一起呼吸与危重症医学科耐碳青霉烯类鲍曼不动杆菌感染疑似暴发调查与控制

Investigation and control of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii infectionin the department of respiratory and critical care medicine

  • 摘要:
    目的  分析某院呼吸与危重症医学科耐碳青霉烯类鲍曼不动杆菌(CRAB)疑似医院感染暴发的流行病学特征和传播因素。
    方法  对2023年6月1日-17日呼吸与危重症医学科发生的10例CRAB医院感染病例进行流行病学调查和环境卫生学监测,并采取集束化管理措施进行干预。
    结果  10例CRAB感染患者基础病情危重,发生区域相对集中,呈明显聚集性流行特征。其中床位临时增加、医务人员未固定分组、接触隔离措施落实欠佳、环境清洁消毒不到位以及一次性薄膜手套滥用、手卫生依从性差等均增加交叉感染传播风险。手卫生和环境卫生学监测共采样67个点位,总体合格率为38.80%,饮水机按键、床栏、吊塔、呼吸机表面、陪护家属手及医务人员手和工作服等8个点位检出CRAB,其药敏谱与患者分离菌高度一致。启动暴发应急预案后,通过采取封闭管理、患者分区隔离、医务人员分组诊疗护理、强化环境物表与器械清洁消毒、严格手卫生与一次性手套使用及培训等集束化管理措施后,此次事件得到有效控制。
    结论  未及时早期识别CRAB感染并采取接触隔离措施、医务人员未分组诊疗护理、手卫生依从性差、环境物表清洁消毒不彻底是此次感染疑似暴发事件的主要原因。早期识别医院感染病例,并采取集束化防控措施,可有效控制医院感染暴发事件发生。

     

    Abstract:
    OBJECTIVE  To analyze the epidemiological characteristics and transmission factors of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) infections in the department of respiratory and critical care medicine of a hospital.
    METHODS  An epidemiological investigation and environmental hygiene monitoring were conducted on 10 cases of hospital-associated CRAB infections that occurred in the department of respiratory and critical care medicine from Jun. 1, 2023, to Jun. 17, 2023, and bundled management measures were implemented for intervention.
    RESULTS  The 10 patients infected with CRAB had severe underlying diseases; the infections occurred in a relatively concentrated area, exhibiting obvious clustered epidemiological characteristics. A series of factors were identified as contributing to the increased risk of cross-transmission, including the temporary addition of beds, lack of fixed medical staff grouping, inadequate implementation of contact precautions, inadequate environmental cleaning and disinfection, misuse of disposable plastic gloves and poor hand hygiene compliance. A total of 67 sampling sites were monitored for hand hygiene and environmental hygiene, with an overall, the hands of family members pass rate of 38.80%. CRAB was detected at eight sites, including the buttons of the water dispenser, bed rails, medical pendant, ventilator surfaces and the hands and work uniforms of medical staff, with a high degree of consistency in their drug susceptibility profiles with those isolated from patients. After initiating the outbreak emergency response plan, the incident was effectively controlled through bundled management measures, including closed management, zoning isolation of patients, fixed grouping of diagnosis, treatment and nursing by medical staff, enhanced cleaning and disinfection of environmental surfaces and equipment, strict hand hygiene and use of disposable gloves, etc.
    CONCLUSIONS  The primary causes of this suspected outbreak of infections are the failure to promptly identify CRAB infections at an early stage and implement contact precautions, the lack of fixed medical staff grouping, treatment and nursing by medical staff, poor hand hygiene compliance and inadequate cleaning and disinfection of environmental surfaces. Early identification of hospital-associated infections and the implementation of bundled prevention and control measures can effectively control outbreaks of such infections.

     

/

返回文章
返回