某三甲医院新生儿重症监护病房疑似黏质沙雷菌医院感染暴发调查与处置

Investigation and management of suspected hospital-acquired outbreak of Serratia marcescens infection in neonatal intensive care unit of a three-A hospital

  • 摘要:
    目的 分析某院新生儿科重症监护病房(NICU)发生一起疑似黏质沙雷菌医院感染暴发事件的调查与处置过程, 为医院感染预防与控制提供有价值的参考依据。
    方法 对2024年10月12-18日入住贵州医科大学附属医院NICU 3例黏质沙雷菌检出患儿进行流行病学调查, 对病房环境物表进行环境卫生学采样, 对菌株进行同源性分析, 并采取有效的干预措施。
    结果 2024年10月12日-2024年10月18日新生儿科黏质沙雷菌败血症罹患率为2.20%(2/91), 2023年同期为2.35%(2/85), 比较差异无统计学意义(P=0.946)。3例NICU患儿送检标本检出黏质沙雷菌, 其中1例新生儿考虑为社区, 其他2例判定为黏质沙雷菌败血症。环境卫生学目标菌采样59份, 有1份(病例1使用的输液泵卡槽)检出黏质沙雷菌, 同源性分析结果显示4株黏质沙雷菌的同源性很高, 但不完全同源;通过采取有效的预防控制措施后, 未再出现疑似黏质沙雷菌聚集事件。
    结论 本次事件的发生可能与环境物体表面清洁消毒不到位及个别医务人员手卫生执行不规范导致的感染。

     

    Abstract:
    OBJECTIVE To analyze the investigation and handling process of a suspected outbreak of hospital-acquired Serratia marcescens infection in the Neonatal Intensive Care Unit (NICU) of a certain hospital, and to provide valuable reference for the prevention and control of hospital-acquired infections.
    METHODS An epidemiological investigation was conducted on three S. marcescens-positive neonates admitted to the NICU of the Affiliated Hospital of Guizhou Medical University from Oct. 12 to 18, 2024. Environmental hygiene sampling was carried out on the surfaces of the ward. The homology of the strains was analyzed, and effective intervention measures were taken.
    RESULTS The incidence of S. marcescens sepsis in the NICU from Oct. 12 to 18, 2024 was 2.20% (2/91) compared to 2.35% in the same period of 2023 (2/85), no significant difference was found between the two time periods (P=0.946). Among the three S. marcescens-positive NICU neonates, one was considered community-acquired, while the other two were diagnosed with S. marcescens sepsis. A total of 59 environmental hygiene samples were collected, with one sample detecting S. marcescens in the bedside infusion pump slot of case 1. The homology analysis results showed high homology among the four S. marcescens strains but not completely homologous. After effective preventive and control measures were implemented, suspected S. marcescens clustering events didn′t further occurred.
    CONCLUSION The occurrence of this incident may be attributed to inadequate cleaning and disinfection of environmental surfaces and improper hand hygiene practices by some medical staff.

     

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