上海市医疗机构医护人员手部鲍曼不动杆菌检出率的相关因素分析  

Factors related to positive detection of Acinetobacter Baumannii on the hands of medical-staff in Shanghai

作　　者：张幸 田靓[1] 张红芝[2] 葛忆琳[2] 季晓帆 朱仁义[1] 黄绿斓 ZHANG Xing;TIAN Liang;ZHANG Hongzhi;GE Yilin;JI Xiaofan;ZHU Renyi;HUANG Lyulan(Department of Acute Communicable Disease Control and Prevention,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China;Department of Pathogenic Identification,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海市疾病预防控制中心传染病防治所,上海200336 [2]上海市疾病预防控制中心病原生物检定所,上海200336

出　　处：《上海预防医学》2022年第12期1234-1238,共5页Shanghai Journal of Preventive Medicine

基　　金：上海市加强公共卫生体系建设三年行动计划(2020—2022年)重点学科建设项目(GWV-10.1-XK16)。

摘　　要：【目的】了解上海市医疗机构重点科室医护人员手部鲍曼不动杆菌的检出情况及相关因素,为医院感染控制提供依据。【方法】2018—2020年度每季度对重点科室医生、护士和护工(保洁员)手部参照GB 15982—2012《医院消毒卫生标准》进行采样,对标本进行细菌培养、分离、鉴定。采样同时做问卷调查,记录采样对象从事职业的年限和其所使用的手消毒剂及其成分和实际使用的时间,共709件样本被纳入本研究。【结果】医护人员手部鲍曼不动杆菌检出率为7.05%。医护人员手部鲍曼不动杆菌检出率相关因素的logistic回归模型提示:科室、手消毒剂使用时间分组、医院等级及人员类别是医护人员手部鲍曼不动杆菌检出阳性的相关因素。与重症监护病房(ICU)相比,内科医护人员手部鲍曼不动杆菌检出阳性的风险是ICU的2.846倍(95%CI:1.402~5.776),外科医护人员手部鲍曼不动杆菌检出阳性的风险是ICU的3.357倍(95%CI:1.349~8.353);与使用的手消毒剂使用时间在14 d内相比,使用的手消毒剂在>14 d的医护人员手部鲍曼不动杆菌检出阳性的风险是14 d内的3.076倍(95%CI:1.534~6.168);与三级医院相比,二级医院的医护人员手部鲍曼不动杆菌检出阳性的风险是三级医院的2.235倍(95%CI:1.088~4.588);与护士相比,护工手部鲍曼不动杆菌检出阳性的风险是护士的3.634倍(95%CI:1.764~7.484)。【结论】医护人员手部鲍曼不动杆菌检出率为7.05%。科室、手消毒剂使用时间分组、医院等级和人员类别是医护人员手部鲍曼不动杆菌检出率的相关因素。重点科室中医护人员需要加强手卫生,尤其是护工。内、外科须重视环境清洁消毒。[Objective]This study aimed to investigate the risk factors affecting the positive detection of Acinetobacter baumannii on the hands in medical staff of hospitals in Shanghai,and provide epidemiological evidence for the prevention and control of nosocomial infections.[Methods]The hands of doctors,nurses and care workers in key departments were sampled every quarter from 2018 to 2020 according to GB 15982-2012"Hospital Disinfection and Hygiene Standards".Separation and identification of A.baumannii were followed with sampling shortly.Information about the working years of sampling subjects,the hand sanitizers of which sampling subjects had used and the ingredients and actual using time of the hand sanitizers was collected while sampling.Finally,709 samples were selected for this research after excluding the unqualified samples.[Results]The positive detection of the hand samples was 7.05%.The logistic regression model suggested that the department,the time of using hand sanitizer,the hospital grade and occupational category were determinants of A.baumannii positive detection on hands in medical staff.The risk of A.baumannii positive detection in internal medicine department was 2.846(95%CI:1.402-5.776)times higher than that in intensive care unit while it was 3.357(95%CI:1.349-8.353)times higher in surgery department than that in intensive care unit.Regarding the use of hand sanitizer,the risk of A.baumannii positive detection was 3.076(95%CI:1.534-6.168)times higher in the staff used the hand sanitizer over 14 days than in the medical staff used the sanitizer within 14 days.The risk of A.baumannii positive detection in medical worker in secondary hospitals was 2.235(95%CI:1.088-4.588)times than in tertiary hospitals.The risk of A.baumannii positive detection of care workers was 3.634(95%CI:1.764-7.484)times higher than nurses.[Conclusion]The positive detection of hand samples was 7.05%.Department,the time of using hand sanitizer,the hospital grade and occupational category were determinants of A.baumannii positive

关 键 词：鲍曼不动杆菌 手卫生 相关因素 医护人员 

分 类 号：R187[医药卫生—流行病学]