神经内科ICU耐碳青霉烯类肺炎克雷伯菌感染疑似暴发调查与控制  

Investigation and control on a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae infection in the neurological intensive care unit

作　　者：韩颖[1] 赖晓全 徐敏 王洪波 田磊 魏诗晴 HAN Ying;LAI Xiao-quan;XU Min;WANG Hong-bo;TIAN Lei;WEI Shi-qing(Department of Healthcare-associated Infection Management;Department of Laboratory Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 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检验科,湖北武汉430030

出　　处：《中国感染控制杂志》2023年第5期569-573,共5页Chinese Journal of Infection Control

基　　金：国家自然科学基金资助项目(71974062)。

摘　　要：目的 调查神经内科重症监护病房(ICU)耐碳青霉烯类肺炎克雷伯菌(CRKP)感染暴发原因,为有效控制多重耐药菌医院感染提供依据。方法 对2021年6-7月某院神经内科ICU检出CRKP的患者进行现场流行病学调查和环境卫生学监测,并采取控制措施,评价防控效果。结果 共发生CRKP医院感染7例,罹患率为12.28%(7/57),与2019、2020年同期罹患率相比,差异有统计学意义(P<0.05)。环境卫生学监测显示:手标本CRKP检出率为6.67%(1/15),为1名保洁员手;环境物体表面CRKP检出率为5.45%(3/55),分别为19床床头柜、19床输液泵、1号床手持电脑(PDA)。在采取集中隔离CRKP感染患者,严格限制人员流动,病区清洁与消毒,加强手卫生监管等一系列针对性措施后,此次事件得到有效控制。结论 此次可判定为一起CRKP疑似医院感染暴发事件,推测CRKP感染患者未采取集中隔离措施、环境消毒不彻底及手卫生执行不到位是此次暴发事件的主要原因。早期识别感染暴发,调查原因,及时采取有效的针对性措施是控制感染暴发的关键。Objective To investigate the causes of the outbreak of carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in the neurological intensive care unit(ICU),and provide evidence for effective control of multidrug-resistant organism healthcare-associated infection(HAI).Methods An on-site epidemiological investigation and environmental hygiene monitoring were conducted on patients with CRKP infection in the neurological ICU of a hospital from June to July 2021.Control measures were taken,and the effectiveness of prevention and control mea-sures was evaluated.Results There were 7 cases of CRKP HAI cases,with an incidence of 12.28%(7/57),which was significantly different from the incidence during the same period in 2019 and 2020(P<0.05).Environmental hygiene monitoring showed that the isolation rate of CRKP from hand specimens was 6.67%(1/15),which was from the hand of a cleaner.Isolation rate of CRKP from environmental object surface was 5.45%(3/55),which were from bedside table and infusion pump of bed-19,as well as personal digital assistant-1(PDA-1).After taking a series of targeted measures such as centralized isolation of CRKP-infected patients,strict restriction on personnel movement,ward cleaning and disinfection,and strengthening hand hygiene supervision,the outbreak has been effectively controlled.Conclusion This event is considered as a suspected outbreak of CRKP HAI.It is speculated that the main causes for this outbreak were the failure to adopt centralized isolation measures for CRKP-infected patients,incomplete environmental disinfection,and poor execution of hand hygiene.Early identification of infection outbreak,investigation of causes,and timely adoption of effective targeted measures are key to controlling infection outbreaks.

关 键 词：神经内科 重症监护病房 耐碳青霉烯类肺炎克雷伯菌 多重耐药菌 暴发 

分 类 号：R181.32[医药卫生—流行病学]