一起烧伤病区疑似创面MRSA感染聚集的调查  

Investigation of a clustering of suspected traumatic MRSA infections in burn plastic surgery ward

作　　者：许波银[1] 李娴[2] 许海燕[3] 张海峰[1] 张弦[4] 曹玲[5] 宋培琴[6] 褚少朋[2] 袁咏梅[1] XU Bo-yin;LI Xian;XU Hai-yan;ZHANG Hai-feng;ZHANG Xian;CAO Ling;SONG Pei-qin;CHU Shao-peng;YUAN Yong-mei(Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China;不详)

机构地区：[1]南通大学附属医院感染管理办公室,江苏南通226001 [2]南通大学附属医院微生物实验室,江苏南通226001 [3]南通市疾病预防控制中心,江苏南通226001 [4]南通大学附属医院感染性疾病科,江苏南通226001 [5]南通大学附属医院烧伤病房,江苏南通226001 [6]南通大学附属医院护理部,江苏南通226001

出　　处：《中华医院感染学杂志》2024年第20期3113-3118,共6页Chinese Journal of Nosocomiology

基　　金：中国博士后科学基金资助项目(2020M670041ZX);南通市卫健委面上课题基金资助项目(MSZ2022002);南通市科技局社会民生科技基金资助项目(MS12021063);南通大学附属医院感染管理课题基金资助项目(Tfg2103)。

摘　　要：目的调查一起疑似烧伤创面耐甲氧西林金黄色葡萄球菌(MRSA)感染聚集事件,分析原因及医院感染防控存在的薄弱环节。方法选取2021年6月21-23日南通大学附属医院6例MRSA创面感染患者为研究对象,进行现场调查、流行病学调查及环境卫生学检测,对分离株耐药性及同源性进行分析。结果该病房全年新发医院感染25例次,感染部位以创面皮肤软组织为主;MRSA为主要病原菌;6月共检出MRSA10株,为全年检出最高峰,其中3例为医院感染病例;流行病学调查显示患者住院时间和空间分布存在部分交叉;病区收治患者数量多,床间距小;特殊耐药菌携带患者未按菌种集中安置;微生物检测结果显示病区物体表面、工作人员手及手卫生设施合格率低。患者鼻腔与创面MRSA分离株高度同源,仅对磺胺甲噁唑/甲氧苄啶、利福平、利奈唑胺、替加环素及万古霉素敏感;护工使用中防水围裙皱褶内及患者床头柜表面鲍氏不动杆菌(AB)分离株存在同源性;推断环境清洁消毒不到位,防护围裙污染可能是此次感染聚集事件的主要原因。结论严格执行接触隔离和手卫生规范,彻底的环境清洁与消毒是MRSA感染预防和控制的关键。同时加强多药耐药菌管理,及时发现和防控聚集性感染苗头,重视环境监测及分离株同源性分析,是控制医院感染暴发和精准防控的关键。OBJECTIVE To investigate a suspected aggregation of methicillin-resistant Sta phylococcus aureus(MR-SA)infection in burn wounds,and to analyze the causes and weakness in the prevention and control of nosocomial infection.METHOD From Jun.21 to 23,2021,six patients with MRSA wound infection in the Affiliated Hospital of Nantong University were selected as the study subjects,and on-site investigation,epidemiological surveys and environmental hygiene tests were carried out to analyze the drug resistance and homology of the obtained isolates.RESULTS A total of 25 new cases of nosocomial infection occurred in the ward throughout the year,the infection site was mainly the skin and soft tissue of the wound.MRSA was the main pathogen.In 6 months,a total of 10 strains of MRSA were detected,which was the highest in the whole year,and 3 cases of them were nosocomial infections.Epidemiological investigations showed that there was partial crossover in hospital duration and spatial distribution among patients.The number of patients admitted in the ward was large,with small spacing between beds.Patients carrying specific resistant bacteria were not housed in clusters according to strain.Microbiological test results showed a low pass rate of compliance of object surfaces,staff's hands and hand hygiene facilities in the word.The MRSA strains isolated from the nasal cavity and the wound were highly homologous,and were only sensitive to cotrimoxazole,rifampicin,linezolid,tigacycline and vancomycin.The AB isolated from the crease of the waterproof apron used by the nurse and the surface of the bedside table of the patient showed homology.It is deduced that inadequate cleaning and disinfection of the environment and contamination of the protective apron might be the main cause of the infection cluster event.CONCLUSIONS Strict implementation of contact isolation and hand hygiene norms,thorough environmental cleaning and disinfection were the key to MRSA infection prevention and control.Meanwhile,strengthening MDROs management,timely de

关 键 词：烧伤创面 耐甲氧西林金黄色葡萄球菌 聚集感染 同源性分析 流行病学调查 

分 类 号：R826.5[医药卫生—临床医学]