一起疑似导管相关血流感染暴发的调查  

Investigation on a suspected outbreak of catheter-related bloodstream infection

作　　者：王淑颖[1] 任淑华[1] 袁美娟[1] 赵洪峰[1] 金慧成[1] 沈强[1] 宋爱华[1] 

机构地区：[1]杭州市第一人民医院感染管理科,310006

出　　处：《国际流行病学传染病学杂志》2014年第5期317-320,共4页International Journal of Epidemiology and Infectious Disease

基　　金：杭州市科技发展计划项目（20120633B01）

摘　　要：目的探讨导管相关血流感染（CRBSI）暴发的判定，为其防控提供临床依据。方法对2013年10月1一15日发生在杭州市某医院的6例疑似CRBSI病例的临床特征、病原学结果、流行病学资料及环境卫生学监测结果等进行回顾分析。结果根据血培养及导管尖端病原培养或两套血培养病原一致性，6例疑似CRBSI病例最终确诊3例，均为胃肠道肿瘤术后患者，病原分别为耐甲氧西林凝固酶阴性葡萄球菌（MRC-NS）、耐甲氧西林表皮葡萄球菌（MRSE）、大肠埃希菌。3例确诊患者问无明显流行病学关联。环境卫生学监测未检出多重耐药致病菌以及与上述患者病原菌一致的病原微生物，但医务人员手卫生检查合格率为80％。结论此次疑似CRBSI暴发事件为假暴发，CRBSI的暴发应根据病原学诊断一致性来判断。胃肠道肿瘤术后常因留置中心静脉导管及肠外营养液输注，尤其容易引发血流感染。医务人员应注意手卫生在院内感染中的重要作用。Objective To investigate the diagnosis of catheter related bloodstream infection （CRBSI） outbreak, so as to provide basis for its prevention and control. Methods The clinical characteristics, etiology, epidemiological data and environmental hygiene monitoring results of a suspected CRBSI outbreak with 6 cases in a hospital in Hangzhou city from October 1st to 15th 2013 were analyzed. Results According to the pathogen culture results from peripheral blood samples and catheter tip samples or the consistency in results of two sets of blood culture, 3 cases were finally confirmed as having CRBSI out of 6 suspected CRBSI cases. The 3 CRBSI cases all received gastrointestinal tumor resection and their pathogens were methicillin resistant coagulase negative Staphylococcus （MRCNS）, methieillin-resistant Staphylococcus aureus （MRSE）, Escherichia coli, respectively. No significant epidemiological association was found among the 3 cases. Environmental hygiene monitoring found neither multidrug-resistant pathogens nor the same pathogenic bacteria that infected the patients, but that the qualified rate of hand hygiene of medical staff was only 80%. Conclusions The suspected CRBSI outbreak was a false one this time. The identification of the disease outbreak should be established on the consistency of different etiological diagnosis. Because of indwelling central catheters and intestinal venous nutrition transfusion, patients with gastrointestinal cancer after operation are especially easy to have bloodstream infection. Medical staff should pay more attention to hand hygiene.

关 键 词：导管 留置 血流感染 流行病学 

分 类 号：R197.3[医药卫生—卫生事业管理]