一起老年住院患者诺如病毒医院感染暴发的调查

A Nosocomial Norovirus Outbreak in Senior Inpatients

[目的]对上海市长宁区某医院老年住院患者病区发生的诺如病毒感染事件进行调查,了解医院感染控制工作存在的薄弱环节。[方法]采用现场流行病学方法进行调查,采用病区采样、询问、知识问卷、观察医护人员操作等方法收集导致医院感染暴发的相关信息。[结果]有11例老年住院患者与6名护工出现急性胃肠炎症状;该院老年病区的急性胃肠炎罹患率为11.56%(17/147);经实时聚合酶链反应(RT-PCR)方法检测,14份粪样中,10份诺如病毒Ⅱ型核酸阳性;床扶手表面大肠菌群阳性。通过对收集资料的分析,发现该院在医院感染控制工作的管理制度、手卫生、医护人员的消毒隔离知识和个人防护意识等方面存在薄弱环节。[结论]这是一起由诺如病毒感染引起的医院感染暴发事件,该院感染控制工作在管理制度、培训教育等方面需加以提高。

[ Objective ] To identify the weak links in the control of nosocomial infection through an investigation of norovirus outbreak in the wards of senior inpatients in a hospital of Changning District, Shanghai. [ Methods ] A field epidemiological investigation, including ward sampling, inpatient interviewing, questionnaire survey, and observing the working procedures of medical staff operation in the wards, was conducted to collect information relative to the infection outbreak. [ Results ] There were 11 elderly inpatients and 6 nursing staff presenting the symptoms of acute gastroenteritis. The attack rate of acute gastroenteritis in the wards of senior inpatients was 11.56% （17/147）. Positive norovirus genome-Ⅱ nucleic acid were identified in l0 out of 14 fecal samples by real-time polymerase chain reaction （RT-PCR）; fecal coliform was positive in one sample from bed rail. Through the analysis of collected data, weak links were identified in the management system of nosocomial infection, hand hygiene, staff＇s disinfection and quarantine knowledge, and personal protective awareness. [ Conclusion ] The norovirus outbreak indicates that the hospital needs to improve management system and training on nosocomial infection control.