新生儿脓疱疮医院感染聚集发病的监测与控制.docVIP

新生儿脓疱疮医院感染聚集发病的监测与控制 基金项目：中华医院感染控制研究基金（ZHYY2013-001） 摘要：目的：加强产房环境和人员的监测，降低新生儿脓疱疮的发病率。方法：实时监测新生儿脓疱疮发生率，聚集发病时进行临床资料和环境卫生学流行病学调查。结果：2013年12月发生新生儿脓疱疮4例，发病率为0.97%，明显高于其他月份。患儿发病日龄4-11天，分泌物分离出金黄色葡萄球菌。从一名产房助产士的鼻腔和手，沐浴室洗澡网托和婴儿沐浴室护士的工作服中分离出金黄色葡萄球菌，药敏结果与患儿分泌物分离菌株药敏谱一致。采取了将鼻腔携带金黄色葡萄球菌的助产士调离直接接触婴儿的岗位，取消婴儿沐浴室洗澡用网托，进入沐浴室更换清洁工作服等一系列干预措施。连续监测3个月，无新感染病例发生。结论：助产士鼻腔携带致病菌，环境、物品和设备消毒不到位，医护人员手卫生依从性差是造成感染发生的重要原因。应加强产科病区的环境和物品的消毒工作，加强工作人员鼻腔和手携带病原菌情况检测，以便及时采取干预措施。 关键词：新生儿脓疱疮；金黄色葡萄球菌；干预 Surveillance And Control of Impteigo Neonatorum Nosocomial Infection Clustering Cases Abstract: Objective: By strengthening the surveillance of enviroment and staffs of delivery rooms in order to reduce the incidence of impetigo neonatorum. Methods: Surveillance the incidence of impetigo neonatorum, adopt the Epidemilolgical survey methods to analyse the clinical data and environmental hygiene data when clustering cases arised. Results: During the December of 2012,4 impetigo neonatorum cases came up, the incidence was 0.97%, higher than other months. The onset day was 4-11 days . Staphylococcus aureus were isolated from secretion, a midwife’s nasal fossae and hands, a bath mat and nurse’s overalls in infant’s bath room. Those pathogens’ susceptibility testing results were same to the secretions. Interventions were taken including remove the midwife from her position, cancel the bath mat, replace clean overalls before enter the bath room. None of new infection cases appeared in the next three months. Conclusions: The factors leading to the nosocomial infections included pathogens colonized in midwife’s nasal fossae, environment disinfection unqualified and poor compliance of hand hygiene. To take interventions in time, we should strengthen the obstetrics environment disinfection and stress the detecting of the pathogens in medical staffs’ nasal fossae. Key Words: impetigo neonatorum; Staphylococcus aureus; intervention 新生儿脓疱疮是新生儿期的常见病[1,2]，我院新生儿脓疱疮的感染率持续在0.25%左右。2013年12月，我院出现了4例新生儿脓疱疮感染患儿，感染率为0.97%，高于以往感染率。现场调查