A型主动脉夹层术后VAP医院感染聚集事件的调查与控制

Investigation and control of nosocomial infections in VAP after type A aortic dissection

目的调查和控制A型主动脉夹层术后呼吸机相关性肺炎(VAP)聚集性发生事件,建立感染预防控制对策。方法选取2018年11—12月该院重症监护病房(ICU)主动脉夹层术后发生耐碳青霉烯类肺炎克雷伯菌(CRKP)所致的呼吸机相关肺炎(VAP)患者3例作为研究对象,对其进行流行病学调查与环境卫生学监测,并采取相应的预防控制措施。结果3株从患者痰液中检出的CRKP抗菌药物敏感度与其医疗环境表面(如床下层、床旁桌)、医务人员手卫生检出的CRKP一致。针对可能的传播途径提出医院感染防控措施,及时终止该医院感染聚集事件。结论该医院感染聚集事件可能是由医务人员手卫生、医疗环境表面引起的交叉感染,应落实加强多重耐药菌接触隔离措施,有效避免医院感染聚集的发生和传播。

Objective Investigate and control the aggregation of ventilator-associated pneumonia(VAP)after type A aortic dissection,and establish prevention and control measures for infection.Methods Three patients with ventilator-associated pneumonia(VAP)due to CRKP who underwent aortic dissection in the ICU in the hospital from November to December 2018 were selected as the research subjects.Conducted epidemiological investigation and environmental hygiene monitoring on patients,and took corresponding preventive control measures.Results A total of 3 strains of CRKP were detected from the patient's sputum.The sensitivity of antibacterial drugs was the same as that of CRKP detected by the medical environment surface(such as under the bed,table next to the bed),and hand hygiene of medical staff.In view of possible transmission routes,nosocomial infection prevention and control measures had been proposed,and the incident of nosocomial infections had been terminated in a timely manner.Conclusion The hospital infection gathering event may be a cross infection caused by medical staff′s hand hygiene and the surface of the medical environment.Measures should be taken to strengthen contact and isolation of multi-drug resistant bacteria to effectively prevent the occurrence and spread of nosocomial infections.