重症监护病房发生导管相关性血流感染的临床调查分析

Catheter-associated Bloodstream Infections in Intensive Care Unit

目的分析造成导管相关性血流感染(CA-BSIs)的病原菌、寻找可能的传播途径及针对性处理。方法对医院重症监护病房短期内发生8例CA-BSIs的病原菌、医务人员手和环境监测结果进行回顾分析。结果发生血源性感染的病原菌以肺炎克雷伯菌、溶血葡萄球菌、铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌为主;同一患者不同部位的多处采样分离菌属具有同源性;其中,静脉血与导管血或导管尖端培养同一病原菌4例;静脉血与痰培养同一病原菌4例;相关部位采样48份,其中阳性标本9份,阳性率18.75%,与血培养病原菌基本一致。结论医务人员手污染、导管护理不当和环境污染存在正相关,手污染是主要传播媒介;加强医务人员手卫生、严格无菌操作、保持环境清洁是护理预防和有效控制医院感染的基础和关键。

OBJECTIVE To analyze the pathogens causing catheter-associated blood stream infections （CA-BSIs） and seek the possible routes of transmission to prevent them. METHODS A total of 8 patients with the CA-BSIs were retrospectively analyzed with pathogens,hand contamination and air quality. RESULTS Klebsiella pneumoniae,Staphylococcus haemolyticus,Pseudomonas aeruginosa,Escherichia coli and Acinetobacter baumannii were the main pathogens causing CA-BSIs. The isolated pathogenic bacteria from different parts of the same patients were similar. Among them,same bacteria were cultured from venous blood,catheter blood or the front of catheter in 4 cases,in other 4 cases were from venous blood and sputum. From 48 samples,9 were positive which accounted for 18.75%,the type of cultured bacteria was similar to blood cultures. CONCLUSIONS Hand contamination ,nonstandard catheter care and air quality are positively associated with CA-BSIs. Nurses＇ hands are the major dissemination medium.Strengthening the hand hygiene and sterile working consciousness and making the air clean are basis and the key to prevent and control hospital infection.