新生儿重症监护病房肺炎克雷伯菌的感染分析

Klebsiella pneumoniainfection in neonatal intensive care unit

目的分析新生儿重症监护病房肺炎克雷伯菌感染的暴发,为预防与控制新生儿重症监护病房感染提供依据。方法针对2010年6月13-20日新生儿重症监护病房发生的4例肺炎克雷伯菌感染开展流行病学调查,查找感染源与传播途径,并采取集中隔离感染患者,重症监护病房安装空气动态器,营养液、静脉输液现配现用,使用一次性包装洗手液,注重医务人员手卫生,规范执行无菌操作等综合性干预措施。结果重症监护病房共有21例新生儿,4例发生产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌感染,感染率为19.05%;环境卫生学监测采集样本37份,有14份病原菌检出阳性,阳性率为41.2%,其中3份培养出肺炎克雷伯菌肺炎亚种细菌。结论医务人员无菌操作执行不规范以及存放洗手液容器污染严重,是造成该次肺炎克雷伯菌感染暴发的主要原因;感染管理科应加强医院感染监测工作,采取有效的预防控制措施,最大限度地降低发生医院感染的风险。

OBJECTIVE To analyze the reasons and process of the outbreak of Klebsiella pneumonia for the prevention and control of infections in neonatal intensive care unit.METHODS A retrospective analysis of the epidemiology of Klebsiella pneumonia infection in the neonatal intensive care unit from Jun 13 to Jun 20 2010 was done to find the source of infection and transmission.Furthermore,comprehensive interventions including the concentrated isolation of infected patients,the installation of air dynamic conditioning systems in the unit,the receiving of active nutrition and intravenous fluids,the using of disposable packaging hand sanitizer,the focusing on the hand hygiene of medical personnel and the implementation of non-bacteria operations were under taken.RESULTS Among twenty-one patients in the neonatal intensive care unit,four patients were infected by K.pneumonia and the incidence was19.05%.There were three positive subspecies of K.pneumonia in thirty-seven samples by the method of environmental hygienic monitoring.CONCLUSION The lack of standardization of non-bacteria operation by medical staff and the pollution of hand washing liquid storage containers are the reasons of K.pneumonia outbreak.Department of infection control should strengthen the hospital infection monitoring work and adopt effective measures to maximize lower risk of hospital infection.