重症监护病房鲍曼不动杆菌感染现场调查及风险管理研究

Field Investigation on ICU Acinetobacter baumannii Infection and Risk Management

目的对重症监护病房泛耐药鲍曼不动杆菌(PDR-AB)所致的院内感染进行确认和流行病学调查,探讨风险管理机制在控制院内感染中的应用,保护患者和医务工作者的健康。方法 针对2007年3月在重症监护病房中的7例鲍曼不动杆菌感染的患者进行现场流行病学调查,同时对医院重症监护病房医务人员手及环境进行细菌采样与培养,识别并评估院内感染风险,制订风险控制措施并验证其可行性。结果重症监护病房环境中存在PDR-AB定植,严格执行消毒程序,能够彻底清除环境中的PDR-AB。本次调查中该病房院内感染的风险管理关键点包括规章制度,医护人员尤其是护工和保洁员的相关知识培训和院内感染的管理策略及技术等三方面。结论重症监护病房需进行严格的清洁与消毒,及时进行现场流行病学调查的同时将风险管理机制应用于院内感染的全程防控是减少院内感染的发生、暴发或流行的有效措施。

Objective To investigate the hospital acquired infection caused by Pan-drugresistant Acinetobacter baumanii（PDR-AB） in intensive care unit（ICU）,and to explore the application of risk management in the control of hospital acquired infection. Methods Seven cases of acquired PDR-AB infection in ICU in March,2007 were retrospectively analyzed and field investigation was conducted.Samples from the hands of medical staff and the environment were collected,cultured and then were identified by RAPID system.The potential risks were identified,evaluated and the feasibility of risk management strategy was explored. Results There was PDR-AB colonization in the ICU environment,and strict implementation of sterilization procedures may completely remove the environment PDR-AB.The three critical points in the risk management of hospital acquired infection were rules or regulations,training of related knowledge and strategy,and techniques of management. Conclusions Strict cleaning and disinfection are necessary in ICU,timely epidemiological field investigation and the simultaneous application of risk management in the full process of infection control might be effective measures against the emergence,outbreak or epidemic of hospital acquired infection.