ICU内疥疮感染爆发流行的危险因素及防控措施

Scabies outbreak in ICU： risk factors and valid interventions

目的探讨引起医院ICU内疥疮感染爆发流行的危险因素及有效控制措施。方法回顾2012-01～2013-01在国内医院ICU内所发生的两起疥疮感染事件的流行病学资料，包括首发病例特征、疫情流行情况、引起爆发流行的相关危险因素及疫情控制过程等，并进行分析。结果案例1共26例感染，包括医护人员25例（96．15％）、护理员1例（3．84％），疫情历时20d，发病高峰期8例感染，占感染病例总数30．77％。案例2共45例感染，包括医护人员35例（77．78％）、1例护理员（2．22％）、2例住院患者（4．44％）、7例医护人员家属（15．56％），疫情持续52d，其中两次发病高峰（分别占感染病例总数的20．00％、33．33％）。两案例在诊断过程中存在误诊现象，其中案例2最终未能确诊。医务人员的值班室、集体宿舍及ICU病房是造成疥疮传播的主要场所。疥疮感染事件发生后，两案例均通过采取有效地消毒隔离措施使疫情得到控制。结论疥疮具有人群普遍易感性、高度接触传染性，容易误诊、延迟诊断；集中居住、手卫生习惯是否良好及防治意识差是造成医院疥疮爆发流行的主要因素；有效的控制与消毒隔离措施是控制疥疮感染爆发流行的关键。

Objective To explore the risk factors and effective measures of prevention and control of scabies outbreak in ICU. Methods The epidemiology of the two events of scabies infection in Chinese hospital intensive care unit from January 2012 to January 2013 was reviewed and analyzed, including the characteristics of the first case, epidemic situation, related risk factors and control process. Results Twenty - six persons were infected in event 1, including 25 health care workers （96.15%） and 1 nursing staff （3.84%）. It lasted for 20 days and 8 persons were infected in the peak time, accounting for 30.77% of the total number of infected cases. Forty - five persons were infected in event 2, including 35 health care workers （77.78%）, 1 nursing staff （2.22%）, 2 patients （4.44%） and 7 family members of medical staff （ 15.56% ）. It lasted for 52 days, including two peak times （ accounting foi 20.00% and 33.33% of the infected people partly）. Both of the two events were misdiagnosed and the second case failed to be diagnosed finally. The medical staff duty room, dormitory and ICU wards were the main places causing scabies. Both the scabies events were successfully controlled by taking effective disinfection and isolation measures. Conclusion Scabies is generally susceptible, highly contagious and easily misdiagnosed or delayed to diagnose. Living together, bad hand hygiene habits and poor prevention consciousness are the main risk factors of the scabies outbreak. The effective disinfection and isolation measures of all the infected staff are the key to control the scabies outbreak.