染的风险[26]。医院应加强培训、监督，提高医护人员的个人防护和手卫生依存性执行率，从而有效控制MDRO院内感染的发生。
清洁消毒与医疗废物管理不到位本研究发现，MDRO防控中环境清洁消毒环节存在显著缺陷：诊疗用品使用后清洗消毒执行率为48.45%，床单元日常清洁消毒执行率仅为45.88%，终末消毒率为56.70%。和王敏芳[27]的研究结果一致，高频接触表面致病菌污染普遍，强化清洁可有效遏制MDRO传播[20,28]。此外，MDRO患者生活垃圾按医疗废物处置率仅58.76%，低于指南要求[17]及陈菲[29]研究数据，医疗废物管理疏漏易致病原体扩散。诊疗环境清洁消毒不足与医疗废物处置不规范是交叉感染的重要风险源。建议医院严格落实MDRO患者环境清洁消毒流程，同时完善医疗废物分类监管体系，通过标准化操作与定期督查提升执行质量，保障医疗安全。
3.4　加强MDRO感染高风险科室的防控
本研究显示，ICU患者MDRO医院感染率显著高于其他科室，差异有统计学意义（P<0.01），ICU患者是多重耐药菌感染的高危人群，其感染风险较普通病房患者高5～10倍，MDRO感染可加重患者病情，导致病死率上升[30]。Meta分析指出[31]，ICU患者常伴有高血压、糖尿病等疾病，加之器官功能衰退及侵入性操作等，都会增加病人MDRO感染风险。因此，医院应基于不同科室MDRO感染状况，特别关注如ICU这类感染高风险科室，采取精准干预措施，以有效降低MDRO院内感染风险。
综上所述，本研究构建的医院MDRO感染防控评价指标体系为今后国家层面防控体系的制定奠定了基础，对医疗机构多重耐药菌的感染防控工作起到了积极推动作用，通过临床实证研究验证了指标体系的可行性与适用性。实证研究数据为医疗机构优化MDRO防控策略提供科学指导，助力实现MDRO防控工作的精细化管理和精准感控。
基金
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  • 甘肃省自然科学基金项目(23JRRA1235)
文献
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202411387
  • 接收时间：2024-11-20
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2024-11-20
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甘肃省自然科学基金项目(23JRRA1235)
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    甘肃省中医院公共卫生与医院感染管理处，甘肃 兰州 730050

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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