ICU耐甲氧西林金黄色葡萄球菌快速监测及防控

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)在ICU的定植、分布及其防控效果。方法新进入ICU病房患者即刻采鼻前庭拭子和72h后符合呼吸道感染指针患者的吸痰导管标本。采用荧光PCR快速检测mecA、nuc基因。并定期对医护人员鼻腔、手等相关环境标本跟踪监测防控。结果 MRSA阳性率检出率:患者鼻前庭拭子为9.9%,吸痰导管为2.7%;医护人员鼻前庭拭子为7.1%、手为4.0%、袖口为4.4%;MRSA阳性医护人员与患者鼻腔采用莫匹罗星擦拭,手加强消毒后MRSA检出率均为0.0%,但每季度医护人员鼻腔MRSA仍有检出。结论 PCR方法阳性率明显高于常规培养方法。鼻腔前庭是MRSA的主要定植部位,是主要感染源,手是重要传播途径,监测重症监护室患者鼻腔前庭及医护人员的鼻腔前庭、手是控制MRSA院内感染的重要防控目标。     

医护人员携带MRSA及其耐药基因的研究

目的研究医院医护人员携带耐甲氧西林金黄色葡萄球菌及其抗药基因携带情况,为抗菌药物合理使用提供参考。方法采用细菌分离鉴定方法和基因扩增技术,对医院医护人员鼻前庭和手上采集的标本进行了细菌分离鉴定和抗药基因检测。结果上海市医院4种岗位医护人员鼻前庭MRSA平均携带率为1.81%,手上MRSA平均携带率为0.83%,以医生和工勤人员携带率较高。鼻前庭分离的MRSA菌株qacA基因阳性率为33.33%,手分离到的MRSA菌株qacA基因的阳性率为54.55%。结论上海市医院医护人员鼻前庭和手上MRSA携带率不高,但此类菌株抗消毒剂基因阳性率较高,提示应加强适时监控。     

MRSA在ICU分布情况调查与随机扩增多态性DNA同源性分析

目的:监测ICU医护人员、住院患者,及环境中MRSA的携带及分布情况,以提出针对性预防与控制措施。方法:对本院ICU的20位医护人员、8例住院患者的手、咽和鼻前庭等部位,及ICU环境中的物体表面和空气同时进行采样,采用免疫富集-显色培养基分离MRSA,应用VITEK 32全自动微生物分析仪进行菌种鉴定和药敏试验;对MRSA进行随机引物扩增多态DNA检测并进行同源性分析;比较MRSA的耐药谱分型和随机扩增多态性DNA基因分型之间的差异,判断医护人员、住院患者及环境中分离的MRSA的相关性。结果:共检出31株MRSA,20位医护人员11位检出15株MRSA,8位患者5位检出9株MRSA,分离于同一个体不同部位的重复分离株经随机扩增多态性DNA同源性分析均为同一克隆菌株。52份环境物体表面检出7株MRSA。根据随机扩增多态DNA聚类分析可以将检出的MRSA分为3个类型。结论:医护人员MRSA带菌率较高,部分医务人员、住院患者和环境中分离的MRSA有较高的同源性,ICU存在人与人和人与环境之间的MRSA传播。     

医院环境MRSA检测在院内感染控制的意义研究

目的：了解医院环境MRSA检测在院内感染控制的意义。方法：在2010年10月至2012年2月期间,对我院各临床科室的医护人员、陪护人员的手和鼻前庭、住院患者的床头柜、床沿、床头和门把手进行采样,其中床头柜4株,床头和门把手各2株,住院患者床沿、医护人员手和陪护人员鼻前庭各1株。取标本358份标本,细菌鉴定利用VITEK-32和ATB半自动微生物鉴定仪进行。结果：共分离出65株葡萄球菌,而耐甲氧西林金黄色葡萄球菌（MRSA）为11株,占葡萄球菌的16.92%。结论：我院环境标本中MRSA分离率较高,为达到预防、减少和控制MRSA感染的目的,需要提高医院的环境质量。     

一起MRSA医院感染暴发的调查与控制

目的调查一起耐甲氧西林金黄色葡萄球菌(MRSA)医院感染暴发的原因,探索有效的控制措施。方法通过现场调查及对标本的病原学检测,了解发病原因,提出有效控制措施。结果该医院在较短时间内连续发生13例MRSA感染病人,为一起MRSA医院感染暴发事件。从13例患者标本中所分离的MRSA除对利奈唑胺和万古霉素全部敏感之外,对其他10种临床常用抗菌药物全部耐药。经细菌基因分析证明13例患者感染的MRSA具有同源性,同时也同环境标本分离的MRSA具有同源性。结论该医院发生一起MRSA医院感染暴发事件,感染的发生与医务人员手及诊疗用品接触传播有关,经积极采取有效控制措施使疫情得到及时控制。     

强化手卫生控制ICU内MRSA感染的效果分析

目的探讨强化手卫生，包括改进医护人员洗手条件，加强洗手教育，提高洗手依从性等措施，对ICU内耐甲氧西林金葡菌（MRSA）感染控制的效果。方法监测分析强化手卫生前后ICU内痰标本MRSA菌株检出率的变化。结果强化手卫生使ICU内痰标本MRSA的检出率从16．9例／1000人天／月降低到9．3（P〈0．05），并且降低的程度与医护人员洗手依从率密切有关。结论强化手卫生对控制ICU内MRSA的医院感染切实有效，而合理安排工作量，加强教育和监督才能提高洗手依从性。     

ICU多重耐药菌感染患者目标监测与干预

目的 了解多重耐药菌在ICU中的流行情况并采取积极的控制措施,防止发生多重耐药菌医院感染暴发流行.方法 对ICU多重耐药菌进行目标性监测,分析2009-01-2010-12 ICU送检标本检出的多重耐药菌资料,并采取干预措施.结果 实施24个月内,检出感染或定植多重耐药菌152例,占全部送检菌株的45.30％,感染部位以下呼吸道为主,占67.76％(103株),耐药菌株以产ESBLs的菌株为主,共1 22株(80.26％),均采取了手卫生、接触隔离、合理使用抗生素等干预措施,未发生医院感染暴发流行.结论 合理使用抗菌药物,采取隔离措施,加强医务人员的清洁手消毒等干预措施,能有效预防多重耐药菌的发生与流行.     

实施目标性监测和综合干预措施对降低骨科术后耐甲氧西林金黄色葡萄球菌医院感染的效果分析

摘要 目的 分析医院实施MRSA目标性监测和综合干预措施对降低骨科术后MRSA医院感染的效果。方法 选取某院骨科手术患者,2018年1-6月为干预前阶段,2018年7月-12月为干预阶段,对骨科手术患者实施MRSA目标性监测和综合干预措施,分析骨科患者术后MRSA院内感染的危险因素,对比干预前后医护人员手和鼻咽部MRSA检出情况和各项干预措施依从性以及骨科MRSA院内感染的趋势。结果 骨科患者术后MRSA院内感染的危险因素是开放性骨折﹑手术时间﹑应用抗生素种类和糖尿病。干预前医护人员手MRSA检出10例,鼻咽部MRSA检出12例,干预后医护人员手MRSA检出2例,鼻咽部MRSA检出1例,2组数据比较差异有统计学意义(P<0.05)|干预后各预防防控措施依从性也有了不同程度的提高|干预前骨科患者标本MRSA检出35例,干预后骨科患者标本MRSA检出14例,干预前后数据比较有统计学意义(P<0.05)。结论 医院实施MRSA目标性监测和综合干预措施,可降低骨科MRSA院内感染。     

重症监护病房鲍曼不动杆菌医院感染暴发调查与对策分析

目的：对发生于重症监护病房（ICU）的鲍曼不动杆菌（ABA）医院感染暴发进行调查,为控制医院感染提供依据和对策。方法按《医院消毒技术规范》要求进行采样和细菌培养,对患者、环境来源菌株进行细菌鉴定和药敏试验。结果环境中ABA检出率从高到低依次为吸痰小瓶（88．9％）、护工手（60．0％）、呼吸机回路（37．5％）、医务人员手（28．0％）、床头桌面（25．0％）、鼻拭子（13．3％）、设备按钮（12．5％）、医务人员工作服（12．0％）、工作人员拖鞋底（6．7％）。患者痰标本和医院环境中分离到的ABA具有相同的耐药菌谱。此次感染暴发的感染源为1例ABA感染患者,暴发原因为呼吸机回路非一次性使用和医护人员手卫生依从性差。结论规范医务人员操作行为、严格无菌技术、加强病房环境管理、提高医护人员手卫生依从性,能有效预防和控制医院感染。     

手卫生培训对社区医护人员手部带菌含量的效果研究

目的:探讨手卫生培训对减少社区医护人员手部带菌含量的效果.方法:选择沙园社区卫生服务中心作为手卫生培训干预组,昌岗社区卫生服务中心作为对照组,每中心随机抽选医护人员各60名,对干预组的医护人员进行手卫生强化培训,培训前对两组医护人员在接触病人或操作后进行手微生物采样.在培训后分别对对照组和干预组进行手微生物采样进行追踪,比较分析、并提出对策,检查干预组成员手卫生的依从性及效果.结果:经过强化培训后,干预组与对照组相比,每平方厘米手部所含细菌菌落明显减少,医护人员洗手依从性增加,P＜0.05,差异有统计学意义.结论:手卫生培训能使社区医护人员掌握正确手卫生的方法,提高手卫生的依从性,有效降低社区医护人员手部细菌的含量,降低社区医院感染的发生率.     

科室管理者率先垂范对医务人员手卫生行为的影响

目的观察医院科室管理人员率先执行《医务人员手卫生规范》对医务人员手卫生措施执行力的影响,提升手卫生执行率。方法采用现场调查方法,通过临床科室管理人员实际行为和示范作用,对临床医务人员手卫生实施干预。结果实施教育干预措施前的第2季度,洗手液和速干手消毒液5个科室每个床位平均日消耗量为13.28 ml;实施教育干预措施后的第4季度,每个床位平均日消耗量为17.25 ml。干预之后的第3、4季度,每个科室医务人员手卫生执行率和合格率都高于干预前的第2季度。结论临床科室管理者率先示范作为对科室医务人员手卫生行为有明显促进作用。     

First identification of methicillin-resistant Staphylococcus aureus MLST types ST5 and ST45 and SCCmec types IV and Vt by multiplex PCR during an outbreak in a respiratory care ward in central Taiwan

We used molecular typing methods to investigate an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infections in a respiratory care ward in Taiwan. From March to June 2006, the incidence of MRSA infection increased 3.75-fold. The overall carrier rates among the health care workers (HCWs) were 31.3% (total S. aureus), 16.4% (MRSA), and 14.9% (methicillin-sensitive SA, MSSA). Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), antibiograms derived from susceptibility testing of MRSA isolates, and multiplex polymerase chain reaction (PCR) provided strong epidemiologic and microbiologic evidence that the outbreak of MRSA infections at our hospital was linked to the same PFGE pulsotype A SCCmec type II, pvl-negative, MLST ST5 strain of MRSA isolated from seven HCWs and five patients. The outbreak was controlled by application of topical fucidin ointment to the anterior nares in all colonized HCWs. Multiplex PCR combined with PFGE and MLST is a feasible method for outbreak investigations in routine clinical laboratories.     

Immediate control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization occurred from November 2001 in the neonatal intensive care unit (NICU) of our hospital. Since the establishment of our NICU in 1991, some MRSA has been detected in NICU patients. For MRSA infection preventive measures, utilization of the following items was implemented: mupirocin ointment, diluted povidone iodine, methylrosaniline chloride, and disposable rubber gloves. Patients in whom MRSA was detected received intranasal administration of the mupirocin ointment three times daily and were bathed in, or their entire body was wiped with diluted povidone iodine once daily for the first 3 days in each week. In addition, they received an intraoral application of methylrosaniline chloride daily. All therapy was done until MRSA strains were undetectable for 3 continuous weeks. Genotypes of 13 MRSA strains isolated from eight inpatients and one mother were analyzed by pulsed-field gel electrophoresis (PFGE). All PFGE patterns were identical, except for one, which had one distinct migrating fragment. These data suggested that this MRSA outbreak was caused by the same strain, which was derived from the mother of a low-birth-weight infant born on October 30, 2001. Gradually, the number of inpatients carrying MRSA decreased, until finally MRSA was no longer observed, in April 2002. Fortunately, we controlled the MRSA outbreak immediately, and none of the inpatients developed severe MRSA infection. We think that in our NICU, which is isolated from other hospital wards, it is important to prevent the entrance of MRSA-carrying mothers.     

肝移植病房MRSA分子流行病学研究

目的研究我院肝移植病房MRSA同源性分布情况。方法收集我院2005年3月-2006年11月肝移植病人中分离金葡菌共57株，用头孢西丁纸片法进行MRSA表型检测，筛选MRSA，并用脉冲场凝胶电泳（PFGE）对MRSA菌株进行同源性检测。结果57株金葡菌中，46株为MRSA。MRSA经PFGE分为8个型（A～H型）。以A型（27株）、B型（10株）为主。在2005年3月-2006年11月发生了A1亚型的暴发流行。结论MRSA在肝移植病人间流行情况十分严重．及时检测MRSA并进行流行病学研究将有利于控制耐药菌的播散。     

我国各地区18所教学医院金葡菌临床分离株杀白细胞毒素基因检测及分子流行病学调查

目的研究我国多所医院临床分离金葡菌中杀白细胞毒素（PVL）分布特征及与临床疾病的关系。方法对18所教学医院临床分离809株金葡菌进行PCR检测PVL基因，PVL阳性菌株经纸片扩散法检测MRSA表型，mecA～femB双重PCR确证MRSA基因型，并对PVI，阳性的MRSA进行SCCmec分型，脉冲场凝胶电泳（PFGE）法对PVL阳性的MRSA进行同源性分析。结果809株金葡菌中58株（58／809，7．2％）携带PVL基因。沈阳检出率较高，其次为武汉，与其他医院差异有统计学意义（P〈0．05）；PVL阳性的MRSA15株（15／407，3．5％），MSSA43株（43／402，11．1％），差异无统计学意义（P〉0．05）；PVL阳性的门诊菌株7．9％（5／63），住院6．9％（53／746／，差异无统计学意义（P〉0．05）。PVL阳性的MRSA经SCC—mec分型，Ⅱ型3．8Voo（2／53），Ⅲ型4．7％（12／258），未分型1．0%（1／104），差异无统计学意义（P〉0．05）。PVL阳性的MRSA经PFGE后，A克隆株73．3％（11／15）；B克隆株13．3%（2／15）；C克隆株6．7％（1／15）；D克隆株6．7％（1／15），差异有统计学意义（P〈0．05）。结论PVL可以引起严重感染，及时进行检测并做同源性分析，采取有效的措施控制医院感染的暴发。     

Infection control for a methicillin-resistant Staphylococcus aureus outbreak in an advanced emergency medical service center, as monitored by molecular analysis

A methicillin-resistant Staphylococcus aureus (MRSA) outbreak occurred in an advanced emergency medical service center between 2010 and 2011. Our objective was to evaluate the status of the MRSA outbreak, as monitored by molecular analysis. Twenty-eight MRSA strains were isolated from blood samples from 11 patients, from other specimens (pharynx, nasal cavity, etc.) from 12 patients, from two environmental samples, and from the skin, middle nasal meatus, and urine of one patient each from other wards. Pulsed-field gel electrophoresis (PFGE) was performed to evaluate horizontal transmission. Molecular typing by PFGE showed that the 28 MRSA strains presented 7 patterns in total, and that 11 of the MRSA strains had the same PGFE pattern. Unselective use of intranasal mupirocin ointment, MRSA monitoring for new inpatients, and prevention of direct or indirect contact infection were performed. However, the number of inpatients with MRSA did not quickly decrease, and additional molecular typing by PFGE showed that 10 of 19 MRSA strains found (5 of 6 from blood, 5 of 13 from other specimens) were the same as those found previously. Lectures and ward rounds were performed repeatedly, and staff participation in ward rounds was suggested. Finally, the number of inpatients with MRSA significantly decreased more than 6 months after the intervention. Although the MRSA outbreak was thought to have ended, follow-up molecular typing by PFGE showed that horizontal transmission persisted. Our data suggest that various combinations of infection control measures are essential when dealing with an MRSA outbreak, and monitoring by molecular analysis using PFGE is useful to identify the status of the outbreak.     

粤西地区耐甲氧西林金黄色葡萄球菌流行病学特征与变迁相关研究

目的研究粤西地区近5年来耐甲氧西林金黄色葡萄球菌（MRSA）医院感染、定植、院内爆发、社区感染、检出率、耐药率、菌落形态学变迁与特征,以提高对MRSA菌检测和医院感染控制水平。方法回顾分析本院2003～2008年形态学、医院感染、定植、社区感染、MRSA检出率、院内爆发,进行对照分析。结果①医院感染MRSA所占比例上升至70．2％;②医院感染MRSA占95．2％,社区MRSA占4．8％;首次培养分离呈不溶血MRSA占85．7％;⑧社区MRSA对复方磺胺、环丙沙星、庆大霉素、四环素、克林霉素耐药率为16．7％、0％、33．3％、33．3％、33．3％,医院MRSA则为53．7％、100％、100％、70．4％、98．2％。结论MRSA首次培养分离呈不溶血菌落特征为主;医院感染MRSA逐年递增．呈递增趋蛰．随院内感染爆发次数增加而递增;社区MRSA相比医院MRSA体外药物敏感试验显示较为敏感。     

某体检中心医务人员手卫生及体检人群接触类传染病现状的调查

目的：调查某体检中心医务人员手卫生及体检人群中接触类传染性疾病的现状。方法使用现场观摩模式对体检中心143名医务人员的手卫生依从率、正确率、五个手卫生环节执行情况进行观察,对未规范手卫生的原因进行分析。总结2012年6-11月体检者中接触类传染性疾病的检出情况及其与住院患者该类疾病检出率的比较。结果医务人员手卫生平均依从率为34．6％,正确率为53．8％;其中护士手卫生依从率、正确率最高,分别是70．4％和69．0％,与其他医务人员相比有统计学意义（P＜0．05）;接触体液类人员手卫生依从率最低,为15．9％,临床医生手卫生正确率最低,为16．1％;五个手卫生环节中,各类人员在“离开病房环境后”环节执行率最高;未规范手卫生原因分析,主要集中在“体检者都很健康”和“太麻烦”两个方面。体检人群中接触类传染性疾病检出率为9．6％,与住院患者检出率接近。结论体检中心医务人员手卫生依从率较低,正确率不高,各类人员特别是非护理人员对手卫生的认识还存在一定的误区,相关部门应针对性的强化手卫生监督及巡查力度。体检人群中接触性传染性疾病检出率并不低于普通病区,从事体检工作的医务人员与其他医务人员一样存在潜在感染风险,应重视相应防护措施。     

Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study

Objective  We compared handwashing (HW) and alcohol-based handrub (ABH) for skin tolerance, acceptability, and hand hygiene compliance in health-care workers (HCWs) in a multicentric study. Design and setting  Before/after study over two periods (P1 and P2) in seven ICUs. Monitoring of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in two ICUs (U4 and U6). Subjects and patients  All HCWs of the seven ICUs, and the patients of U4 and U6 without MRSA carriage on admission. Interventions  Handwashing was available in P1 and P2. ABH was introduced after P1 and available throughout P2. HCWs completed questionnaires on skin tolerance in P1 and P2, and on acceptability in P2. Compliance with hand hygiene was assessed in P1 and P2 using a standardized method. ICU-acquired MRSA colonization/infection in U4 and U6 was recorded. Measurements and main results  Hand erythema was reported during P1 and P2 by 21.7 and 11% of HCWs, respectively (P = 0.01), itching by 15.8 and 7.1% (P = 0.02), oozing by 0.8 and 1.1% (P = 0.82), and bleeding by 4.2 and 1.1% (P = 0.1). ABH was considered easier and quicker than HW (P < 0.01), but overall acceptability did not differ between the two. Compliance increased from 51% (334/647) in P1 to 60% (251/418) in P2, P < 0.01. No significant reduction in MRSA colonization/infection between P1 and P2 (P = 0.30) was observed, but the study was underpowered. Conclusions  Self-report questionnaires show that when ABH is available in ICUs, fewer unpleasant skin sensations are reported. ABH is considered to be easier and quicker to use than HW and compliance is improved after glove removal.