实习护士与医务人员鼻腔多药耐药菌定植现状调查  

Investigation of current multiple drug-resistant status colonizing bacterial in nasal of student nurses and medical staffs

作　　者：白艳玲 闫中强[2] 索继江[1] 刘华[3] 赵璇[3] 杨阳[4] 郑志刚 于季红[6] 李璐[1] 刘伯伟[1] 姚宏武[1] 刘运喜[1] BAI Yan-ling;YAN Zhong-qiang;SUO Ji-jiang;LIU Hua;ZHAO Xuan;YANG Yang;ZHENG Zhi-gang;YU Ji-hong;LI Lu;LIU Bo-wei;YAO Hong-wu;LIU Yun-xi(Chinese PLA General Hospital,Beijing100853,China)

机构地区：[1]解放军总医院感染管理与疾病控制科,北京100853 [2]解放军总医院第二医学中心感染管理与疾病控制科,北京100853 [3]解放军总医院第一医学中心神经内科,北京100853 [4]解放军总医院第一医学中心护理部,北京100853 [5]中央军委后勤保障部办公厅第一门诊部,北京100842 [6]解放军总医院第二医学中心国际部检验科,北京100853

出　　处：《中华医院感染学杂志》2019年第20期3180-3184,共5页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2017YFC0806308);传染病防治重点基金资助项目(2018ZX10733402);解放军总医院临床科研扶持基金资助项目(2017FC-GLCX-3001)

摘　　要：目的了解实习护士及医院医务人员鼻腔多药耐药菌携带情况及指导正确的隔离防护。方法随机选择2018年6月-2019年2月来解放军总医院实习的新护士61人,分别于实习前、实习7个月采集鼻拭子送检;不同时间段采集重症医学科、呼吸科监护室、急诊科监护室、神经内科监护室及神经内科3个普通病区的115名医务人员及已实习3个月的18名实习护士鼻拭子送检,进行病原菌鉴定,并做药敏分析,筛选耐甲氧西林金黄色葡萄球菌(Methicillin-resistant staphylococcus aureus,MRSA)及耐碳青霉烯类肠杆菌科细菌(Carbapenems resistant enterobacter,CRE)了解定植情况。结果共采集标本255份,医务人员未检出CRE,MRSA检出率15.38%;实习护士未检出CRE,MRSA检出率33.33%;新实习护士实习7个月后未检出CRE,MRSA检出率为100.00%,三组人员MRSA检出率差异有统计学意义(P=0.001)。不同人员类别MRSA检出率差异有统计学意义(P=0.001);未实习护士实习前及实习7个月MRSA检出率差异有统计学意义(P=0.012);不同ICU与普通病区医务人员MRSA检出率差异无统计学意义(P=0.416)。结论未实习护士及实习护士鼻腔MRSA携带率高于医务人员,可能与医院重视隔离防护有关,建议对新入科护士做鼻腔定植菌的监测及去定植,并在工作中加强防护。OBJECTIVE To investigate the carrying situation of multi-drug resistant bacteria in nasal cavity of student nurses and hospital medical staff and to guide proper isolation protection.METHODS Nasal swabs were collected before-and after-7months internship of 61student nurses who were randomly selected in PLA general hospital from Jun.2018to Feb.2019.Swabs also sampled at different time-period from 115medical staff who worked in intensive care department,respiratory ICU,emergency ICU,neurology ICU and three general wards of neurology,and 18student nurses who had 3months internship.Those swabs were sent for pathogen identification and drug sensitivity analysis to screen the colonization of methicillin-resistant Staphylococcus aureus(MRSA)and carbapenems-resistant Enterobacter(CRE).RESULTS A total of 255samples were collected,CRE was not detected and MRSA detection rate was 15.38%of medical staff;CRE was not detected and MRSA detection rate was 33.33%of student nurses;CRE was not detected and MRSA detection rate was 100.00%of student nurse after 7 months internship.The difference in MRSA detection rate was significant(P=0.001).There were significant differences in MRSA detection rate of different personnel categories(P=0.001).The difference in MRSA detection rate was significant of student nurse before-and after-7months internship(P=0.012).There was no significant difference in MRSA detection rate between medical staff in different ICU and general ward(P=0.416).CONCLUSION MRSA carrying rate in nasal cavity of student nurses before-and after internship was higher than that of medical staff,which may be related to the hospital's emphasis on isolation and protection.It is suggested that the newly admitted nurses should be monitored and implanted with nasal colonization bacteria,and strengthen the protection during work.

关 键 词：实习护士 医务人员 鼻腔 肺炎克雷伯菌 耐甲氧西林金黄色葡萄球菌 

分 类 号：R378[医药卫生—病原生物学]