某基层医院泛耐药鲍曼不动杆菌感染暴发的调查与控制

目的对某院重症监护病房(ICU)泛耐药鲍曼不动杆菌(XDRAB)下呼吸道感染暴发事件进行调查与控制。方法对2013年10月27日—12月27日该院ICU5例XDRAB下呼吸道感染患者进行流行病学调查,查找感染源、传播途径,采取干预措施。结果 5例患者痰标本和环境物体表面采样均分离出XDRAB,分离的菌株及其耐药谱基本一致,推断为同一病原体污染环境导致的XDRAB医院感染暴发。消毒前采集标本54份,26份阳性,ICU门把手、床单、电话等均检出XDRAB。通过调查,确定室内环境及仪器设备的污染、清洁消毒措施执行不力、医务人员手卫生依从性不足等是造成此次XDRAB医院感染暴发的原因。针对感染环节,积极落实防控措施,之后多次采样均无XDRAB检出,亦无新发感染病例。结论 ICU内环境污染是此次XDRAB医院感染暴发的主要原因,严格执行多重耐药菌隔离防控措施能有效控制鲍曼不动杆菌医院感染暴发。

Survey and control of extensively drug resistant Acinetobacter baumannii infection outbreak in a basic level hospital

ObjectiveTo survey and control an extensively drug resistant Acinetobacter baumannii(A. baumannii) (XDRAB) lower respiratory tract infection（LRTI） outbreak in intensive care unit (ICU) of a hospital. MethodsFrom October 27, 2013 to December 27, 2013， 5 cases of XDRAB LRTI occurred in ICU，epidemiological investigation was conducted， sources and transmission routes of infection were searched, intervention measures were performed. ResultsXDRAB were isolated from patients’ sputum and environmental object surface, drug resistant spectrums of isolated XDRAB were almost the same， suggesting the outbreak was due to the contamination of environment by the same pathogen. 54 specimens were taken before disinfection, 26 were positive, XDRAB were isolated from door handles, sheets and telephones. Investigation concluded that the outbreak of XDRAB infection was due to contamination of indoor environment and equipment， incomplete disinfection， and inadequate hand hygiene compliance of health care workers. After the implementation of a series of control measures, XDRAB was not found, and there was no new XDRAB infection cases. ConclusionEnvironment contamination is the main cause of this XDRAB healthcare associated infection（HAI） outbreak, strict implementation of isolation,prevention and control measures of MDROs can effectively control HAI outbreak caused by A. baumannii.