急诊住院病房多重耐药鲍曼不动杆菌医院内感染暴发的原因调查及控制对策

Investigation on outbreak of nosocomial infection of multi-drug resistant acinetobacter baumannii in the wards of emergency department and control countermeasures

目的：调查急诊住院病房多重耐药鲍曼不动杆菌（MDRABA）医院内感染暴发流行的原因，探讨控制对策的有效性。方法对急诊住院病房2013年3月2～28日发生的13例下呼吸道MDRABA感染患者进行流行病学、危险因素、环境微生物监测调查。结果患者多为老年、基础病情危重，有气管插管或气管切开联合机械通气、使用多种广谱抗菌药物、应用肾上腺糖皮质激素，低蛋白血症等多种危险因素。环境微生物监测中物体表面和手共分离到鲍曼不动杆菌17株，与患者痰液分离的13株鲍曼不动杆菌耐药谱完全相同，为MDRABA，存在对亚胺培南等碳青酶烯类抗菌药物耐药的菌株。13例患者死亡4例，治愈9例。结论医务人员诊疗操作中洗手缺乏依从性和规范性，医疗设备特别是呼吸机清洁消毒不彻底是此次患者下呼吸道MDRABA医院内感染暴发流行的主要原因。严格隔离患者、提高医务人员手卫生的依从性、对医疗设备彻底清洁消毒可预防医院内感染暴发流行。

Objective To investigate the causes of multi-drug resistant acinetobacter baumannii（MDRABA） nosocomial infection outbreak in the wards of emergency department ,and to explore effective control measures. Methods A total of 13 pa-tients with lower respiratory tract infection of MDRABA ,who were in the wards of Emergency Department from March 2nd to 28th 2013,were investigated on epidemiology,risk factors and environmental microbiological monitoring. Resutls Most of the patients had multiple risk factors such as the elderly,serious basic diseases,tracheal intubation or tracheotomy＋mechanical ventilation,the use of a variety of broad-spectrum antibiotics,application of adrenocortical hormone,hypoproteinemia and so on. 17 strains of acinetobacter baumannii were isolated from surface and hands of objects in environmental microbiological monitoring ,drug resis-tant spectrum of which were exactly the same as that of 13 strains of acinetobacter baumannii isolated from sputum of patients. These strains of acinetobacter baumannii were confirmed as MDRABA ,including antimicrobial drug resistance to carbapenems as imipenem. Among 13 patients,4 cases died,and the other 9 cases were cured. Conclusion Medical personnel is lack of the compliance and normative of washing hands ,medical equipments especially as ventilators are with incomplete cleaning and disin-fection. Both above were the main causes of the outbreak of lower respiratory tract hospital infection in MDRABA. Strict isolation of patients,improvement of hand-washing compliance and complete cleaning and disinfection of medical equipments can prevent outbreak of hospital infection.