耐碳青酶烯类抗菌药物鲍氏不动杆菌医院感染暴发与控制.docVIP

?1462?  Chin J No socomiol Vol. 20 No . 10 2010  ?论　著 耐碳青酶烯类抗菌药物鲍氏不动杆菌 医院感染暴发与控制 杜明梅 ,邢玉斌 ,邓春燕 ,索继江 ,刘运喜 (解放军总医院感染管理与疾病控制科 ,北京 100853) 摘要 :目的　调查重症监护病房 ( ICU)耐碳青酶烯类抗菌药物鲍氏不动杆菌感染暴发 ,并采取有效控制感染措 施。方法　采用前瞻性和回顾性调查相结合的方法对 2009年 11月 ICU住院的 32例患者资料进行流行病学调 查和病区内环境卫生学检测分析 ;采取环境消毒、隔离防护、强手卫生等一系列感染控制措施控制感染暴发。 结果　耐碳青酶烯类鲍氏不动杆菌感染或定植 10例 ,患者罹患率达 31. 25 % ,例次感染率为 50. 00 % ,日感染率 28. 74‰;患者基础疾病严重、度使用抗菌药物、吸机辅助呼吸、院时间长等是鲍氏不动杆菌感染的易感因 素 ;病房空气、面、分公用医疗器械鲍氏不动杆菌检出率 50. 00 % ,医务人员手和工作服鲍氏不动杆菌检出 率 30. 00 %。结论　病房环境鲍氏不动杆菌污染严重、务人员接触传播可能是造成此次鲍氏不动杆菌流行的 重要原因 ;彻底病房环境消毒、卫生依从性提高等消毒隔离防护措施的长期执行 ,在控制和预防医院感染暴发 中发挥重要作用。 关键词 :碳青酶烯类 ;鲍氏不动杆菌 ;医院感染 ;暴发流行 Aci net obacte r ba uma nnii in ICU and Its Successf ul Control ( General H os p i t al of PL A , B ei j i n g 100853 , Chi na) baum annii (CRAB) in an ICU , to identif y t he risk facto rs fo r t he out break , and to cont rol it successf ully. METHODS The data of 32 inpatient s in t he ICU in Nov 2009 were analyzed p ro spectively and ret ro spectively. we enhanced hand hygiene and adopted environmental disinfection and isolating p rotection to co nt rol t he out break. RESUL TS The out break involved 10 patient s who se infection or colo nization occurred in Nov 2009. Ten out of 32 inpatient s were isolated A ci netobacter st rains during t he st udy period. All t he st rains were resistant to meropenem environmental survey of t he ICU found t hat bot h medical equip ment and t he environment harbo red CRAB st rains. The epidemiologic data obtained showed t he main risk factors of 10 patient s were severe diseases , overused antibiotics , mechanical ventilatio n and long duration of ho spital stay. CRAB occurrence may be favored by t he selectio n p ressure of p revio usly used antibiotics. Lack of p roper hand hygiene after patient s and equip ment co ntact facilitated t his t ransmission. CONCL USIONS Our findings suggest t hat environmental co ntaminatio n of t he ICU and infectio n t ransmissio n wit hin healt h care facilities by medical staff play a maj