综合干预措施防控急诊重症病区耐碳青霉烯类肠杆菌科细菌的效果研究  

Effects of Comprehensive Intervention Measures on Prevention and Control of Carbapenem-resistant Enterobacteriaceae in Emergency Intensive Care Unit

作　　者：周仕丹[1] 刘春来[1] 李妍 曹海燕[2] 庄志辉[3] 贾玲 孙坚[4] 晏辉钧 ZHOU Shidan;LIU Chunlai;LI Yan;CAO Haiyan;ZHUANG Zhihui;JIA Ling;SUN Jian;YAN Huijun(Dept.of Hospital Infection Management,Huizhou Municipal Central Hospital,Guangdong Huizhou 516001,China;Inspection Center,Huizhou Municipal Central Hospital,Guangdong Huizhou 516001,China;Emergency Intensive Care Unit,Huizhou Municipal Central Hospital,Guangdong Huizhou 516001,China;College of Veterinary Medicine,South China Agricultural University,Guangdong Guangzhou 510642,China;Dept.of Microbiology,Zhongshan Medical College,Sun Yat-sen University,Key Laboratory of Tropical Disease Control,Sun Yat-sen University,Ministry of Education,Guangdong Guangzhou 510080,China)

机构地区：[1]惠州市中心人民医院医院感染管理部,广东惠州516001 [2]惠州市中心人民医院检验中心,广东惠州516001 [3]惠州市中心人民医院急诊重症病区,广东惠州516001 [4]华南农业大学兽医学院,广东广州510642 [5]中山大学中山医学院微生物学教研室,中山大学热带病防治研究教育部重点实验室,广东广州510080

出　　处：《中国医院用药评价与分析》2021年第7期886-889,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：惠州市科技计划项目(No.2020Y534)。

摘　　要：目的:了解耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)在急诊重症病区(emergency intensive care unit,EICU)的检出情况,探讨EICU落实综合干预措施防控CRE的效果,为医院感染防控提供参考依据。方法:某三级甲等医院(以下简称“该院”)院感专职人员分别于2017年、2018年对EICU的环境与物体表面、医务人员以及住院患者进行采样,筛查CRE;2018—2020年,通过严格落实手卫生、隔离措施、清洁消毒、主动监测等集束化感控措施,评价干预效果。结果:2017年,在该院EICU的1个回风口表面检出1株耐碳青霉烯类大肠埃希菌(carbapenem-resistant Escherichia coli,CREC),该菌带有多种碳青霉烯类耐药基因(bla_(IMP-4)、bla_(NDM-1)和bla_(VIM-2));2018—2020年,该院EICU的医院感染发病率逐年降低,未发现CRE引起的医院感染患者。结论:采用综合干预措施,可有效地减少CRE在病区环境与物体表面的定植,减少CRE在病区的交叉传播。OBJECTIVE:To investigate the detection status of carbapenem-resistant Enterobacteriaceae(CRE)in emergency intensive care unit(EICU),and to explore the effect of comprehensive intervention measures for prevention and control of CRE in EICU,so as to provide reference for prevention and control of nosocomial infection.METHODS:In 2017 and 2018,the environment and surface of the EICU,the medical personnel and inpatients were sampled by the professional staff of a grade Ⅲ,level A hospital(hereinafter referred to as“the hospital”)to screen for CRE.From 2018 to 2020,the effectiveness of the intervention were evaluated through strict implementation of cluster infection control measures such as hand hygiene,isolation measures,cleaning and disinfection and active monitoring.RESULTS:In 2017,the carbapenem-resistant Escherichia coli strain with multiple carbapenem resistance genes(bla IMP-4,bla NDM-1 and bla VIM-2)was detected on the surface of the return air vent in EICU.From 2018 to 2020,the incidence of nosocomial infection in EICU decreased year by year,and no nosocomial infection caused by CRE was found.CONCLUSIONS:Comprehensive intervention measures can effectively reduce the colonization of CRE in the environment and on the surface of objects,and reduce the cross-transmission of CRE in the ward.

关 键 词：耐碳青霉烯类肠杆菌科细菌 医院保健相关感染 手卫生 多重耐药菌 

分 类 号：R978.1[医药卫生—药品]