新冠重症ICU一起疑似耐碳青霉烯类鲍氏不动杆菌医院感染暴发调查与现场处理  

Investigation of suspected outbreak of nosocomial infection of carbapenemresistant Acinetobacter baumannii in COVID-19 infected patients in severe condition treated in intensive care unit and onsite treatment

作　　者：曾慧[1] 孟庆兰[1] 张莉[1] 刘敏[1] 郭慧青 ZENG Hui;MENG Qing-lan;ZHANG LI;LIU Min;GUO Hui-qing(The Affiliated Hospital of Inner Mongolia Medical University,Hohhot,Inner Mongolia 010050,China)

机构地区：[1]内蒙古医科大学附属医院疾病预防控制部,内蒙古呼和浩特010050

出　　处：《中华医院感染学杂志》2023年第23期3669-3673,共5页Chinese Journal of Nosocomiology

基　　金：内蒙古自治区科学技术厅基金资助项目(2021GG0235)。

摘　　要：目的调查新型冠状病毒感染(简称新冠)重症患者救治重症监护病房(ICU)耐碳青霉烯类鲍氏不动杆菌(CRAB)医院感染暴发原因,分析事件危险因素。方法对2023年1月12日-1月31日内蒙古医科大学附属医院新冠重症ICU的8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。结果该院新冠重症ICU短期内出现8例患者CRAB感染,流行病学调查显示上述患者均为新冠病毒感染患者,基础病情重,存在住院时间重叠、床单元面积不足、护工存在交叉、保洁员为新员工,物表擦拭消毒不规范;环境微生物调查中,共采集65份环境表面和医务人员手标本,3份检出CRAB,检出率为4.62%(3/65),异常部位分别为患者床栏、监护仪面板、营养泵,其药敏结果与8株患者检测出的CRAB基本一致;通过采取暂停收治患者、加强多药耐药菌防控培训、规范工作人员手卫生、加强落实消毒隔离等干预措施后,该事件得到有效控制。结论新冠重症ICU应急扩容改造,布局流程不尽合理,环境物表清洁消毒不及时不彻底,CRAB感染医务人员接触隔离措施落实不到位,可能是导致此次CRAB医院感染暴发的主要原因。OBJECTIVE To investigate the cause of suspected outbreak of nosocomial infection of carbapenem-resistant Acinetobacter baumannii(CRAB)in patients with severe COVID-19 infection in the intensive care unit(ICU)and to analyze the risk factors for the event.METHODS Epidemiological investigation and environmental hygiene detection were conducted on eight patients with CRAB infection in the ICU of the Affiliated Hospital of Inner Mongolia Medical University from Jan 12 to Jan 31 in 2023,and the corresponding intervention measures were taken.RESULTS CRAB infection occurred in eight severe cases of COVID-19 in ICU in a short period of time.Epidemiological investigation showed that all the above patients were COVID-19 infected patients with serious basic conditions,and the problems including overlapping hospital stays,insufficient bed sheet area,overlapping nursing workers,new cleaning staff and non-standard cleaning and disinfection of surfaces existed.In the investigation of environmental microorganisms,a total of 65 specimens were collected from the environmental surfaces and hands of healthcare workers.CRAB was detected in three samples,with a detection rate of 4.62%(3/65).The abnormal sites were patient bed rails,monitor panels and nutrition pumps,in which the sensitivity results were basically consistent with eight strains of CRAB detected in patients.After taking intervention measures such as suspending the treatment of patients,strengthening the training of prevention and control of multi-drug resistant bacteria,standardizing the hand hygiene of staff,and strengthening the implementation of disinfection and isolation,the incident was effectively controlled.CONCLUSION The emergency capacity expansion and transformation of COVID-19 intensive care unit(ICU),unreasonable layout process,incomplete cleaning and disinfection of environmental surface,and inadequate implementation of contact isolation measures for medical personnel infected with CRAB may be the main reasons for the outbreak of nosocomial infection of CRAB.

关 键 词：新型冠状病毒感染 耐碳青霉烯类鲍氏不动杆菌 医院感染 暴发 流行病学调查 现场防控 

分 类 号：R181.3[医药卫生—流行病学]