成人ICU患者多重耐药菌感染预防与控制的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.06.013

摘要/Abstract

摘要：

目的检索并总结成人ICU患者多重耐药菌感染预防与控制的最佳证据，为临床规范化管理提供循证依据。方法系统检索国内外相关指南网站及各专业协会网站，包括UpToDate、BMJ Best Practice、英国国家卫生与临床优化研究所网、美国国立指南库、加拿大安大略省注册护士协会网站、医脉通、Cochrane Library、Embase、PubMed、Web of Science、中国知网、万方数据库、维普数据库、中国生物医学文献数据库等中关于成人ICU多重耐药菌感染预防与控制的指南、专家共识、系统评价、证据总结及原始研究，检索时限为建库至2023年4月。由2名研究者独立进行文献质量评价和资料提取。结果共纳入19篇文献，包括1篇指南、8篇专家共识、1篇专家意见、2篇系统评价和7篇原始研究，最终形成危险因素、手卫生、去定植、主动监测、设备相关策略、接触防护、患者隔离、环境清洁、人员培训、多学科协作管理等10个主题，41条最佳证据。结论该研究总结了成人ICU患者多重耐药菌感染预防与控制的最佳证据，可为临床转化提供资源准备、为护理人员进行科学有效的护理实践提供临床决策依据。专科护理人员应合理选择最佳证据进行应用，并不断更新最佳证据，规范护理实践，提高护理质量。

关键词: 多重耐药菌, 重症监护室, 证据总结, 循证护理学

Abstract:

Objective To search and summarize the best evidence for the prevention and control of multidrug-resistant organism infection in adult ICUs，and to provide evidence-based basis for clinical standard control. Methods We systematically searched relevant guideline websites and professional association websites，UpToDate，BMJ best practice，National Institute for Health and Care Excellence，National Guidelines Clearinghouse，Registered Nurses’ Association of Ontario，Yimaitong，the Cochrane Library，Embase，PubMed，Web of Science，CNKI，Wanfang，VIP and SinoMed to collect all the clinical guidelines，system reviews，expert consensuses，evidence summaries and original research related to prevention and control of multidrug-resistant organism infection in adult intensive care units. The search period was from the establishment of the database to April 30，2023. 2 researchers independently conducted the literature quality evaluation and data extraction. Results A total of 19 articles were included，including 1 guideline，8 expert consensuses，1 expert opinion，2 systematic evaluations，and 7 original studies. Ultimately，10 evidence themes and 41 pieces of best evidence were formed，including risk factors，hand hygiene，decolonization，active monitoring，equipment related strategies，contact protection，patient isolation，environmental cleaning，personnel training management supervision，and multidisciplinary collaborative management. Conclusion This study summarizes 41 pieces of best evidence for the prevention and control of multidrug-resistant organism infections in adult ICUs，which can provide resource preparation for clinical transformation and clinical decision-making basis for nursing staff to conduct scientific and effective nursing practices. Specialized nursing staff should reasonably select the best evidence for localized application，continuously update the best evidence，standardize nursing practices，and improve nursing quality.

Key words: Multidrug-Resistant Organism, Intensive Care Unit, Evidence Summery, Evidence-Based Nursing

施晓柳, 施金梅, 沈红五, 张倩, 张艳. 成人ICU患者多重耐药菌感染预防与控制的最佳证据总结[J]. 中华护理杂志, 2024, 59(6): 727-735.

SHI Xiaoliu, SHI Jinmei, SHEN Hongwu, ZHANG Qian, ZHANG Yan. Summary of best evidence for prevention and control of multidrug-resistant organism infection in adult ICU[J]. Chinese Journal of Nursing, 2024, 59(6): 727-735.

图/表 5

图1 文献筛选流程图

Figure 1 Flow chart of literature

表1 纳入文献的一般特征（n=19）

Table 1 Characteristics of included studies（n=19）

表2 纳入专家共识和专家意见的评价结果（n=9）

Table 2 Quality evaluation of included expert consensus and opinions（n=9）

表3 纳入系统评价的评价结果（n=2）

Table 3 Quality evaluation of included systematic reviews（n=2）

表4 成人ICU患者多重耐药菌感染预防与控制的最佳证据总结

Table 4 The evidence summary of the prevention and control of multidrug resistant organism infections in adult ICUs

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