环境筛查系列措施对ICU物体表面多重耐药菌检出率的影响

目的 探讨多重耐药菌环境筛查对降低重症监护病房（ICU）物体表面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（CRAB）的效果。 方法 2018年9—11月为基线调查期；2018年12月—2019年8月为干预期，干预期每季度进行常规筛查，及时反馈，加强环境清洁消毒及相关知识培训；比较干预前后环境物体表面MRSA、CRAB的检出情况。 结果 基线调查共采集标本896份，干预后共采集标本2 880份，其中MRSA检出率由18.08%下降至0，CRAB检出率由4.46%下降至0.83%；基线调查时住院患者MRSA、CRAB检出率分别为48.86%、36.08%，干预后住院患者MRSA、CRAB检出率分别为37.42%、27.27%；干预前后环境物体表面、住院患者的MRSA、CRAB检出率比较，差异均有统计学意义（均P < 0.05），每季度呈逐渐下降的趋势。环境中检出MRSA、CRAB最常见的位置分别为：床周地面（34/168，20.24%）、头部垫巾（19/168，11.31%）、呼吸机面板（13/168，7.74%）、床头柜（12/168，7.14%）、吊塔（12/168，7.14%）。基线调查时呼吸内科ICU MRSA、CRAB检出率均最高，分别为75.00%（24/32）、25.00%（8/32），干预后呼吸内科ICU未检出MRSA，CRAB检出率干预后为3.13%（3/96）。 结论 对重点部门进行常规多重耐药菌环境筛查可以有效降低ICU物体表面多重耐药菌的定植，降低患者感染的风险。

Effect of environmental screening measures on isolation rate of multidrug-resistant organisms on object surface in intensive care unit

Objective To evaluate the effect of environmental screening of multidrug-resistant organisms (MDROs) on reducing methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) on object surface in intensive care unit (ICU). Methods Baseline survey period was from September to November in 2018, intervention period was from December 2018 to August 2019, during intervention period, routine screening was conducted every quarter, timely feedback was given, environmental cleaning and disinfection as well as related knowledge training was strengthened; isolation of MRSA and CRAB on surface of environmental objects before and after intervention were compared. Results 896 specimens were collected during baseline survey period, 2 880 specimens were collected after intervention, MRSA isolation rate decreased from 18.08% to 0, CRAB isolation rate decreased from 4.46% to 0.83%; isolation rates of MRSA and CRAB in hospitalized patients were 48.86% and 36.08% respectively at baseline survey period, isolation rates of MRSA and CRAB were 37.42% and 27.27% respectively after intervention; isolation rates of MRSA and CRAB isolated from environmental object surface and hospitalized patients before and after intervention were both significantly different (both P < 0.05), there was a trend of gradual decline every quarter. The most common isolation sites of MRSA and CRAB from environment were: bedside floor (34/168, 20.24%), head pad (19/168, 11.31%), ventilator panel (13/168, 7.74%), bedside table (12/168, 7.14%), and medical hanging tower (12/168, 7.14%). At baseline survey period, isolation rates of MRSA and CRAB in respiratory ICU were the highest, which were 75.00% (24/32) and 25.00% (8/32) respectively, after intervention, MRSA was not isolated in respiratory ICU, isolation rate of CRAB was 3.13% (3/96). Conclusion Routine environmental screening for MDROs in key departments can effectively reduce the colonization of MDROs on the surface of ICU objects and reduce the risk of infection in patients.