我院ICU多重耐药鲍曼不动杆菌聚集性病例与环境污染调查分析

doi:10.3969/j.issn.1007-3205.2019.11.017

河北医科大学学报

我院ICU多重耐药鲍曼不动杆菌聚集性病例与环境污染调查分析

1.华北石油管理局总医院医学装备科, 河北任丘 062552;2.华北石油管理局总医院医院感染管理科,
河北任丘 062552;3.华北石油管理局总医院医务科，河北任丘 062552

出版日期:2019-11-25 发布日期:2019-11-21
作者简介:杨宝财（1973-），男,河北任丘人，华北石油管理局总医院副主任技师，医学学士，从事临床检验学研究。
基金资助:
中国石油天然气股份有限公司华北油田分公司科技项目专项（2018-HB-G0701）

Investigation and analysis on multidrug-resistant Acinetobacter baumannii infection cases and environmental pollution in ICU

1. Department of Medical Equipment， General Hosptial of North China Petroleum Administration，
Hebei Province, Renqiu 062552， China；2.Department of Hospital Infection Management， General
Hosptial of North China Petroleum Administration， Hebei Province, Renqiu 062552， China；
3.Department of Medical， General Hosptial of North China Petroleum Administration，
Hebei Province, Renqiu 062552， China

Online:2019-11-25 Published:2019-11-21

摘要/Abstract

摘要： ［摘要］
〖HTH〗目的〖HTSS〗〖KG*2〗调查我院重症监护病房（intensive care unit，ICU）多重耐药鲍曼不动杆菌（multidrug-resistant Acinetobacter baumannii，MDR-AB）医院获得性肺炎聚集性病例与医院环境污染的相关性，为预防和控制ICU患者MDR-AB医院感染提供环境流行病学依据。
〖HTH〗方法〖HTSS〗〖KG*2〗采用现场流行病学调查方法，对短时间内我院ICU出现的3例MDR-AB医院获得性肺炎患者、周围环境以及医务人员标本进行干预前后大面积环境卫生学采样监测，用VITEK-2 Compact全自动细菌鉴定及药敏分析系统进行菌株鉴定与药敏分析。采取分区分色管理方法实施强化环境清洁消毒等综合干预措施，追踪干预效果。
〖HTH〗结果〖HTSS〗〖KG*2〗对干预前80份环境标本进行微生物监测，其中护理站电脑键盘、医护人员手、床单、手消压盖、抢救车剪刀、回风口、患者胸部皮肤、隔离衣袖口、床挡板扶手等14份标本分离出鲍曼不动杆菌，其耐药谱与痰培养耐药菌株相一致。干预后连续2个月环境采样146份标本，均未检出MDR-AB。连续实施干预措施6个月后，标本合格率由77.50%上升至96.57%,医院感染率由干预前2.15%（214/9 965）下降至1.56%（185/11 866），差异均有统计学意义（P＜0.05）。
〖HTH〗结论〖HTSS〗〖KG*2〗MDR-AB医院感染的发生与患者周围环境污染密切相关，分区分色强化环境清洁消毒等综合干预措施可以有效降低医院感染暴发风险。

关键词: 多重耐药鲍曼不动杆菌, 重症监护病房, 交叉感染

Abstract: ［Abstract］Objective〖HTSS〗To investigate the relevance between the multidrug-resistant Acinetobacter baumannii(MDR-AB） hospital acquired pneumonia and environmental pollution in intensive care unit(ICU). Based on the result, we can provide environmental and epidemiological basis for preventing and controlling MDR-AB nosocomial infection in ICU patients.
〖HTH〗〖WTHZ〗Methods〖HTSS〗With field epidemiological investigation method, we carried out large area hygiene sampling monitoring on three MDR-AB hospital acquired pneumonia patients,environment and medical staff in ICU before and after the intervention. Using VITEK-2 Compact bacteria identification and drug susceptibility analysis system we identified the specific strain of bacteria and corresponding drug susceptibility. Zone and color separation method was adopted in the environmental sterilization and the effect of intervention was traced.
〖HTH〗〖WTHZ〗Results〖HTSS〗Before the intervention we monitored 80 environmental samples. MDR-AB strains of consistent drug-resistant patterns with previous MDR-AB strains isolated from patients′ sputum cultures were found in 14 samples, including computer keyboards at the nursing station, hands of medical staff, bed sheets, lids of hand disinfection solution, scissors in rescue vehicles, air-returning outlets, patients chest skin, cuffs of isolation clothes and bed baffle handrails. No MDR-AB was found in 146 environmental samples after the intervention in the following two months. Six months after the intervention. The qualified rate of specimens increased from 77.50% to 96.57%, and the hospital infection rate decreased from 2.15%(214/9 965) to 1.56%(185/11 866). Which was of significant difference from the rate before the intervention（P＜0.05）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗The occurrence of MDR-AB hospital infection is highly related to the environmental pollution. Intervention with sterilization based on zone and color separation can effectively lower the risk of hospital infection outbreak.

Key words: multidrug-resistant Acinetobacter baumannii, intensive care unit, cross infection

杨宝财1，苗勤2*，刘海涛2，方玲2，于大巍2，何敬堂3. 我院ICU多重耐药鲍曼不动杆菌聚集性病例与环境污染调查分析[J]. 河北医科大学学报, doi: 10.3969/j.issn.1007-3205.2019.11.017.

YANG Bao-cai1, MIAO Qin2*, LIU Hai-tao2, FANG Ling2, YU Da-wei2, HE Jing-tang3. Investigation and analysis on multidrug-resistant Acinetobacter baumannii infection cases and environmental pollution in ICU[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.1007-3205.2019.11.017.

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我院ICU多重耐药鲍曼不动杆菌聚集性病例与环境污染调查分析

Investigation and analysis on multidrug-resistant Acinetobacter baumannii infection cases and environmental pollution in ICU

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