多重耐药菌感染防控制度与措施.pdf

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1、1/12 四川省复员退伍军人医院多重耐药菌管理联席会议制度为进一步加强我院多重耐药菌管理，促进医院感染管理科、检验科、药剂科、临床科室多部门协作，做好多重耐药菌医院感染预防与控制工作，根据多重耐药菌感染预防和控制技术指南（试行）等相关要求，建立联席会议制度。1、参加人员医院感染管理科、检验科、药剂科工作人员，各科室医院感染管理组长，必要时邀请医院感染管理委员会主任及相关人员参加。2、时间安排由医院感染管理科牵头，每半年召开一次。3、会议内容（1）各部门对上半年的多重耐药菌管理工作进行总结，介绍各自工作进展情况，用具体的数据说明管理效果和存在的问题。（2）提出解决问题的方案、具体措施及下一阶段的

2、工作重点。4、各部门职责1）医院感染管理科：对多重耐药菌感染患者或定植高危患者进行监测，落实多重耐药菌控制措施：手卫生措施、隔离措施、无菌操作、保洁和环境消毒的监督。负责每季度向全院公布检验科统计结果。2）检验科：及时向临床科室反馈病原学培养结果及药敏报告，对多重耐药菌应做特殊说明；发现耐药菌时书面通知临床科室，电话通知医院感染管理科；每季度统计临床常见分离细菌菌株及其药敏情况，包括全院和重点部门多2/12 重耐药菌的检查变化情况。3）药剂科：及时向检验科通报我院抗菌药物品规变化情况，参与多重耐药菌感染患者会诊，负责抗菌药物临床应用管理，落实抗菌药物的合理使用，根据细菌耐药情况发布抗菌药物的预

3、警信息。4）临床科室：及时、规范采集病原学标本，根据药物敏感试验合理选用或调整抗菌药物；对多重耐药感染或定植患者采取接触隔离措施，及时上报多重耐药菌医院感染病例。多重耐药菌医院感染管理制度及防控措施1、加强多重耐药菌的医院感染管理：当发现有多重耐药菌株流行可能时，医院感染管理科应及时组织调查，临床科室、检验科必须密切协作，并在全院公布感染发生情况，报告医院感染管理委员会、抗菌药物使用指导小组，减少使用可促使这些特殊病原体选择性生长的药物，同时组织人员进行流行病学调查。如出现耐亚胺培南等泛耐药菌株，建议所发生的病区应检查所有的其他病人所用的抗菌药物方案，必要时停用所有可促进这些特殊病原体选择性生

4、长的药物而改用替代药物。2、多重耐药菌的监测：（1）开 展多 重 耐 药菌 的 目 标性 监 测耐甲 氧 西 林金 黄 色 葡萄 球 菌（MRSA）、耐万古霉球菌（VRE）、产超广谱-内酰胺酶（ESBLs）细菌、多重耐药鲍曼不动杆菌、耐碳青霉烯铜绿假单胞菌等（2）早期检出带菌者、严密监测高危人群加强检验科对多重耐药菌的检测，早期检出多重耐药菌感染患者和定植患文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4

5、ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3

6、X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T

7、10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9

8、X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7

9、文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I

10、9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C

11、3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A73/12 者。根据监测结果指导临床对多重耐药菌医院感染的控制工作。从其他医院转入者及易感者的检查，尤其是对年老体弱、有严重基础疾病的免疫力低下患者、接受侵入性检查治疗患者、住院时间长及近期使用广谱、高档抗菌药物治疗的

12、患者等高危人群要严密监测MRSA（耐甲氧西林金葡菌）。3、诊断与报告：主要依赖送检标本的病原学培养结果。临床科室、检验科、医院感染管理科应根据各自的职责做好治疗、消毒、隔离、上报、监测等工作，以防止扩散、流行。（1）临床科室各科室医师应在患者开始抗菌药物治疗前进行微生物学培养，以尽早明确病原菌及药敏结果。获得病原学结果后根据患者临床症状、体征及必要的辅助检查判定系多重耐药菌感染、定植或污染，根据药敏结果合理选用或调整抗菌药物。对于感染及定植患者应及早采取消毒隔离措施，若属于医院感染散发则于 24 小时内及时上报医院感染病例。每天早交接内容中增加科内是否有多重耐药菌感染或定植患者的相关内容，以提

13、醒医务人员采取有效隔离措施；主管医师应在病程中记录多重耐药菌检出、抗菌药物使用及采取隔离措施的情况。重视对具有多重耐药菌感染或定植高危因素患者的监测，及时采集、送检有关标本，必要时开展主动筛查，以及时发现、早期诊断多重耐药菌感染患者和定植患者。临床各科室要关注本院和本科室的细菌耐药监测结果，并根据细菌耐药监测的总结分析报告，合理使用抗菌药物。文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10

14、R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4

15、ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3

16、X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T

17、10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9

18、X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7

19、文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I

20、9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A74/12（2）检验科检验科检出多重耐药菌后，应当及时通知相关临床科室，以便采取有效的治疗和感染控制措施。对检出的多重耐药菌须在检验结果上标注，并填写多重耐药菌MDRO 报告处置表，并向院感染管理科报告当日多重耐药菌检出情况。检验科应

21、不断完善细菌耐药的检测水平，每季度向全院公布一次临床常见分离细菌菌株及其药敏情况、全院多重耐药菌的检出变化情况。（3）医院感染管理科经常下科室了解检验科多重耐药菌检出情况，并查阅病历，对属于感染或定植患者，向该临床科室发放多重耐药菌隔离措施处置表、指导科室多重耐药菌隔离措施执行情况并进行追踪，一旦发现有传播迹象，比如与患者共居一室的其他患者的标本培养出现同一菌种，医院感染管理科应与科室感染控制小组成员合作进行更深入的追踪调查，以防流行的发生。4、加强抗菌药物合理使用管理：严格按照抗菌药物临床应用指导原则和医院抗菌药物临床应用管理办法（试行）要求，严格执行抗菌药物分级使用管理制度和抗菌药物临床应

22、用预警机制。合理使用的前提是要依据病原学药敏结果，同时严格按照权限开处方，联合用药以及使用万古霉素、广谱头孢菌素、碳青霉烯类等必须严格掌握用药指征。避免由于抗菌药物的滥用而导致耐药菌的产生。5、多重耐药菌防控措施：（1）临床科室根据耐药菌检出结果，必须进行接触隔离，由科室负责人监督病区内的MDRO 患者的接触隔离措施的落实情况，感控医师和护士应积极文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9

23、P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3

24、V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ

25、8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10

26、K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:

27、CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R

28、9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 Z

29、W5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A75/12 配合。（2）应对多重耐药菌感染患者和定植患者实施隔离措施，首选单间隔离，也可以将同类多重耐药菌感染者或定植者安置在同一房间。隔离病房不足时才考虑进行床边隔离。在床尾和病历卡上标贴蓝色接触隔离标识，以提醒医务人员以及家

30、属，设置隔离病房时，还需在门上粘贴接触隔离标识，防止无关人员进入。当实施床旁隔离时，应先诊疗护理其他患者，MDRO 感染或定植患者安排在最后。（3）应尽量减少与感染或定植者接触的医务人员数量。最好限制每班诊疗患者为医生、护士各一人，所有诊疗尽可能由他们完成，包括标本的采集。（4）医务人员对患者实施诊疗护理活动过程中应当严格遵循手卫生制度，提高手卫生依从性。医务人员在直接接触患者前后、进行无菌技术操作前，接触患者使用的物品或处理其分泌物、排泄物后，必须洗手或使用速干手消毒剂进行手消毒。（5）在实施诊疗护理操作中，有可能接触患者的伤口、溃烂面、黏膜、体液、引流液、分泌物、排泄物时，应当戴手套。预计

31、与患者或其环境如床栏杆有明显接触时，需要加穿隔离衣。离开患者床旁或房间时，须把防护用品脱下，并洗手或用快速手消毒剂擦手。（6）对于非急诊用仪器（如血压计、听诊器、体温表、输液架）等应专用。其他不能专人专用的物品（如轮椅、担架），在每次使用后必须消毒（1000mg/L含氯消毒剂）。（7）进行床旁诊断接触患者后的仪器设备（心电图）必须在检查完成后用消毒剂进行擦拭。（8）如患者需离开隔离室进行诊断、治疗，应先电话通知相关科室，以文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A

32、7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5

33、I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10

34、C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10

35、HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A

36、10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编

37、码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P1

38、0R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A76/12 便他们作好准备，防止感染的扩散。转送患者去其他科室时，必须由一名工作人员陪同，并向接收方说明对该患者诊疗时应采取接触隔离措施。（9）收治多重

39、耐药菌感染或定植患者的病室，其清洁、消毒用品（抹布、拖布等）应当专室专用；对患者经常接触的物体、设备设施表面，每天清洁和擦拭消毒不少于2 次，被患者血液、体液污染时应当立即消毒。使用过的抹布、拖布必须消毒处理（1000mg/L 含氯消毒剂作用30 分钟）。当出现多重耐药菌感染暴发或者疑似暴发时，应当增加清洁、消毒频次。（10）感染者或携带者应隔离至连续3 个标本（每次间隔 24 小时）培养均阴性，方可解除隔离。6、医疗废物的处理：锐器放置在锐器盒中，其余医疗废物均放置在黄色感染性医疗废物袋中，由医疗废物转运专职人员收集，医疗废物处置中心集中处理。7、宣教：（1）医护人员：通过院、科二级组织多重

40、耐药菌管理相关知识培训，如消毒隔离知识、抗菌药物合理使用、细菌耐药现状及应对、手卫生与医院感染的预防等。（2）工人：进行面对面的现场指导与演示，主要是手卫生、消毒隔离知识。（3）患者与家属：医务人员应重视与患者及家属的沟通，告知洗手等消毒隔离措施的重要性，提供洗手设施或手消毒剂。MRSA 与 VRE医院感染预防与控制措施文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB

41、9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A

42、7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5

43、I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10

44、C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10

45、HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A

46、10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编

47、码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A77/12 MRSA 与 VRE是引起医院感染的重要病原菌之一，一旦科室发生这两种耐药菌的感染，可采取以下预防控制措施：一、耐甲氧西林金黄色葡萄球菌（MRSA）流行株有传播医院感染的巨大潜力，MRSA 株经常耐多种抗菌药物，仅对万古霉素和 1-2 种药物敏

48、感。一旦医院内发生MRSA，传播非常快，因为其主要的传播方式是通过医务人员的手，需采取以下预防控制措施：1减少医务人员和病人在病区内的传播。立即将感染或带定植菌的MRSA病人隔离于单人间。如无条件时可做好床边隔离，并以“接触隔离”警示标明。2早期检测病例，尤其是从外院转入我院者，筛查高危人群，保证早期检测和恰当的预防控制措施。3及时送检做病原学检测，合理选用抗菌药物。4医务人员接触感染或定植病人后要加强洗手，可用快速手消毒剂擦拭双手。出入病房必须戴口罩、帽子、穿隔离衣，在诊疗、护理病人或处理MRSA 污染物品时要穿围裙。5严格控制探视及加强陪护人员的管理，陪护人员出入病房必须戴口罩、帽子、穿隔

49、离衣。6制订 MRSA 暴发期间病人和医务人员的医院感染管理预案。二、耐万古霉素肠球菌（VRE）肠球菌可以从外科伤口感染、肝和腹腔内脓肿、糖尿病人溃疡脚的创面培养到。粪肠球菌和屎肠球菌是正常人胃肠道的共生菌。医疗机构内VRE的主要传播途径是医务人员手接触VRE病人或其周围环境，通常与不恰当的洗手有关。VRE的感染需要采取以下预防控制措施：文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9

50、A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW5I9P10R9A7文档编码:CB9X5A10K5T10 HZ8R3X10C3V4 ZW