JP2005025281A - Method for managing microbial in-hospital infection - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an information management means for supervising a medical institution for in-hospital infection as a system to efficiently discover infections and construct countermeasures. <P>SOLUTION: For a facility where an inspection system has been previously introduced because of a contract or the like, means for encoding localizations within a facility and for encoding combinations of infectious microorganisms are introduced. Using the system for the analysis of the behavior of infectious microorganisms allows the early detection of the condition and frequency of the occurrence of infection, routes of infection and the like, leading to more appropriate countermeasures against in-hospital infection. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
[Technical field to which the invention belongs]
The present invention relates to a business method for providing a novel microbial nosocomial infection management method for enabling early measures against nosocomial infection in medical institutions such as hospital facilities.
[0002]
[Prior art]
Nosocomial infection in medical institutions is a major problem that can be called a medical accident. Although all pathogenic microorganisms can cause nosocomial infections, the current problems are highly toxic bacteria such as M. tuberculosis and Legionella, food poisoning bacteria such as Salmonella and pathogenic Escherichia coli O-157, methicillin-resistant Staphylococcus aureus ( MRSA), vancomycin-resistant enterococci, and other resistant bacteria that do not work with antibiotics, such as Serratia and Pseudomonas aeruginosa, but there are opportunistic bacteria that are weak in the environment but easy to infect medical devices.
About 15 years ago, nosocomial infections became the first social problem in Japan because of a hepatitis B infection of a medical staff due to a needlestick accident. After that, MRSA nosocomial infections occurred frequently throughout the country, starting with an infection at a university hospital in Tokyo, where a lawsuit was filed in 1991. Since then, many hospitals have focused on prevention of needlestick accidents and prevention of MRSA infections, but for the past few years, deaths due to opportunistic infections, which were apt to be neglected because they are weakly pathogenic and effective Examples are in succession.
There are few statistics of nosocomial infections in Japan and the world, but in the epidemiological survey in the United States, about 2 million people suffer from nosocomial infections and 125,000 people die each year. If this is applied to Japan, approximately 700,000 people are hospitalized and 44,000 people die annually. This is equivalent to more than three times the annual traffic deaths of about 13,000 people.
In July 2000, the Ministry of Health, Labor and Welfare started the “In-Hospital Infection Control Surveillance Project” for intensive care units (ICU) and clinical laboratories in hospitals.
[0003]
[Problems to be solved by the invention]
An object of the present invention is to provide an information management means for monitoring nosocomial infection in a medical institution as a system and constructing an efficient detection and countermeasure for the infection.
[0004]
[Means for Solving the Problems]
In order to solve the above-mentioned problems, the present inventors have conducted extensive research and, as a result, coded the localization within the facility, and further coded the combination of infecting microorganisms, for the facility where the management system was previously introduced by contract etc. Introducing measures such as doing this, and analyzing the dynamics of infectious microorganisms using this system, the state of infection, the frequency of infection, the route of infection, etc. can be detected at an early stage, and more appropriate hospital infection measures can be taken. The present invention has been completed.
[0005]
That is, the present invention
"1. Participating facilities in the Microbiology Hospital Infection Management System specify at least the name of the facility, the location within the facility, and the name of the sample material, and provide the sample to the testing facility. The testing facility measures the pathogenic bacteria in the sample provided from the participating facility. The measured values obtained for each facility are collected by the data analysis department using the information transfer and storage tool, and the distribution of the in-hospital pathogens and / or the infectious route of the institution is evaluated from the obtained data. Microbiology nosocomial infection control method that can be provided.
2. 2. Confirmation of nosocomial microbiological infections by location within a participating facility and / or by sample material name of a participating facility, and evaluation of nosocomial infectious pathogens and / or infectious route of infection. Microbial nosocomial infection control method.
3. The method for managing a microbial nosocomial infection according to claim 1, wherein the drug susceptibility of the pathogenic bacterium is pattern-coded, and the similarity of the in-house nosocomial infection pathogenic fungus distribution and / or the in-house infection route is evaluated from the pattern analysis of the pattern code.
4). 4. The method for controlling infection in a microbiological hospital according to claim 3, wherein the pattern code of the drug susceptibility of the pathogen is the display classification for the following drugs.
Code 1: ABPC + IPM / CS
Code 2: CEZ + CAZ
Code 3: GM + AMK
Code 4: EM + CLDM
Code 5: MINO + OFLX
Code 6: VCM
5. 2. The method of managing a microbial nosocomial infection according to claim 1, wherein the pathogen is measured at regular intervals, collected in a data analysis department, and the distribution of the infectious nosocomial pathogen and / or the infectious route of the institution is evaluated over time. "
Consists of.
[0006]
DETAILED DESCRIPTION OF THE INVENTION
The data collection method in the present invention is as follows.
The facilities for which data is collected in the present invention individually make business alliances such as contracts, and perform periodic sampling, sample provision, and sample testing. This target facility is called a microbe hospital infection control system participating facility.
[0007]
Participating facilities specify at least the name of the facility, the location within the facility, and the name of the sample material, and provide the sample to the inspection facility when collecting and providing the sample. Furthermore, patient ID is also specified if desired. The facility name means a hospital name, a clinic name, etc., and means a target facility. Localization within a facility means, for example, a department in a hospital, a ridge number, a floor number, a room number, etc., and information necessary and sufficient for identification is provided as appropriate. The sample material name means the origin information of collected samples such as urine, feces, sputum, pus, secretions, blood and the like. For other samples, specify the date of collection, time of collection, etc. The patient ID is a desired specific item and is so-called patient information. For example, the name is concealed in relation to personal secret information, converted into an ID number, and information such as gender, age, disease history, disease name, etc. is provided as desired.
[0008]
The sample is transferred to an inspection facility immediately after collection or under conditions that prevent the sample from being denatured by refrigeration. The transfer to the inspection facility is not particularly limited, but is preferably completed within one day in consideration of the sample transfer time. Laboratory facilities refer to so-called clinical laboratory facilities.
[0009]
The laboratory will measure the pathogens in the samples provided by the participating facilities. The pathogenic bacteria can be changed at any time according to the desire of the facility such as bacteria and viruses. Bacteria are the microorganisms disclosed in the above prior art, and viruses can be negotiated at any time, such as varicella virus, adenovirus, parvovirus, rotavirus, HB virus, HC virus, and HA virus.
[0010]
In the inspection facility, measurement values are obtained for these samples from time to time, each related information is attached, and the information is stored using an information transmission and storage tool. As the information transmission storage tool, any information transmission tool such as the Internet, an intranet, a wireless run, a dedicated line, an FD, and a CD can be used, and the storage is accumulated in a host computer or the like that is made into a database. The data analysis department analyzes the measured values and related information obtained for each facility using an information transmission and storage tool. In the present invention, since related information is input and in particular, in-facility localization and in-house time series localization can be analyzed, this system enables nosocomial infection routes, nosocomial infection frequency, nosocomial infections. The level and distribution of nosocomial infections can be objectively judged, making it easy to establish a comprehensive countermeasure early in nosocomial infection.
[0011]
In one embodiment of the present invention, the drug sensitivity of pathogenic bacteria (staphylococcus, Pseudomonas aeruginosa, etc.) is pattern-coded, and from the pattern analysis of the pattern code, the similarity of the distribution of pathogenic bacteria in the hospital and / or the infection in the hospital Perform route evaluation. β-lactam agents (penicillins, cephems, monobactams, carbapenems, penems, etc.), aminoglycoside antibiotics, macrolide antibiotics, new quinolone antibacterials, quinolones, etc. And pattern-analyze it. In the analysis, the origin of each pathogen and the infection route are identified from the similarity of the patterns.
The pattern codes of drug susceptibility of pathogenic bacteria are classified for display for the following drugs, for example. This combination of medicines differs for each requested facility, and the pattern code calculation method also differs for each facility. Also, the number of digits of the pattern code can be freely set up to 8 lines.
In addition, each abbreviation of a medicine has the following meaning.
ABPC: ampicillin IPM / CS: imipenem / cilastatin CEZ: cefazolin CAZ: ceftazidime GM: gentamicin AMK: amikacin EM: erythromycin CLDM: clindamycin MINO: minocycline OFX: ofloxacin VCM: vancomycin code 1: ABPC + IPM / CS
Code 2: CEZ + CAZ
Code 3: GM + AMK
Code 4: EM + CLDM
Code 5: MINO + OFLX
Code 6: VCM
[0012]
In the present invention, pathogens are measured at regular intervals, collected in the data analysis department, and the time course evaluation of the in-hospital infectious pathogenic bacteria distribution and / or the in-house infection route is performed. This makes it possible to grasp infection at an early stage of nosocomial infection, and to enable early detection of the route of infection spread. The measurement interval varies depending on the name of the sample material, but it is recommended to measure once to several times every day, every other day, or once to several times every month.
[0013]
【Example】
EXAMPLES The present invention will be described below with reference to examples. However, the present invention is not limited to these examples, and all the inventions are targeted as long as the basic idea is included in each claim.
[Example 1]
1 and 2 show one aspect of the basic information and the output after aggregation for MRSA detection. FIG. 1 shows sample-related basic related data describing the ward (facility localization), patient name, department name, patient age, sample material name, patient ID, and sample collection date (acceptance date) from the left. By securing this information, it is possible to grasp the status of nosocomial infection of MRSA. In the figure, “3F Higashi” means a patient on the third floor of the East Ward, “Sample Material Name” means the sample collection site (collection source), and “Ophthalmic oil” appears in the eyes. Specimen collected from a sputum and a sputum collected by suction. The pharyngeal fluid is collected from the pharynx, and the wound gauze is a sample of gauze applied to the wound. The wound refers to the fluid collected from the wound periphery. The examples show that all were collected in May.
FIG. 2 shows an aggregate sample and shows detection of MRSA on a monthly basis from May 1st to 31st. By checking the monthly fluctuations, it is possible to determine the speed of infection, the frequency of infection, the scope of infection, and the route of infection. The fourth floor of the West Wing is blocked from other departments, and it can be estimated that some effective measures have been established. However, although the 5th floor of the west wing is the same building, it is presumed that infection spread from the 5th and 6th floors of the east wing, indicating that early countermeasures for this infection route are urgent issues. Infection suggests that each department of the ward can be easily settled, suggesting that a well-established management system and establishment of defenses are essential at this facility. The material analysis shows that the problem of infection at the wound, which is a wound, is high, and provides a great help for preventive measures.
[0014]
[Example 2]
FIG. 3 is one form of a system that encodes (MRSA) drug susceptibility patterns and enables analysis of infection routes within a facility by pattern analysis. Each horizontal axis lists the date of reception of the patient's specimen, the name of the sample material, the localization in the facility, the amount of collected bacteria, each drug, and the pattern code. The degree of MRSA for each drug indicates R: resistance, I: intermediate between resistance and sensitivity, S: sensitivity, blank: no data. Then group the drugs,
Code 1: ABPC + IPM / CS
Code 2: CEZ + CAZ
Code 3: GM + AMK
Code 4: EM + CLDM
Code 5: MINO + OFLX
Code 6: VCM
Classified. The pattern for each patient was coded with R: 4 points, I: 2 points, S: 1 point, and no data: 0 points. The top patient is
Code 1: ABPC + IPM / CS = 8
Code 2: CEZ + CAZ = 0
Code 3: GM + AMK = 0
Code 4: EM + CLDM = 0
Code 5: MINO + OFLX = 8
Code 6: VCM = 1
Thus, patient ID 02-05787-5 is encoded as 800081. Similarly, patient ID02-0462-1 and patient ID02-02936-1 are 881041, which is the same pattern code, and the identity of infection can be estimated. Moreover, since patient ID02-0462-1 and patient ID02-02936-1 show the same pattern code, although they are 5F west wing and 5F east wing, the infection route between these 5F is estimated. Furthermore, the patient ID 02-0607-7 in the 5F West Wing has a pattern code of 884041, and it is detected that the same strain is spreading in the 5F West Wing. As described above, in the system of the present invention, the number of floors and the number of buildings as the in-facility localization are added as input elements, which can be analyzed in combination with the drug resistance pattern. It is intended to provide a simpler and early detection means for a route.
[0015]
[Example 3]
FIG. 4 shows the detection status of the monitoring bacteria in each facility, with the monitoring target bacteria in the column and the localization (ward) in each facility in the row. Pseudomonas aeruginosa is detected from specimens from almost all facilities, and other drug resistant bacteria are not detected. On the 7th floor, the detection of fungal cells is high in both the west and east buildings, and the need for protection against bacterial infection is presumed.
[0016]
[Example 4]
The system using the information transmission and storage tool of the present invention is exemplified as follows.
About the nosocomial infection control system according to the present invention, the participating facilities make a contract in advance, and a user ID and a password are given if desired. The facility decides in advance about the contents to be provided for in-hospital infection analysis information. At least the name of the facility, the location in the facility, the name of the sample material, and the like are specified for the sample. The main contents of these codes are converted into bar codes, for example. The collected sample is transported to a participating facility and a predetermined inspection facility, where the sample is specified and various microorganism tests are performed. In the test, the presence or absence of microorganisms in the sample, the identification of the microorganisms present, and the drug resistance against them are tested. The test result and each specific information are sent from the inspection facility to the host database by the information transmission tool and accumulated in the host database. After being stored in the information transmission and storage tool in this way, data is taken out at regular intervals determined in advance with participating facilities and subjected to statistical analysis processing. The analysis is performed by various pre-programmed software, and the participating facilities are regularly accessed as an output form, or the participating facilities can access through the information transmission tool to obtain desired analysis data. Participating facilities can obtain materials such as distribution of infectious pathogens in the hospital and evaluation of infectious routes of infection.
[0017]
[Example 5]
Examples of output of the present invention are as follows, but can be expanded sequentially.
1) Bacteria type detection status list: A list of target bacteria detection patients by ward and department and ward, number of detections by department, detection rate comparison data in all data, and the like are output. As a result, MRSA (other specific bacteria) detection status in the hospital can be freely classified and unified by specifying conditions such as by department (by ward, by department, etc.) and by specimen. By comparing the detection status with the previous month and the month before last, it is possible to grasp the occurrence status of nosocomial infections and the progress of countermeasures. In addition, it is possible to unify the status of hospital infections and motivate measures for hospital infections.
2) Classification of strains from the viewpoint of drug sensitivity pattern: The drug sensitivity is pattern-coded for each customer, and classification output is made possible for each identical code. The output drug can be selected and set for each customer so that there is a difference between strains. As a result, provide comments that warn of nosocomial infections. By classifying drug sensitivity patterns by digitization and screening and analyzing the identity of the bacterial species from the drug sensitivity patterns, the possibility of nosocomial infection spread by the same strain is warned, and further search by DNA classification or the like is promoted. It is also useful for early detection of infections caused by the same bacteria that spread across wards and departments.
3) Detection status of mycobacteria and other pathogens to be monitored: The number of detection data for each ward of bacteria containing MRSA and a profile about the bacteria are output. The output is limited to bacteria that require nosocomial infection countermeasures. To report the detection status of bacteria that are important in hospital infection countermeasures but have insufficient recognition in the medical field, and to be able to report the profile of the reported bacteria name at the same time, thus detecting resistant bacteria It is possible to make the necessary tests known.
4) Blood culture positive list: Outputs culture positive patient name and detected bacteria name data in order of material collection date. For example, this week and the past three weeks are output and can be compared. A master file is set for each bacterial species with a strong tendency to be resistant, and a warning comment is output regarding the possibility of nosocomial infections if the standard file is detected. Output the profile of the detected bacteria. This makes it possible to grasp the overall tendency of detected bacteria in blood culture and to predict the occurrence of nosocomial infections due to serious blood infections. Moreover, when the same bacterial species is intensively detected from a plurality of patients, the possibility of nosocomial infection can be predicted.
5) Antimicrobial susceptibility rate of major bacteria: Main drug susceptibility rate data for high-frequency isolates is output by ward and department. Clarify drug efficacy. For example, a drug having a drug sensitivity of 90% or more is clearly indicated. The name of the medicine to be output is appropriately selected according to the request results. Thereby, the sensitivity of the main antimicrobial agent with respect to the main microbe for every medical department and every ward can be grasped | ascertained, and it can be used as a treatment guideline. In addition, drug data with a sensitivity of 90% or more is a guideline for selecting an antibacterial drug. By always carrying the doctor, you can get quick treatment guidelines.
6) Higher bacterial species of detection bacteria by material: The most frequently separated bacteria best 5 (for example) by sample material is output. The materials are grouped together so that the detection trend (excluding resident bacteria) is clear. Thereby, a doctor can grasp | ascertain the number of detection bacteria and the detection rate from the main material provided for a microbe test | inspection, and a doctor can make it a guideline of treatment. This document can be obtained quickly by always carrying it with a doctor.
【The invention's effect】
As described above, according to the present invention, at least the name of the facility, the location within the facility, and the name of the sample material are specified and the sample is provided to the inspection facility with respect to the facility participating in the microbiology hospital infection management system, and the inspection facility is provided from the participating facility. The measured pathogens of each sample were measured, and the measured values obtained for each facility were collected by the data analysis department using the information transmission and storage tool. From the obtained data, the distribution of infectious pathogenic bacteria in the facility and / or the facility The present invention provides a method for controlling the infection of microorganisms in a hospital that enables the evaluation of the route of infection in the interior of a microorganism, and is extremely useful as a system for managing infection in a hospital of microorganisms. In the present invention, the bacteria were detected by a known test already established by a clinical test method or the like.
[Brief description of the drawings]
FIG. 1 shows basic information about MRSA detection.
FIG. 2 shows an aspect of output after aggregation of basic information regarding detection of MRSA.
FIG. 3 shows one form of a system that encodes (MRSA) drug susceptibility patterns and allows analysis of infection routes within a facility by pattern analysis.
FIG. 4 shows the state of detection in each institutional location of monitored bacteria, taking the in-facility localization (ward) in a row.

Claims (5)

Participating facilities of the Microbiology Hospital Infection Control System identify at least the name of the facility, the location within the facility, and the name of the sample material, and provide the sample to the testing facility. The testing facility measures the pathogenic bacteria in the sample provided from the participating facility, This measurement value obtained for the facility is collected by the data analysis department using the information transmission and storage tool, and it is possible to provide an evaluation of the in-hospital infection-causing fungus distribution and / or the infectious route of infection from the obtained data. Microbiology nosocomial infection control method. 2. Confirmation of nosocomial infection of microorganisms by in-house localization of participating facilities and / or sample material names of participating facilities, and evaluation of nosocomial infectious pathogenic fungi and / or infectious routes of institution. Microbial nosocomial infection control method. The method for managing a microbial nosocomial infection according to claim 1, wherein the drug sensitivity of the pathogenic bacterium is pattern-coded, and the similarity of the in-house nosocomial infection pathogenic fungi distribution and / or the in-house infection route is evaluated from the pattern analysis of the pattern code. 4. The method for controlling infection in a microbiological hospital according to claim 3, wherein the pattern code of the drug susceptibility of the pathogen is the display classification for the following drugs.
Code 1: ABPC + IPM / CS
Code 2: CEZ + CAZ
Code 3: GM + AMK
Code 4: EM + CLDM
Code 5: MINO + OFLX
Code 6: VCM 2. The method for managing a microbial nosocomial infection according to claim 1, wherein the pathogen is measured at regular intervals, collected in a data analysis department, and the distribution of the infectious nosocomial pathogen and / or the infectious route of the institution is evaluated over time.

Images