多学科团队联合干预一起新生儿阴沟肠杆菌医院感染暴发的效果分析

Effect of multidisciplinary team intervention on outbreak of Enterobacter cloacae infection in neonates

目的探讨新生儿阴沟肠杆菌引起医院感染暴发的原因,多学科团队(MDT)联合干预的效果和优势,建立感染防控对策。方法对12例聚集性发热新生儿的临床资料及流行病学调查结果及标本检测进行分析。结果 12例聚集性发热新生儿,9例血培养结果示阴沟肠杆菌生长。此次医院感染暴发发生在春节前后,均有基础疾病,其中早产儿8例,低体重儿5例。结论与新生儿及早产儿免疫力低下、抗菌药物使用、环境、隔离与消毒、手卫生、病区医院感染监控以及阴沟肠杆菌的生物学特性等综合因素有关;及时启动应急预案,MDT协作联合干预真正起到了1+1>2的合力作用。改建新生儿科不合理布局、流程;构建便于有效清洁消毒的地面、墙面和设施;合理调配人力资源,加强对新生儿科感控制度、流程等的全方位监管力度;加强培训,做好标准预防,确保手卫生、空气物表清洁消毒等各项感控措施落实到位是防控新生儿阴沟肠杆菌医院感染暴发的关键环节;MDT协作联合干预新生儿阴沟肠杆菌医院感染暴发效果明显。

OBJECTIVE To explore the causes of outbreak of Enterobacter cloacae nosocomial infection in neonates,observe the effect and advantages of multidisciplinary team（MDT）intervention and put forward the prevention and control countermeasures.METHODS The clinical data of 12 neonates with clustered fever were analyzed,the result of the epidemiological survey was observed,and the result of specimens culture was investigated.RESULTS Of the 12 neonates with clustered fever,9 were positive for blood culture,showing the growth of E.cloacae.The nosocomial infection outbroke around the spring festival,all of the neonates had underlying diseases,including 8 cases of premature infants and 5 cases of low body weight.CONCLUSION The nosocomial infection induced by the E.cloacae is associated with the low immunity of neonates and premature infants,use of antibiotics,environment,isolation and disinfection,hand hygiene,monitoring of nosocomial infection in wards and biological characteristics of E.cloacae.The emergency plan was launched in time,and the MDT collaborative joint intervention really played the combined role of 1＋12.Reconstructing the unreasonable layout and process of neonatology;constructing ground,wall and facilities that are easy to clean and disinfect effectively;rationally deploying human resources,strengthening all-round supervision of neonatal sense of control,processes,and intensifying training and standard prevention to ensure that all the prevention measures such as hand hygiene,cleaning and disinfection of air and object surfaces were carried out in place are the key links for the prevention and control of the E.cloacae nosocomial infection in the neonates.The MDT intervention can achieve remarkable effect on the prevention of the E.cloacae nosocomial infection in the neonates.