耐碳青酶烯类抗菌药物鲍氏不动杆菌医院感染暴发与控制

目的调查重症监护病房(ICU)耐碳青酶烯类抗菌药物鲍氏不动杆菌感染暴发,并采取有效控制感染措施。方法采用前瞻性和回顾性调查相结合的方法对2009年11月ICU住院的32例患者资料进行流行病学调查和病区内环境卫生学检测分析;采取环境消毒、隔离防护、加强手卫生等一系列感染控制措施控制感染暴发。结果耐碳青酶烯类鲍氏不动杆菌感染或定植10例,患者罹患率达31.25%,例次感染率为50.00%,日感染率28.74‰;患者基础疾病严重、过度使用抗菌药物、呼吸机辅助呼吸、住院时间长等是鲍氏不动杆菌感染的易感因素;病房空气、地面、部分公用医疗器械鲍氏不动杆菌检出率50.00%,医务人员手和工作服鲍氏不动杆菌检出率30.00%。结论病房环境鲍氏不动杆菌污染严重、医务人员接触传播可能是造成此次鲍氏不动杆菌流行的重要原因;彻底病房环境消毒、手卫生依从性提高等消毒隔离防护措施的长期执行,在控制和预防医院感染暴发中发挥重要作用。

Nosocomial Outbreak of Infection with Carbapenem-resistant Aclietobacter baumannii in ICU and Its Successful Control

OBJECTIVE To investigate a nosocomial outbreak of infection with carbapenem-resistant Acinetobacter baumannii(CRAB) in an ICU,to identify the risk factors for the outbreak,and to control it successfully.METHODS The data of 32 inpatients in the ICU in Nov 2009 were analyzed prospectively and retrospectively.we enhanced hand hygiene and adopted environmental disinfection and isolating protection to control the outbreak.RESULTS The outbreak involved 10 patients whose infection or colonization occurred in NOV 2009.Ten out of 32 inpatients were isolated Acinetobacter strains during the study period.All the strains were resistant to meropenem and imipenem.The hospital infection rate was 31.25%,and the case-time infection rate was 50.00%.The environmental survey of the ICU found that both medical equipment and the environment harbored CRAB strains.The epidemiologic data obtained showed the main risk factors of 10 patients were severe diseases,overused antibiotics,mechanical ventilation and long duration of hospital stay.CRAB occurrence may be favored by the selection pressure of previously used antibiotics.Lack of proper hand hygiene after patients and equipment contact facilitated this transmission.CONCLUSIONS Our findings suggest that environmental contamination of the ICU and infection transmission within health care faeilities by medical staff play a major role in this outbreak.Enhancement of hand hygiene compliance,extensive environmental cleaning and education of other infectioncontrol practices contribute to the termination of the outbreak.