血液净化中心阴沟肠杆菌血流感染疑似暴发的调查与控制

目的对某三级医院肾病内科血液透析患者阴沟肠杆菌血流感染疑似暴发进行调查与控制,为临床防治提供参考。方法对2018年5月21日—6月6日该院肾病内科的血液透析患者进行流行病学调查,对医院空气、透析用水和透析液、透析材料、使用中消毒剂、医务人员手、物体表面、患者手及深静脉置管处皮肤等进行环境卫生学检测,针对感染原因进行分析和采取严格防控措施。结果 2018年5月21日—6月6日,共6例患者发生导管相关血流感染,血培养均检出阴沟肠杆菌,发病率为3.03‰(6/1 980)。环境卫生学监测共采集标本133份,其中空气、透析用水及透析液、一次性透析管路、使用中消毒剂采样标本检测均合格;医务人员手采样合格率为61.54%(8/13);物体表面采样合格率为80.28%(57/71),患者手及深静脉置管处皮肤采样6份,不合格1份;环境卫生学监测均未检出阴沟肠杆菌。危险因素分析结果表明,糖尿病、透析前需要溶栓的患者中心静脉导管相关阴沟肠杆菌血流感染的发生率高,差异有统计学意义(均P0.05)。6例感染患者住院治疗2周后血培养阴性,出院继续门诊血透治疗。血液净化中心连续观察2个月未再出现新发感染病例。结论血液净化中心需加强医务人员手卫生、环境清洁与消毒工作,切断外源性感染途径。加强血液透析患者血管导管置管部位及血糖的管理,透析前避免溶栓等措施可减少导管相关血流感染的发生。

Investigation and control of a suspected outbreak of Enterobacter cloacae bloodstream infection in blood purification center

Objective To investigate and control a suspected outbreak of Enterobacter cloacae(E. cloacae) bloodstream infection in hemodialysis patients in department of nephrology of a tertiary hospital, provide reference for clinical prevention and treatment. Methods Epidemiological investigation was carried out on hemodialysis patients in department of nephrology of a hospital from May 21 to June 6, 2018. Environmental hygiene detection were performed on hospital air, dialysis water and dialysate, dialysis materials, in-use disinfectant, hands of health care workers(HCWs), object surface, as well as hands and skin at deep vein catheterization sites of patients, causes of infection were analyzed, strict prevention and control measures were taken. Results From May 21 to June 6, 2018, a total of 6 patients suffered from catheter-related bloodstream infection(CRBSI), all were isolated E. cloacae from blood culture, incidence of CRBSI was 3.03‰(6/1 980). 133 spcimens were collected for environmental hygiene monitoring, detection results of air, dialysis water and dialysate, disposable dialysis pipeline, and in-use disinfectant were all qualified; qualified rate of hand sampling of HCWs was 61.54% (8/13); qualified rate of object surface sampling was 80.28% (57/71), 6 specimens of hands and skin at deep venous catheterization sites of patients were taken, 1 specimen was unqualified; E. cloacae was not detected in environmental hygiene monitoring. Risk factors analysis showed that incidence of E. cloacae CRBSI was higher in patients with diabetes mellitus and those who needed thrombolysis before dialysis, difference were both statistically significant (both P<0.05). After 2-week treatment during hospitalization, blood cultures of 6 infected patients were all negative, patients continued hemodialysis treatment in outpatient departmen after discharged. No new infection case was observed in the blood purification center for 2 months. Conclusion Blood purification center should strengthen hand hygiene of HCWs, clean and disinfect environment, and cut off the route of exogenous infection. Strengthening the management of vascular catheterization site and blood sugar of hemodialysis patients, as well as avoidance of thrombolysis before hemodialysis can reduce the occurrence of CRBSI.