某医院重症监护病房泛耐药鲍曼不动杆菌疑似感染暴发的调查与处置  

Investigation and treatment of a suspected outbreak of extensively drug-resistant Acinetobacter baumannii infection in ICU of a hospital

作　　者：刘迪 赵晓宇[1] 刘佳微 武慧荷 刘玉芹 王凯[1] 冶挺 LIU Di;ZHAO Xiao-yu;LIU Jia-wei;WU Hui-he;LIU Yu-qin;WANG Kai;YE Ting(Qinghai Provincial People’s Hospital,Xining Qinghai 810000,China)

机构地区：[1]青海省人民医院,青海西宁810000

出　　处：《中国消毒学杂志》2021年第1期58-62,共5页Chinese Journal of Disinfection

摘　　要：目的调查某医院重症监护病房(ICU)发生的泛耐药鲍曼不动杆菌(XDR-AB)引起的疑似医院感染暴发的原因。方法收集8例感染XDR-AB的患者资料,对疑似受到污染的环境物品开展环境卫生学监测采样,进行微生物培养和致病菌鉴定、开展药敏检测试验,并通过调取感染发生期间ICU的监控录像及开展现场手卫生观察2种方式调查医务人员无菌操作及手卫生执行情况。结果该医院ICU在2019年1-3月内连续发生8例XDRAB感染患者,属于疑似医院感染暴发。患者平均年龄58.38±16.41岁,2例转科继续治疗,4例出院,2例死亡。观察到医务人员手卫生依从性为36.36%。在该ICU空气、物体表面、医务人员标本中,检出鲍曼不动杆菌共22株,检出率55%。结论该医院此次综合ICU所发生的XDR-AB感染与环境消毒不彻底、医务人员手卫生依从性差、无菌操作不规范相关。通过落实整改措施,有效控制了本次疑似院内感染的发展。Objective To investigate the causes of a suspected nosocomial infection outbreak caused by extensively drug-resistant Acinetobacter baumannii(XDR-AB)in intensive care unit(ICU)of a hospital.Methods By collecting the data of 8 patients infected with XDR-AB,environmental items suspected of being contaminated were monitored by environmental hygiene,microbial culture and pathogen identification and drug susceptibility testing experiments were carried out.medical staff’s sterility operation and hand hygiene implementation were investigated by retrieving surveillance video and field on-site hand hygiene observation.Results There were 8 consecutive cases of XDR-AB infection from January to March in 2019 in the ICU of the hospital,which was a suspected nosocomial infection outbreak.The average age of the patients was 58.38±16.41 years old,2 cases were transferred to another department for further treatment,4 cases were discharged,and 2 cases died.It was observed that the hand hygiene compliance of medical staff was 36.36%.A total of 22 strains of Acinetobacter baumannii were detected in the air,surface of objects,and specimens of medical staffs in the ICU,with a detection rate of 55%.Conclusion The XDR-AB infection in general ICU of the hospital was related to the incomplete disinfection of environment,poor compliance of medical staff’s hand hygiene and irregular aseptic operation.Through the implementation of rectification measures,the suspected nosocomial infection was controlled effectively.

关 键 词：泛耐药菌 鲍曼不动杆菌 重症监护病房 疑似医院感染暴发 防控措施 

分 类 号：R184[医药卫生—流行病学] R197.323[医药卫生—公共卫生与预防医学]