Construction of the prevention and control system of multidrug resistant organism infection in organ donation after citizens′ death based on Donabedian theory

doi:10.3877/cma.j.issn.1674-3903.2025.05.005

Abstract

Abstract:

Objective

To explore the construction of the prevention and control system of multidrug resistant organism (MDRO) infection in organ donation after the death of citizens.

Methods

Based on Donabedian′s " Structure Process Outcome" quality theory as the core theoretical framework, a preliminary draft of the system was developed through literature research and clinical practice. The Delphi method was used to determine the prevention and control system for MDRO infections in organ donation after the death of citizens. The Analytic Hierarchy Process was used to calculate the weights of each indicator, and a database was established using Excel 2019. Descriptive statistical analysis was conducted on the data using SPSS 22.00.

Results

A total of 20 experts participated in the two rounds of inquiry, with a 100% positivity rate among the experts. The expert authority coefficients are 0.83 and 0.90, and the Kendall harmony coefficients are 0.540 and 0.568, respectively (all P<0.05). The coefficient of variation of each indicator is <0.25, and the average importance score ranges from 4.48 to 4.72 points, indicating that the indicator settings are scientific and the expert recognition is high. The final system for preventing and controlling organ donation after the death of citizens includes three primary indicators (structural indicators, process indicators, and outcome indicators), eight secondary indicators, and 33 tertiary indicators. The structural indicators cover three secondary indicators: quality control system, prevention and control facilities, and management standards. The process indicators include three secondary indicators: supplier maintenance, organ acquisition, and organ preservation. The outcome indicators involve the detection of MDRO and the implementation of prevention and control measures.

Conclusion

The prevention and control system of MDRO infection in organ donation after the death of citizens constructed in this study, demonstrates high validity and reliability, and can provide partial theoretical reference for the safe and high-quality implementation of the prevention and control of MDRO infection in organ donation.

Key words: Donabedian theory, Organ donation, Multidrug resistance, Delphi method

Yongpeng Zhang, Guozhen Chen, Ling Bai, Haiping Liu, Jinjiang Zhu, Chenguang Ding. Construction of the prevention and control system of multidrug resistant organism infection in organ donation after citizens′ death based on Donabedian theory[J]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(05): 320-325.

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References 19

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指标	均数	标准差	CV	权重
A结构指标	4.60	0.52	0.11	0.330 9
A1质控体系	4.80	0.42	0.09	0.340 4
A1.1建立捐献器官获取MDRO感染防控管理的阶梯式团队，人员职责明确	5.00	0.00	0.00	0.137 7
A1.2定期进行MDRO感染相关培训，实施持续质量改进	4.30	0.48	0.11	0.118 5
A1.3有MDRO感染控制相关督查和质控记录	3.90	0.57	0.15	0.107 4
A2防控设施	4.70	0.48	0.10	0.333 3
A2.1 MDRO感染防控所需设施配置完善齐备，标识明显	4.40	0.52	0.12	0.121 2
A2.2 MDRO感染防控设施按照规范使用	4.20	0.42	0.10	0.115 7
A3管理规范	4.60	0.70	0.15	0.326 2
A3.1有MDRO感染防控相关制度	5.00	0.00	0.00	0.137 7
A3.2有MDRO感染防控相关流程和执行细则	4.80	0.42	0.09	0.132 2
A3.3床护比接近1：2.5，设有感控护理人员	4.70	0.48	0.10	0.129 5
B过程指标	4.30	0.95	0.22	0.309 4
B1供者维护	4.90	0.32	0.06	0.388 9
B1.1主动筛查：对高危人群、易感染人群选择细菌定植率较高且方便采样的≥2个部位采集标本，进行MDRO主动筛查	5.00	0.00	0.00	0.059 7
B1.2患者安置：将MDRO定植或感染患者进行隔离，尽可能单间隔离	4.20	0.63	0.15	0.050 1
B1.3环境管理：先清洁、再消毒，做好床单元、物体表面、地面及空调出风口、空气等环境物表清洁消毒工作，必要时增加清洁消毒频率	4.30	0.48	0.11	0.013 1
B1.4强化手卫生：MDRO感染或定植患者床边应单独配备含有乙醇的速干手消毒剂	5.00	0.00	0.00	0.059 7
B1.5药物管理：加强抗菌药物临床应用管理，严格掌握其应用指征，通过分级管理限制抗菌药物使用	5.00	0.00	0.00	0.059 7
B1.6物表擦拭：用含有效氯1 000 mg/L消毒液擦拭病房仪器及各种物表	4.20	0.63	0.15	0.050 1
B1.7皮肤去定植：用2%葡萄糖酸氯已定医用卫生湿巾或洗必泰对MDRO感染患者进行皮肤擦拭	4.20	0.79	0.19	0.050 1
B2器官获取	4.30	0.48	0.11	0.341 3
B2.1供者入室管理：供者入室等环节需要严格手卫生，转运人员如参与获取手术，务必做好自身消毒工作，尤其是手卫生	5.00	0.00	0.00	0.059 7
B2.2手术台准备：应提前在单独的手术间铺置器官修整术台，如器官获取手术与器官修整手术在同一室内进行，则在器官获取术中不能触碰修整术台且修整器械为专项专用，不能用于其他用途	5.00	0.00	0.00	0.059 7
B2.3腹腔器官获取：在获取腹腔器官时，应当尽量避免破坏膈肌	5.00	0.00	0.00	0.059 7
B2.4同时获取避免交叉：当同时获取胸腔器官和腹腔器官时，两组手术人员应避免交叉接触，手术器械及其他所有手术用物应区分使用，胸腔器官获取离体前避免破坏膈肌	5.00	0.00	0.00	0.059 7
B2.5获取人员管理：当获取器官离体后需要临时修整时，获取人员应重新进行外科手消毒及更换手术衣、无菌手套后进行器官修整手术	5.00	0.00	0.00	0.059 7
B2.6器官浸泡：在获取器官离体后可使用3型碘伏稀释后浸泡20 min	4.20	0.42	0.10	0.050 1
B2.7遗体维护：在器官获取和修整手术结束前，禁止进行遗体维护	5.00	0.00	0.00	0.059 7
B3器官保存	3.40	0.52	0.15	0.269 8
B3.1药物使用：器官保存时(Lifeport机械灌注时)可针对性使用抗菌药物	5.00	0.00	0.00	0.059 7
B3.2器官转运：器官转运人员需提前对转运工具进行2%氯已定擦拭作用30 min	5.00	0.00	0.00	0.059 7
C结果指标	5.00	0.00	0.00	0.359 7
C1 MRDO检出	5.00	0.00	0.00	0.520 8
C1.1供器官获取前MRDO检出率＝计划获取前供者MRDO感染检出例数/纳入供者总数×100%。	5.00	0.00	0.00	0.116 0
C1.2离体器官MRDO检出率＝MRDO感染器官数/同期获取器官总数×100%	4.80	0.63	0.13	0.111 4
C1.3某MRDO感染检出率＝指定时间段内该耐药菌检出数/同期该病原体检出菌株总数×100%	5.00	0.00	0.00	0.116 0
C1.4供者来源感染发生率＝受者与供者相同的MDRO感染例数/指定时间段内获取器官的总例数×100%	4.40	0.70	0.16	0.102 1
C2防控措施落实	4.60	0.52	0.11	0.479 2
C2.1 MRDO主动筛查率＝对供者进行MRDO感染筛查的例数/同期供者总例数×100%	5.00	0.00	0.00	0.116 0
C2.2手卫生依从性＝医务人员维护/获取/转运器官采取手卫生措施的次数/同期机会总数×100%	4.90	0.32	0.06	0.113 7
C2.3其他防控措施落实率＝医务人员维护/获取/转运器官采取既定MRDO防控措施的次数/同期机会总数×100%	4.90	0.32	0.06	0.113 7
C2.4 MRDO感染质控合格率＝MRDO感染患者质控记录完善率/检查总例数×100%	4.80	0.42	0.09	0.111 4
C2.5 MRDO感染相关知识知晓率＝自设MRDO感染知识问卷得分>80分人数/抽考医务人员总数×100%	4.30	0.82	0.19	0.099 8

指标	均数	标准差	CV	权重
A结构指标	4.60	0.52	0.11	0.330 9
A1质控体系	4.80	0.42	0.09	0.340 4
A1.1建立捐献器官获取MDRO感染防控管理的阶梯式团队，人员职责明确	5.00	0.00	0.00	0.137 7
A1.2定期进行MDRO感染相关培训，实施持续质量改进	4.30	0.48	0.11	0.118 5
A1.3有MDRO感染控制相关督查和质控记录	3.90	0.57	0.15	0.107 4
A2防控设施	4.70	0.48	0.10	0.333 3
A2.1 MDRO感染防控所需设施配置完善齐备，标识明显	4.40	0.52	0.12	0.121 2
A2.2 MDRO感染防控设施按照规范使用	4.20	0.42	0.10	0.115 7
A3管理规范	4.60	0.70	0.15	0.326 2
A3.1有MDRO感染防控相关制度	5.00	0.00	0.00	0.137 7
A3.2有MDRO感染防控相关流程和执行细则	4.80	0.42	0.09	0.132 2
A3.3床护比接近1：2.5，设有感控护理人员	4.70	0.48	0.10	0.129 5
B过程指标	4.30	0.95	0.22	0.309 4
B1供者维护	4.90	0.32	0.06	0.388 9
B1.1主动筛查：对高危人群、易感染人群选择细菌定植率较高且方便采样的≥2个部位采集标本，进行MDRO主动筛查	5.00	0.00	0.00	0.059 7
B1.2患者安置：将MDRO定植或感染患者进行隔离，尽可能单间隔离	4.20	0.63	0.15	0.050 1
B1.3环境管理：先清洁、再消毒，做好床单元、物体表面、地面及空调出风口、空气等环境物表清洁消毒工作，必要时增加清洁消毒频率	4.30	0.48	0.11	0.013 1
B1.4强化手卫生：MDRO感染或定植患者床边应单独配备含有乙醇的速干手消毒剂	5.00	0.00	0.00	0.059 7
B1.5药物管理：加强抗菌药物临床应用管理，严格掌握其应用指征，通过分级管理限制抗菌药物使用	5.00	0.00	0.00	0.059 7
B1.6物表擦拭：用含有效氯1 000 mg/L消毒液擦拭病房仪器及各种物表	4.20	0.63	0.15	0.050 1
B1.7皮肤去定植：用2%葡萄糖酸氯已定医用卫生湿巾或洗必泰对MDRO感染患者进行皮肤擦拭	4.20	0.79	0.19	0.050 1
B2器官获取	4.30	0.48	0.11	0.341 3
B2.1供者入室管理：供者入室等环节需要严格手卫生，转运人员如参与获取手术，务必做好自身消毒工作，尤其是手卫生	5.00	0.00	0.00	0.059 7
B2.2手术台准备：应提前在单独的手术间铺置器官修整术台，如器官获取手术与器官修整手术在同一室内进行，则在器官获取术中不能触碰修整术台且修整器械为专项专用，不能用于其他用途	5.00	0.00	0.00	0.059 7
B2.3腹腔器官获取：在获取腹腔器官时，应当尽量避免破坏膈肌	5.00	0.00	0.00	0.059 7
B2.4同时获取避免交叉：当同时获取胸腔器官和腹腔器官时，两组手术人员应避免交叉接触，手术器械及其他所有手术用物应区分使用，胸腔器官获取离体前避免破坏膈肌	5.00	0.00	0.00	0.059 7
B2.5获取人员管理：当获取器官离体后需要临时修整时，获取人员应重新进行外科手消毒及更换手术衣、无菌手套后进行器官修整手术	5.00	0.00	0.00	0.059 7
B2.6器官浸泡：在获取器官离体后可使用3型碘伏稀释后浸泡20 min	4.20	0.42	0.10	0.050 1
B2.7遗体维护：在器官获取和修整手术结束前，禁止进行遗体维护	5.00	0.00	0.00	0.059 7
B3器官保存	3.40	0.52	0.15	0.269 8
B3.1药物使用：器官保存时(Lifeport机械灌注时)可针对性使用抗菌药物	5.00	0.00	0.00	0.059 7
B3.2器官转运：器官转运人员需提前对转运工具进行2%氯已定擦拭作用30 min	5.00	0.00	0.00	0.059 7
C结果指标	5.00	0.00	0.00	0.359 7
C1 MRDO检出	5.00	0.00	0.00	0.520 8
C1.1供器官获取前MRDO检出率＝计划获取前供者MRDO感染检出例数/纳入供者总数×100%。	5.00	0.00	0.00	0.116 0
C1.2离体器官MRDO检出率＝MRDO感染器官数/同期获取器官总数×100%	4.80	0.63	0.13	0.111 4
C1.3某MRDO感染检出率＝指定时间段内该耐药菌检出数/同期该病原体检出菌株总数×100%	5.00	0.00	0.00	0.116 0
C1.4供者来源感染发生率＝受者与供者相同的MDRO感染例数/指定时间段内获取器官的总例数×100%	4.40	0.70	0.16	0.102 1
C2防控措施落实	4.60	0.52	0.11	0.479 2
C2.1 MRDO主动筛查率＝对供者进行MRDO感染筛查的例数/同期供者总例数×100%	5.00	0.00	0.00	0.116 0
C2.2手卫生依从性＝医务人员维护/获取/转运器官采取手卫生措施的次数/同期机会总数×100%	4.90	0.32	0.06	0.113 7
C2.3其他防控措施落实率＝医务人员维护/获取/转运器官采取既定MRDO防控措施的次数/同期机会总数×100%	4.90	0.32	0.06	0.113 7
C2.4 MRDO感染质控合格率＝MRDO感染患者质控记录完善率/检查总例数×100%	4.80	0.42	0.09	0.111 4
C2.5 MRDO感染相关知识知晓率＝自设MRDO感染知识问卷得分>80分人数/抽考医务人员总数×100%	4.30	0.82	0.19	0.099 8

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