ICU泛耐药鲍曼不动杆菌感染暴发调查及控制
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摘要
目的调查某院重症监护病房(ICU)泛耐药鲍曼不动杆菌医院感染暴发的原因,查找传染源与传播途径,为预防和控制医院感染的发生提供依据。方法对某院ICU2018年1—2月泛耐药鲍曼不动杆菌感染患者进行流行病学调查以及ICU环境卫生学监测,采取综合措施控制暴发流行。结果该院ICU短时间内10例患者发生泛耐药鲍曼不动杆菌感染,其中B08、C08、A02床患者标本检出的AB药敏结果相同,为一疑似克隆株;C09、B09、A03床患者标本检出的AB药敏结果相同,为另一疑似克隆株。通过环境卫生学监测,分别从输液泵、床头桌、床栏、输液塔、护理桌、监护仪、手消架、设备塔、床尾手摇、医务人员随身用品的标本中检出了类似的AB克隆株,采取综合控制措施后,未再出现新发泛耐药鲍曼不动杆菌感染病例,于3月5日从环境及医务人员手的标本中未再分离出耐药AB。结论 ICU医务人员手卫生状况差及环境消毒不彻底是导致此次医院感染暴发的主要原因。
Objective To investigate the causes of healthcare-associated infection(HAI)outbreak caused by extensively drug-resistant Acinetobacter baumannii(XDR-AB)in intensive care unit(ICU)of a hospital,and find out the sources and routes of transmission,so as to provide evidence for the prevention and control of HAI.Methods Epidemiological investigation of patients with XDR-AB infection and environmental hygiene monitoring on ICU of a hospital from January to February 2018 were carried out,comprehensive measures were taken to control the outbreak.Results XDR-AB infection occurred in10 patients in ICU in a short period of time,antimicrobial susceptibility testing results of AB isolated from B08,C08 and A02 beds were the same,which was a suspected clone,antimicrobial susceptibility testing results of AB isolated from C09,B09 and A03 beds were the same,which was another suspected clone.Through environmental hygiene monitoring,similar AB clones were isolated from the specimens of infusion pump,bedside table,bedside rail,infusion tower,nursing table,monitor,rack for hand disinfectant,equipment tower,hand-operated handle at the end of bed,and health care workers' paraphernalia.No new XDRAB infection occurred after comprehensive control measures were taken,no drug-resistant AB was isolated from environment and health care workers' hands on March5.Conclusion Poor hand hygiene of health care workers and incomplete environmental disinfection in ICU are the main causes for the outbreak of HAI.
Objective To investigate the causes of healthcare-associated infection(HAI)outbreak caused by extensively drug-resistant Acinetobacter baumannii(XDR-AB)in intensive care unit(ICU)of a hospital,and find out the sources and routes of transmission,so as to provide evidence for the prevention and control of HAI.Methods Epidemiological investigation of patients with XDR-AB infection and environmental hygiene monitoring on ICU of a hospital from January to February 2018 were carried out,comprehensive measures were taken to control the outbreak.Results XDR-AB infection occurred in10 patients in ICU in a short period of time,antimicrobial susceptibility testing results of AB isolated from B08,C08 and A02 beds were the same,which was a suspected clone,antimicrobial susceptibility testing results of AB isolated from C09,B09 and A03 beds were the same,which was another suspected clone.Through environmental hygiene monitoring,similar AB clones were isolated from the specimens of infusion pump,bedside table,bedside rail,infusion tower,nursing table,monitor,rack for hand disinfectant,equipment tower,hand-operated handle at the end of bed,and health care workers' paraphernalia.No new XDRAB infection occurred after comprehensive control measures were taken,no drug-resistant AB was isolated from environment and health care workers' hands on March5.Conclusion Poor hand hygiene of health care workers and incomplete environmental disinfection in ICU are the main causes for the outbreak of HAI.
引文
[1]黄文治,乔甫,王妍潼,等.耐碳青霉烯类鲍曼不动杆菌血流感染患者危险因素及预后[J].中国感染控制杂志,2015,14(10):668-671.
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[9]李连红,胡慧敏,周立英,等.ICU耐碳青霉烯鲍曼不动杆菌医院感染暴发调查[J].中华疾病控制杂志,2016,20(10):1076-1078.
[10]高树芳.ICU疑似泛耐药鲍曼不动杆菌肺部感染暴发调查分析[J].海峡预防医学杂志,2017,23(2):27-29.
[11]Apisarnthanarak A,Pinitchai U,Thongphubeth K,et al.Amultifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai Tertiary care center:a3-year study[J].Clin Infect Dis,2008,47(6):760-767.
[12]胡春华,杨怀德,王玉莲,等.多重耐药鲍曼不动杆菌医院感染聚集性病例的调查[J].中国感染控制杂志,2017,16(3):229-232.
[13]杨亚红,张映华,蔡玲,等.综合ICU一起疑似鲍曼不动杆菌感染暴发的调查[J].中国感染控制杂志,2017,16(6):536-539.
[14]寇华炜,温静,杨宝忠,等.重症监护室泛耐药鲍曼不动杆菌感染暴发流行调查与控制对策[J].现代预防医学,2012,39(18):4919-4921.
[15]刘艳.一起泛耐药鲍曼不动杆菌感染暴发调查[J].中国感染控制杂志,2014,13(11):688-695.
[16]中华人民共和国国家卫生和计划生育委员会.重症监护病房医院感染预防与控制规范:WS/T509-2016[S].北京,2016.
[2]赵慧颖,杨艟舸,郭杨,等.内科重症监护病房泛耐药鲍曼不动杆菌定植与感染的监测及控制[J].中华危急病急救医学,2014,26(7):464-467.
[3]徐雅萍,霍瑞,闫中强,等.MDR,XDR,PDR细菌:国际专家关于获得性耐药暂行定义的提案[J].中华医院感染学杂志,2017,24(1):231-240.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[S].北京,2001.
[5]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
[6]El-Ageery SM,Abo-Shadi MA,Alghaithy AA,et al.Epidemiological investigation of nosocomial infection with multidrugresistant Acinetobacter baumannii[J].Eur Rev Med Pharmacol Sci,2012,16(13):1834-1839.
[7]王涛,王瑞兰.医院获得性鲍曼不动杆菌感染危险因素分析[J/CD].中华肺部疾病杂志:电子版,2015,8(2):200-203.
[8]孙洪,张秀琴,周冬梅.综合ICU多重耐药鲍曼不动杆菌医院感染暴发调查与防控措施[J].中国消毒学杂志,2014,31(3):268-273.
[9]李连红,胡慧敏,周立英,等.ICU耐碳青霉烯鲍曼不动杆菌医院感染暴发调查[J].中华疾病控制杂志,2016,20(10):1076-1078.
[10]高树芳.ICU疑似泛耐药鲍曼不动杆菌肺部感染暴发调查分析[J].海峡预防医学杂志,2017,23(2):27-29.
[11]Apisarnthanarak A,Pinitchai U,Thongphubeth K,et al.Amultifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai Tertiary care center:a3-year study[J].Clin Infect Dis,2008,47(6):760-767.
[12]胡春华,杨怀德,王玉莲,等.多重耐药鲍曼不动杆菌医院感染聚集性病例的调查[J].中国感染控制杂志,2017,16(3):229-232.
[13]杨亚红,张映华,蔡玲,等.综合ICU一起疑似鲍曼不动杆菌感染暴发的调查[J].中国感染控制杂志,2017,16(6):536-539.
[14]寇华炜,温静,杨宝忠,等.重症监护室泛耐药鲍曼不动杆菌感染暴发流行调查与控制对策[J].现代预防医学,2012,39(18):4919-4921.
[15]刘艳.一起泛耐药鲍曼不动杆菌感染暴发调查[J].中国感染控制杂志,2014,13(11):688-695.
[16]中华人民共和国国家卫生和计划生育委员会.重症监护病房医院感染预防与控制规范:WS/T509-2016[S].北京,2016.