不同采样工具对医务人员鼻腔携带菌主动筛查结果分析

目的 利用两种采样工具对医务人员鼻腔携带菌进行主动筛查，比较结果差异，探讨神经外科医务人员鼻腔多重耐药菌（MDRO）定植情况，为MDRO的防控提供依据。方法 选取2019年7月某院神经外科110名在岗医务人员为研究对象，主动筛查其鼻腔带菌情况。医务人员左侧鼻孔采用0.85%生理盐水采样管（简称海绵拭子），右侧鼻孔采用一次性鼻腔拭子（简称棉拭子），比较两种工具的采样结果。对检出的MDRO进行耐药性分析、去定植，另外对病房采取集束化干预措施，并比较干预前后的效果。结果 110名医务人员，包括医生31名，护士66名，护工7名，进修及规培生6名。共检出细菌46株，其中10株MDRO，耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯类鲍曼不动杆菌检出率分别为8.18%及0.91%，未检出耐碳青霉烯类肠杆菌、耐碳青霉烯类铜绿假单胞菌、耐万古霉素肠球菌。两种采样方式收集的标本培养24、48及72 h，两组菌落检出结果及半定量结果比较，差异均无统计学意义（均P>0.05）；两种采样方法的采样时间、一次性采集成功率、耗材损耗率、医务人员满意度各指标比较，差异均有统计学意义（均P<0.05）。棉拭子优于海绵拭子，且成本较低。检出的9株MRSA对红霉素、克林霉素耐药率较高，2株分离自护士的MRSA药敏谱表型完全一致。采取防控措施后，8名医护人员MRSA阳性者均转阴，且病房MDRO及其中的MRSA、CRAB的感染率及检出率较干预前均有所下降（P<0.05）。结论 神经外科医务人员鼻腔MRSA定植率较高，生理盐水采样管及一次性鼻腔拭子细菌检出结果几乎一致，从各种指标尤其是成本效益方面综合考量，棉拭子优于海绵拭子。建议对重点科室医务人员做鼻腔定植菌的监测，及时去定植，加强以接触隔离为核心的综合防控措施，以确保有效降低临床MDRO的发生率及医务人员的定植率。

Active screening on nasal bacterial carriage of health care workers by different sampling tools

Objective To compare the differences of two sampling tools used for active screening on nasal bacterial carriage of health care workers (HCWs), evaluate colonization of multidrug-resistant organisms (MDROs) in the nasal cavity of HCWs in department of neurosurgery, and provide basis for the prevention and control of MDROs. Methods In July 2019, 110 HCWs in department of neurosurgery of a hospital were selected as the research objects, their nasal bacterial carriage was actively screened. 0.85% normal saline sampling tube (sponge swab) was used for the left nostril of HCWs, disposable nasal swab (cotton swab) was used for right nostril, sampling result of two tools was compared. The isolated MDROs were performed drug resistance analysis and decolonization, bundle intervention measures were taken in the ward, effect before and after the intervention was compared. Results There are 110 HCWs, including 31 doctors, 66 nurses, 7 attendants, 6 further-traning students and normative training of resident physicians participated in study. A total of 46 strains of bacteria were isolated, 10 of which were MDROs, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) were 8.18% and 0.91% respectively, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus were not found. The specimens collected by two sampling methods were cultured for 24 hours, 48 hours and 72 hours, there were no significant differences in colony detection and semi-quantitative results between two groups (both P>0.05); there were significant differences in the sampling time, success rate of single collection, loss rate of consumables and staff''s satisfaction between two sampling methods (all P<0.05). Cotton swab method was better than sponge swab method, and the cost was lower. Nine strains of MRSA had high resistance to erythromycin and clindamycin, drug susceptibility spectrum of 2 strains isolated from nurses were identical. After taking preventive and control measures, 8 HCWs with positive MRSA all turned negative, infection rate and isolation rate of MDROs, including MRSA and CRAB in wards decreased compared with those before intervention (P<0.05). Conclusion Colonization rate of MRSA in the nasal cavity of HCWs in department of neurosurgery is high, detection results of bacteria with normal saline sampling tube and disposable nasal swab are almost the same, from the comprehensive consideration of various aspects, especially cost-effectiveness, cotton swab is better than sponge swab. It is suggested to monitor bacterial colonization in nasal cavity of HCWs in key departments, timely de-colonize, and strengthen the comprehensive prevention and control measures with contact isolation as the core measure, so as to effectively reduce the incidence of MDROs colonization rate in HCWs.