心脏大血管外科ICU一起疑似耐碳青霉烯类鲍氏不动杆菌医院感染暴发的调查  

Investigation on outbreak of suspected nosocomial infection of carbapenem-resistant Acinetobacter baumannii in intensive care unit of cardiovascular surgery department

作　　者：谭昆 韩秀娟[2] 赖晓全 马思旻 TAN Kun;HAN Xiu-Juan;LAI Xiao-quan;MA Si-min(Tongji Hospital,Tongji Medical College,Hua zhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院医院感染管理科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院医院心脏大血管外科,湖北武汉430030

出　　处：《中华医院感染学杂志》2022年第12期1789-1793,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(71974062);湖北省卫生健康委面上基金资助项目(WJ2019M142)。

摘　　要：目的 对心脏大血管外科重症监护病房一起疑似耐碳青霉烯类鲍氏不动杆菌(CRAB)医院感染暴发进行调查,为多药耐药菌医院感染暴发的预防与控制提供参考。方法 对2021年11月某三级医院心脏大血管外科重症监护病房的5例CRAB感染患者进行流行病学调查和环境卫生学检测,并采取针对性干预措施。结果 流行病学调查发现5例CRAB医院感染的住院时间和床位存在重叠或相邻,护理人员存在交叉,抗菌药物使用强度均较高;环境卫生学监测显示CRAB检出率为5.97%(4/67),检出部位为监护仪面板、吸氧仪、床头柜和加压袋;5株患者检出的CRAB菌株和4株环境检出的CRAB菌株药敏结果基本一致。采取加强接触隔离措施落实,规范手卫生的正确执行,定时对环境物表采取有效的清洁消毒措施并进行主动监测评价,以及联合多部门规范医生抗菌药物的使用等针对性干预措施后,此次事件得到有效控制。结论 心脏大血管外科重症监护病房内环境物表的清洁消毒不及时不彻底,医务人员接触隔离措施落实不到位,抗菌药物使用强度过高可能是导致此次疑似CRAB医院感染暴发的主要原因。及时识别风险因素并采取针对性干预措施可有效控制医院感染暴发。OBJECTIVE To investigate an outbreak of suspected carbapenem-resistant Acinetobacter baumannii(CRAB) nosocomial infection in the intensive care ward of cardiovascular surgery department, so as to provide references for the prevention and control of multidrug-resistant nosocomial infection outbreaks. METHODS Epidemiological investigation and environmental hygiene detection were conducted on 5 patients with CRAB infection who were treated in the intensive care ward of cardiovascular surgery department from a tertiary hospital during Nov. 2021, and the targeted intervention measures were taken. RESULTS The epidemiological survey found that the hospitalization time and beds of 5 patients with CRAB nosocomial infection were overlaped or adjacent, the nursing staff overlapped, and the intensity of antibiotics use was high;the environmental hygiene monitoring showed that the detection rate of CRAB was 5.97%(4/67), and the detection sites were monitor panel, oxygen inhaler, bedside table and pressurized bag;the drug susceptibility results of the 5 CRAB strains detected in patients were basically consistent with that of 4 CRAB strains isolated from the environment. After adopting targeted intervention measures such as enhancing contact isolation, standardizing the correct implementation of hand hygiene, regularly taking effective cleaning and disinfection measures on the environment and object surfaces and conducting active monitoring to evaluate, and cooperating with multiple departments to regulate the use of antibiotics by doctors, the incident was effectively controlled. CONCLUSION The lack of timely and thorough cleaning and disinfection of the environment and object surfaces, the inadequate implementation of contact isolation measures for medical staff, and the excessive use of antibiotics might be the main reasons for the outbreak of suspected CRAB nosocomial infection in the intensive care ward of cardiovascular surgery department. Timely identification of risk factors and targeted intervention strategies can effe

关 键 词：耐碳青霉烯类鲍氏不动杆菌 疑似医院感染暴发 重症监护病房 调查 

分 类 号：R378[医药卫生—病原生物学]