重症监护病房铜绿假单胞菌医院感染暴发调查与对策

Outbreak of pseudomonas aeruginosa causing nosocomial infection in intensive care unit:investigation and strategy

目的对重症监护病房(ICU)发生铜绿假单胞菌感染的暴发进行调查,为控制医院感染提供依据和对策。方法按《医院消毒技术规范》要求采样,按《全国临床检验操作规程》细菌分离培养进行细菌鉴定和药敏试验。结果环境中铜绿假单胞菌检出率从高到低依次为吸痰盘100.0%、护工手66.7%、水龙头50.0%、呼吸机螺纹管道40.0%、治疗盘40.0%、医师手25.0%、床头柜16.7%,患者痰标本及环境中分离到的铜绿假单胞菌具有相同的药敏谱:对环丙沙星、阿米卡星、妥布霉素敏感,对头孢他啶、头孢吡肟、哌拉西林/他唑巴坦及亚胺培南/西司他丁耐药。结论此次暴发的感染源为1例铜绿假单胞菌的定植者,暴发原因为呼吸机螺纹管消毒不彻底及医院人员手卫生落实不够,为预防医院感染,应做好患者隔离、加强医务人员手卫生、严格执行无菌技术与呼吸机管道的管理。

OBJECTIVE To investigate an outbreak of Pseudomonas aeruginosa nosocomial infection in an intensive care unit and find out the cause,the risk factor in order to provide the effective strategy to control the same event of nosocomial infection.METHODS The samples were collected according to the regulation specified by Hospital Degermation Technological Specification.After that,the isolation,culture,and identification as well as susceptibility test of bacteria were carried out according National Clinical Laboratory Operating Instruction.RESULTS The detection rate of P.aeruginosa were 100.0% from sputum aspirator dish samples.66.7% from attendance workers′ hands,50.0% of water tap,40.0% of corrugated pipe of breathing machine,40.0% of cure dish,25.0% of hdoctors′ hands and 16.7% of bedside cupboard in the ICU.The P.aeruginosa isolated from both sputum sample of patient and environment have the same antibiotic sensitivity spectrum which was sensitive to ciprofloxacin,amikacin,and tobramycin but resistive to ceftazidime,cefepime,piperacillin/Tzao and tienam.CONCLUSION The outbreak of P.aeruginosa infection is derived from an case of permanent planting patientltingis due to the inadequacy in breathing machine corrugated tube degermation and personnel′s hands sanitation.In order to prevent the hospital infection,the case isolation,hands sanitation of medical staff,aseptic technique,pipe management of breathing machine should be emphasized.