感染综合防控措施在神经外科监护室疑似CRAB感染暴发中的干预效果

Intervention effects of comprehensive infection prevention and control measures in suspected CRAB infection outbreaks in a neurosurgical care unit

  • 摘要:
    目的 分析神经外科监护室疑似耐碳青霉烯类鲍曼不动杆菌(CRAB)感染暴发的原因, 采取综合防控措施控制感染传播, 为重症监护室多重耐药菌(MDRO)感染控制提供参考。
    方法 收集2024年3月甘肃省人民医院神经外科监护室5例感染CRAB患者流行病学资料, 并进行环境卫生学监测和采取综合感染防控措施。
    结果 共发生5例下呼吸道感染, 均属于医院感染, 所有患者三间分布一致, 患者痰培养均检出鲍曼不动杆菌, 且均对碳青霉烯类、氨基糖苷类和部分β-内酰胺类药物耐药。综合防控措施实施前物体表面和医务人员手共采样25份, 合格率52.00%;治疗车台面和治疗室吸痰瓶壁检出CRAB, 检出率为8.00%;实施后共采样24份标本, 合格率100.00%, 与实施前相比, 差异具有统计学意义(χ2=16.987, P < 0.001)。通过实施隔离、规范病区清洁消毒流程、加强手卫生、规范无菌操作以及人员管理等综合措施, 手卫生依从率、多重耐药菌防控措施执行率、荧光标记清除率等指标均提高, CRAB疑似感染暴发被及时控制。
    结论 此次疑似CRAB医院感染暴发可能与多种因素相关, 及时进行环境卫生学监测和实施综合感染防控措施, 可有效控制CRAB感染蔓延。

     

    Abstract:
    OBJECTIVE To analyze the reasons for the outbreak of suspected carbapenem-resistant Acinetobacter baumannii(CRAB) infections in the neurosurgical intensive care unit to take comprehensive prevention and control measures to control the spread of infections, and to provide a reference for the control of multidrug-resistant organisms (MDRO) infections in intensive care units.
    METHODS Epidemiological data were collected from five patients with CRAB infections in the neurosurgical intensive care unit of Gansu Provincial People′s Hospital in Mar.2024, and environmental hygiene monitoring and comprehensive infection prevention and control measures were conducted.
    RESULTS A total of five cases of lower respiratory tract infections occurred, all of which were hospital-acquired infections, and all patients had consistent spatial-temporal distribution.A.baumannii was detected in the sputum cultures of all patients, and all were resistant to carbapenems, aminoglycosides and some β-lactam drugs.Before the implementation of comprehensive prevention and control measures, a total of 25 samples from the surfaces and the hands of health workers were collected, with a pass rate of 52.00%;CRAB was detected on the surface of treatment carts and the wall of sputum suction bottles in the treatment room, with a detection rate of 8.00%.After the implementation, a total of 24 samples were collected, with a pass rate of 100.00%, and the difference was statistically significant when compared with the pre-implementation period (χ2=16.987, P < 0.001).Through the implementation of comprehensive measures such as isolation, standardization of the ward cleaning and disinfection process, strengthening hand hygiene, standardization of sterile operations and personnel management, the indicators such as hand hygiene compliance rate, the execution rate of multi-drug-resistant bacterial preventive and control measures and the fluorescent marker removal rate were all improved, and the suspected CRAB infection outbreak was timely controlled.
    CONCLUSION This suspected CRAB hospital-acquired infection outbreak may be related to a variety of factors, and timely environmental hygiene monitoring and comprehensive infection prevention and control measures can effectively control the spread of CRAB infection.

     

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