重症监护室高频接触表面耐甲氧西林金黄色葡萄球菌污染的调查研究

Contamination of methicillin-resistant Staphylococcus aureus on frequently touched surfaces in ICUs

目的了解杭州市第一人民医院重症监护室（intensive care unit,ICU）高频接触表面耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aures,MRSA）污染情况,为医院环境感染控制提供依据。方法 2013年3~5月,选择杭州市第一人民医院感染管理重点科室综合ICU和新生儿重症监护室（neonatal intensive care unit,NICU）,并确定12类高频接触表面为MRSA监测的部位,采用无菌棉签涂抹采样,现场直接接种至MRSA显色培养基,采用葡萄球菌鉴定试剂盒及PCR扩增mecA基因鉴定MRSA。结果采集综合ICU高频接触表面样本100份,MRSA阳性率为14.00%,12类高频接触表面中有8类表面（66.67%）检出目标细菌;采集NICU样本100份,MRSA阳性率为16.00%,12类高频接触表面中有9类（75.00%）表面检出目标细菌。两类ICU的MRSA检出率差异无统计学意义（χ2=0.157,P=0.692）;ICU和NICU的电脑键盘均为MRSA检出率最高部位。结论应高度关注ICU病房高频接触表面的MRSA污染,尤其应关注电脑键盘等表面结构较为复杂的物品表面的清洁与消毒,为患者提供清洁而安全的诊疗环境。

Objective To understand the contamination of methicillin-resistant Staphylococcus aureus（MRSA）on high-touch surfaces in intensive care units（ICUs）,and to provide the evidence for environmental infection control. Methods Twelve types of frequently touched surfaces were sampled in ICUs and neonatal intensive care unit（NICU）of hospital using sterile swabs from March to May,2013.MRSA chromogenic medium was used to culture and isolate MRSA,which were then identified by ATB expression and mecA gene amplification. Results Out of 100 samples collected in ICU and 100 samples in NICU,14 and 16samples were MRSA positive.MRSA were also identified in samples collected from 8out of 12 in ICUs and 9out of 12 types of high-touch surfaces in NICU.There was no statistical significance of positive rate between the two ICUs（χ2=0.157,P=0.692）.The most contaminated high-touch surfaces were the keyboard of computer in both ICUs. Conclusions In order to provide a clean and safe clinic environment for patients,contamination of MRSA on frequently touched surfaces in ICUs and NICU should be highly concerned,especially those with complex surface structures such as keyboard of computer.