神经外科ICU疑似耐碳青霉烯类肺炎克雷伯菌医院感染暴发调查与控制

目的对神经外科重症监护病房(ICU)一起疑似耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发进行调查和控制,为多药耐药菌医院感染预防与控制提供参考。方法对2019年5月-6月华中科技大学同济医学院附属同济医院神经外科ICU的6例CRKP感染患者进行流行病学调查和环境卫生学监测,并采取针对性防控策略。结果共发生CRKP医院感染6例;其中5例的住院时间和床位存在重叠或相邻;6例患者的保洁人员为同一人;环境卫生学监测显示CRKP检出率为3.13%(2/64),分别从呼吸机和保洁人员手检出;患者检出的6株CRKP菌株和环境检出的2株CRKP菌株药敏结果基本一致。采取改进环境清洁消毒流程、严格执行手卫生、加强科室人员管理和全员医院感染防控培训及督导等针对性防控策略后,此次事件得到有效控制。结论神经外科ICU内环境清洁消毒不彻底以及医务人员手卫生执行不到位是导致此次疑似CRKP医院感染暴发的主要原因。及时识别并调查原因,采取针对性防控策略是有效控制医院感染暴发的关键。

Investigation and control of ourbreak of a suspected carbapenem-resistant Klebsiella pneumoniae infection in ICU of neurosurgery department

OBJECTIVE To investigate the outbreak of a suspected carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in intensive care unit(ICU)of neurosurgery department so as to provide guidance for prevention and control of multidrug-resistant organisms infections.METHODS A total of 6 patients with CRKP infection who were treated in ICU of neurosurgery department of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from May 2019 to Jun 2019 were enrolled in the study.The epidemiological survey and environmental hygiene monitoring were carried out,and the targeted prevention strategies were taken.RESULTS Totally 6 patients had CRKP nosocomial infection,5 of whom had overlapping or adjacent length of hospital stay and beds;6 patients shared the same cleaning staff.The environmental hygiene monitoring showed that the detection rate of CRKP was 3.13%(2/64),the strains were isolated from ventilators and hands of the cleaning staff.The drug susceptibility rate of the 6 CRKP strains isolated from the patients was basically consistent with that of the 2 CRKP strains isolated from environment.The incident was effectively controlled after the targeted prevention strategies such as the modified procedures of cleaning and disinfection of environment,implementation of hand hygiene,management of personnel,training of control of nosocomial infection and supervision were taken.CONCLUSION The incomplete cleaning and disinfection of environment and poor implementation of hand hygiene of the heath care workers are the leading causes of the outbreak of the suspected CRKP infection in ICU of neurosurgery department.It is the key to identify the causes and take the targeted prevention strategies so as to effectively control the outbreak of nosocomial infection.