一起由骨科医生携带金黄色葡萄球菌引发的手术部位感染聚集事件调查与处置  

Investigation and disposal of an outbreak of surgical site infection caused by orthopedic doctors carrying Staphylococcus aureus

作　　者：郭艳[1,2] 陈文森 付路 刘根焰[4] 洪欣[4] 张翔 GUO Yan;CHEN Wensen;FU Lu;LIU Genyan;HONG Xin;ZHANG Xiang(Department of Infection Management,The First People’s Hospital of Zhengzhou,Zhengzhou 450002,China;Department of Infection Management,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Infection Management,Affiliated Maternity and Child Health Care Hospital of Nantong University,Nantong 226000,China;Department of Laboratory Medicine,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]郑州市第一人民医院感染管理处,河南郑州450002 [2]南京医科大学第一附属医院感染管理处,江苏南京210029 [3]南通大学附属妇幼保健院感染管理科,江苏南通226000 [4]南京医科大学第一附属医院检验科,江苏南京210029

出　　处：《中国感染控制杂志》2025年第1期85-92,共8页Chinese Journal of Infection Control

基　　金：江苏省医院协会医院管理创新研究课题(JSYGY-3-2023-363)。

摘　　要：目的探讨一起手术部位感染(SSI)聚集事件发生的危险因素。方法对2017年6—7月某医院骨科发生的SSI患者进行调查,通过病例对照研究分析感染高危因素,并对患者、医务人员、环境及手术器械进行微生物采样,应用脉冲场凝胶电泳(PFGE)分析患者与环境分离菌株的同源性。结果从4名医务人员鼻腔分泌物分离出金黄色葡萄球菌,其中1名医生D1额及手也分离出金黄色葡萄球菌。PFGE分析发现,2例患者切口分泌物与医生D1鼻腔、额与手分离的金黄色葡萄球菌具有同源性。针对性采用综合感染控制措施,包括:暂停医生D1手术与换药等无菌操作;对包括医生D1在内的所有携带金黄色葡萄球菌的医务人员进行去定植,要求医生D1定期修剪鼻毛;加强无菌操作与手卫生的宣教与监管;将SSI患者集中隔离等。及时施行以上综合干预措施后,这起SSI聚集事件在短时间内得到了有效控制。结论外科医生金黄色葡萄球菌定植可能会导致患者SSI,可考虑对参与特定手术的外科医生定期进行主动筛查与去定植,必要时要求鼻毛茂盛的鼻腔定植者定期修剪鼻毛,以减少SSI的发生。Objective To investigate risk factors for the occurrence of an outbreak of surgical site infection(SSI)in the orthopedic department of a hospital.Methods Patients with SSI in the orthopedic department of a hospital in June-July 2017 were investigated,and the high-risk factors for infection were analyzed through case-control study.Specimens were taken from patients,health care workers(HCWs),environment and surgical devices for microbial detection.The homology between patients’and environmental isolates was analyze by pulsed-field gel electrophoresis(PFGE).Results Staphylococcus aureus(S.aureus)were isolated from nasal secretion of four HCWs,including one doctor(D1)who was also isolated S.aureus from his forehead and hands.PFGE analysis found that S.aureus isolated from incision secretion of 2 patients were homologous to S.aureus isolated from the nasal cavity,forehead,and hands of doctor D1.Several targeted comprehensive infection control measures were implemented,including suspending sterile manipulation(such as surgery and dressing changes)of doctor D1;decolonization for all HCWs(including doctor D1)who carried S.aureus,requiring doctor D1 regularly trim nasal hair;strengthening the education and supervision of sterile manipulation and hand hygiene;implementing centralized isolation for SSI patients,et al.After timely implementation of the above comprehensive intervention measures,this SSI outbreak was effectively controlled in a short period of time.Conclusion Colonization of S.aureus in surgeons may lead to SSI in patients,regular active screening and decolonization of surgeons involved in specific surgeries can be considered,and if necessary,nasal colonized people with dense nasal hair are required to regularly trim their nasal hair to reduce the occurrence of SSI.

关 键 词：骨科手术 手术部位感染 医院感染聚集事件 流行病学调查 脉冲场凝胶电泳 同源性分析 去定植 

分 类 号：R181.32[医药卫生—流行病学]