一起肾脏内科血液透析患者MRSA感染暴发的调查与控制

An outbreak of MRSA infection in hemodialysis patients of nephrology department and control measures

  • 摘要: 目的 对某三级医院肾脏内科血液透析患者耐甲氧西林金黄色葡萄球菌(MRSA)感染暴发事件进行调查与控制,为临床防治提供参考。方法 对2015年8月11日-12月29日医院肾脏内科5例MRSA感染的血液透析患者进行流行病学调查,对环境、物体表面、医务人员手和鼻腔进行采样241份,筛查出的MRSA进行PFGE分子分型,并采取干预措施。结果 JP+2肾脏内科和血液透析室的医务人员手、鼻腔、血压计、床单元采样均分离出与5例患者同种同源的MRSA共4株,环境清洁消毒不彻底、医务人员手卫生执行不严格等是造成本次MRSA暴发的主要原因; 通过隔离、加强环境清洁消毒、提高手卫生依从性等干预措施的执行,MRSA暴发得到有效控制,且绝大部分医务人员鼻腔MRSA去定植成功。结论 环境污染和手卫生依从性低与此次MRSA暴发有关,采用PFGE及早识别医院感染暴发,严格执行多药耐药菌隔离预防控制措施,能有效控制医院感染的暴发。

     

    Abstract: OBJECTIVE To investigate the outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in hemodialysis patients in nephrology department of a tertiary hospital and put forward the control measures so as to provide guidance for clinical prevention and treatment. METHODS The epidemiological survey was conducted for 5 hemodialysis patients with MRSA infection who were treated in the department of nephrology from Aug 11, 2015 to Dec 29, 2015.Totally 241 specimens were collected from the environment, object surfaces, health care workers' hands, and nasal cavity, then the PFGE molecular subtyping was carried out for the isolated MRSA strains, and the intervention measures were taken. RESULTS Totally 4 strains of MRSA that were isolated from the health care workers' hands, nasal cavity, sphygmomanometer, and bed units were homologous to the MRSA strains isolated from the 5 patients.The poor environmental cleaning and disinfection and loose implementation of hand hygiene were the leading causes of the outbreak of MRSA infection.The outbreak of MRSA infection has been effectively controlled by taking the interventions such as the isolation, enhancement of environmental cleaning and disinfection, and most of the health care workers with colonization of MRSA were effectively decolonized. CONCLUSION The outbreak of MRSA infection is associated with the environmental contamination and lower hand hygiene compliance.It is an effective way to carry out the PFGE to identify the outbreak of nosocomial infection as early as possible and strictly implement the measures for isolation, prevention, and control of the multidrug-resistant organisms so as to control the outbreak of nosocomial infection.

     

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