泌外病区耐碳青霉烯类阴沟肠杆菌医院感染暴发调查与控制.doc

泌外病区耐碳青霉烯类阴沟肠杆菌医院感染 暴发调查与控制 ［ ］H的研究某院泌外病区发生耐碳青霉烯类阴沟肠杆菌民院 感染暴发的原因。方法通过现场流行病学调查，对2016年8月7 日?9月21日该院泌尿外科发生4例泌尿道耐碳青霉烯类阴沟肠杆菌 感染进行调查，对疑似污染环境和手术器械、相关物品进行微生物采 样，对细菌培养结果进行微生物鉴定和药敏试验。结果共采集环境 物表标本72份、内镜样本16份，一次性导尿管18份，均未见耐碳青 霉烯类阴沟肠杆菌，采取强化内镜清洗、灭菌流程、改用针对内镜生 物膜的多酶洗液、减少内镜日周转频次等综合防控措施后，控制了疫 情的蔓延。结论该院发生的泌尿道耐碳青霉烯类阴沟肠杆菌感染暴 发可能与内镜清洗，灭菌质量控制环节失控相关。 ，供学习和研宄 使用， 和著作权归原 所有， 己 ［关键词］泌外病区；阴沟肠杆菌；医院感染暴发 ［中阁分类号］R197.3 ［ ］A ［ ］2095-0616 (2017) 08-14-04 [Abstract] Objective To explore the cause of nosocomial infection of carbapenem resistant enterobacter cloacae in urological ward of a hospital. Methods Through field epidemiological investigation ， 4 cases of urinary tract infection due to carbapenem resistant enterobacter cloacae caused in urological ward of the hospital from Auguest 7， 2016 to September 21 , 2016 were investigated , suspected contaminated environment and surgical instruments and related items were microbiologically sampled. Microbial identification and drug sensitivity test were carried on the bacterial culture. Results A total of 72 specimens, 16 endoscopic samples, 18 disposable catheter were collected from the environment, and a total of were obtained. There was no carbapenem resistant enterobacter cloacae. The control measures were taken to prevent the spread of the disease, such as strengthening the cleaning and sterilization process of endoscope, using the multi enzyme washing solution for the endoscopic biofilm, and reducing the frequency of daily turnover of the endoscope. Conclusion Outbreak of carbapenem resistant enterobacter cloacae infection in the hospital may be associated with endoscopic cleaning, sterilization quality control links out of control. [Key words] Urological ward ； Enterobacter cloacae ； Outbreak of nosocomial infection ?沟肠杆菌(enterobacter cloacae)为条件致病菌，广泛分布于 自然界中，随着现代医学技术的迅猛发展、广谱抗菌药、免疫抑制剂 的使用、侵入性诊断治疗手段的增加，已成为院内感染主要的病原菌 ［1］。常常引起肺部感染、败血症、尿路感染等，给临床治疗以及防控 带来了极大的挑战［2］。本研究针对某民院泌外病区在2016年8月7 口?2016年9月21 口期间一起住院患者经内镜手术后出现住院患者 耐碳青霉娣类阴沟肠杆菌(carbapcncm-rcs