ICU泛耐药鲍曼不动杆菌感染暴发调查及控制

目的调查某院重症监护病房(ICU)泛耐药鲍曼不动杆菌医院感染暴发的原因,查找传染源与传播途径,为预防和控制医院感染的发生提供依据。方法对某院ICU2018年1—2月泛耐药鲍曼不动杆菌感染患者进行流行病学调查以及ICU环境卫生学监测,采取综合措施控制暴发流行。结果该院ICU短时间内10例患者发生泛耐药鲍曼不动杆菌感染,其中B08、C08、A02床患者标本检出的AB药敏结果相同,为一疑似克隆株;C09、B09、A03床患者标本检出的AB药敏结果相同,为另一疑似克隆株。通过环境卫生学监测,分别从输液泵、床头桌、床栏、输液塔、护理桌、监护仪、手消架、设备塔、床尾手摇、医务人员随身用品的标本中检出了类似的AB克隆株,采取综合控制措施后,未再出现新发泛耐药鲍曼不动杆菌感染病例,于3月5日从环境及医务人员手的标本中未再分离出耐药AB。结论 ICU医务人员手卫生状况差及环境消毒不彻底是导致此次医院感染暴发的主要原因。

Investigation and control of healthcare-associated infection outbreak caused by extensively drug-resistant Acinetobacter baumannii in intensive care unit

Objective To investigate the causes of healthcare-associated infection(HAI) outbreak caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB) in intensive care unit (ICU) of a hospital, and find out the sources and routes of transmission, so as to provide evidence for the prevention and control of HAI. Methods Epidemiological investigation of patients with XDR-AB infection and environmental hygiene monitoring on ICU of a hospital from January to February 2018 were carried out, comprehensive measures were taken to control the outbreak. Results XDR-AB infection occurred in 10 patients in ICU in a short period of time, antimicrobial susceptibi-lity testing results of AB isolated from B08, C08 and A02 beds were the same, which was a suspected clone, antimicrobial susceptibility testing results of AB isolated from C09, B09 and A03 beds were the same, which was another suspected clone. Through environmental hygiene monitoring, similar AB clones were isolated from the specimens of infusion pump, bedside table, bedside rail, infusion tower, nursing table, monitor, rack for hand disinfectant, equipment tower, hand-operated handle at the end of bed, and health care workers' paraphernalia. No new XDR-AB infection occurred after comprehensive control measures were taken, no drug-resistant AB was isolated from environment and health care workers' hands on March 5. Conclusion Poor hand hygiene of health care workers and incomplete environmental disinfection in ICU are the main causes for the outbreak of HAI.