神经内科ICU耐碳青霉烯类肺炎克雷伯菌感染疑似暴发调查与控制

目的 调查神经内科重症监护病房(ICU)耐碳青霉烯类肺炎克雷伯菌(CRKP)感染暴发原因, 为有效控制多重耐药菌医院感染提供依据。 方法 对2021年6—7月某院神经内科ICU检出CRKP的患者进行现场流行病学调查和环境卫生学监测, 并采取控制措施, 评价防控效果。 结果 共发生CRKP医院感染7例, 罹患率为12.28%(7/57), 与2019、2020年同期罹患率相比, 差异有统计学意义(P＜0.05)。环境卫生学监测显示: 手标本CRKP检出率为6.67%(1/15), 为1名保洁员手; 环境物体表面CRKP检出率为5.45%(3/55), 分别为19床床头柜、19床输液泵、1号床手持电脑(PDA)。在采取集中隔离CRKP感染患者, 严格限制人员流动, 病区清洁与消毒, 加强手卫生监管等一系列针对性措施后, 此次事件得到有效控制。 结论 此次可判定为一起CRKP疑似医院感染暴发事件, 推测CRKP感染患者未采取集中隔离措施、环境消毒不彻底及手卫生执行不到位是此次暴发事件的主要原因。早期识别感染暴发, 调查原因, 及时采取有效的针对性措施是控制感染暴发的关键。

Investigation and control on a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae infection in the neurological intensive care unit

Objective To investigate the causes of the outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in the neurological intensive care unit (ICU), and provide evidence for effective control of multidrug-resistant organism healthcare-associated infection (HAI). Methods An on-site epidemiological investigation and environmental hygiene monitoring were conducted on patients with CRKP infection in the neurological ICU of a hospital from June to July 2021. Control measures were taken, and the effectiveness of prevention and control mea-sures was evaluated. Results There were 7 cases of CRKP HAI cases, with an incidence of 12.28% (7/57), which was significantly different from the incidence during the same period in 2019 and 2020 (P < 0.05). Environmental hygiene monitoring showed that the isolation rate of CRKP from hand specimens was 6.67% (1/15), which was from the hand of a cleaner. Isolation rate of CRKP from environmental object surface was 5.45% (3/55), which were from bedside table and infusion pump of bed-19, as well as personal digital assistant-1(PDA-1). After taking a series of targeted measures such as centralized isolation of CRKP-infected patients, strict restriction on personnel movement, ward cleaning and disinfection, and strengthening hand hygiene supervision, the outbreak has been effectively controlled. Conclusion This event is considered as a suspected outbreak of CRKP HAI. It is speculated that the main causes for this outbreak were the failure to adopt centralized isolation measures for CRKP-infected patients, incomplete environmental disinfection, and poor execution of hand hygiene. Early identification of infection outbreak, investigation of causes, and timely adoption of effective targeted measures are key to controlling infection outbreaks.