藏区重症监护病房首例耐碳青霉烯类鲍曼不动杆菌感染患者相关环境污染及患者感染情况

目的 调查藏区某院新建重症监护病房(ICU)中首例耐碳青霉烯类鲍曼不动杆菌(CRAB)感染患者相关环境污染及患者感染情况，分析传播风险。方法 从2021年11月15日检出的首例CRAB患者入住ICU开始至第60天期间，对入住ICU>48 h的所有患者进行CRAB主动筛查；在首例CRAB感染患者入住ICU第30天高频开展诊疗活动2 h后未消毒前、第60天消毒后未开展医疗活动前的环境分别采样，CRAB显色培养基培养。结果 主动筛查的13例患者中1例CRAB阳性，该病例于11月19日由三级医院ICU转入该院ICU,入住ICU第40天出现发热、吸痰需求增加并检出CRAB,药敏谱与首例病例相似，且安置于首例病例邻床。采样环境标本64份，CRAB阳性9份，阳性率14.06%,其中高频诊疗活动后洗手池、门把手、床栏等8个采样位点CRAB阳性，常规消毒后洗手池水槽检出CRAB。结论 在民族地区基层ICU CRAB防控工作中，对入科患者进行风险评估，高风险患者入科即采取集束化防控措施是可行的；应重点关注洗手池、门把手、床栏等区域污染及洗手池水槽消毒的有效性。

Environmental contamination related to the first patient with carbapenem-resistant Acinetobacter baumannii infection and the infection status of patients in the intensive care unit in Tibetan areas

Objective To investigate the environmental contamination related to first patient with carbapenem-resistant Acinetobacter baumannii (CRAB) infection and the infection status of relevant patients in a newly established intensive care unit (ICU) of a hospital in Tibetan area, and analyze the transmission risk. Methods From the admission in ICU of a patients who was first detected CRAB on November 15, 2021 to the 60th day of hospitalization, all patients who stayed in ICU for >48 hours were performed active screening on CRAB. On the 30th day and 60th day of the admission to the ICU of the first CRAB-infected patient, environment specimens were taken respectively 2 hours after high-frequency diagnostic and therapeutic activities but before disinfection, and after disinfection but before medical activities. CRAB was cultured with chromogenic culture medium. Results Among the 13 patients who were actively screened, 1 case was CRAB positive, he was transferred from the ICU of a tertiary hospital to the ICU of this hospital on November 19th. On the 40th day of admission to the ICU, he had fever, increased frequency for sputum suction, and CRAB was detected. The drug sensitivity spectrum was similar to that of the first case, and he also stayed in the adjacent bed of the first case. 64 environmental specimens were taken, and 9 were positive for CRAB, with a positive rate of 14.06%, 8 sampling points such as the washbasin, door handle and bed rail were positive for CRAB after high-frequency diagnostic and therapeutic activities. After routine disinfection, CRAB was detected from the sink of the washbasin. Conclusion For the prevention and control of CRAB in the basic-level ICU in ethnic areas, it is feasible to conduct risk assessment on admitted patients and adopt bundled prevention and control measures for high-risk patients upon admission. Attention should be paid to the contaminated areas (such as washbasin, door handle, and bed rail) as well as the effectiveness of disinfection of sink of washbasin.