重症监护病房常规操作对耐碳青霉烯鲍曼不动杆菌传播的影响

Effect of routine operations in ICU on the transmission of carbapenem-resistant Acinetobacter baumannii

目的探讨神经外科重症监护病房(NICU)常规诊疗操作对耐碳青霉烯鲍曼不动杆菌(CRAB)在医务人员及患者周围环境的传播及影响因素。方法采用前瞻性队列研究和方便抽样的方法,对2018年12月1日-2019年2月28日某三甲医院神经外科ICU中对CRAB感染患者进行吸痰、更换导管、整理床单元、换药、静脉输液和口腔护理等6项诊疗操作后医务人员隔离衣、手套及患者周围环境进行CRAB检测。结果医务人员CRAB污染率(57.5%)高于周围环境(38.6%)。医务人员污染率较高的操作有换药、整理床单元、吸痰和口腔护理,分别为83.3%、70.0%、66.7%和66.7%。周围环境污染中患者枕头、监护仪导线和三通接头的污染率较高,分别为56.1%、50.7%和49.6%。结论神经外科ICU应加强换药、整理床单元、吸痰及口腔护理等操作中医务人员的防护,及时更换三通接头、枕头、监护仪导线,避免造成交叉感染。

Objective To investigate the spread and influencing factors of carbapenem-resistant Acinetobacter baumannii(CRAB)in the surrounding environment of medical staff and patients after routine diagnosis and treatment in ICU of neurosurgery.Methods Use prospective cohort study and convenient sampling method,on December 1,2018 to February 28,2019,a 3 armour hospital neurosurgery ICU for CRAB infection in patients with sputum suction,replacement of catheter,sheets yuan,treatment,intravenous fluids and 6 items such as oral cavity nursing diagnosis and medical personnel protective clothing,gloves and patients after operation environment detection of CRAB.Results The pollution rate of medical workers CRAB(57.5%)was higher than that of the surrounding environment(38.6%).The operations with higher contamination rate for medical personnel included dressing change,bed sheet arranging,sputum aspiration and oral care,which were 83.3%,70.0%,66.7%and 66.7%,respectively.The pollution rates of pillows,monitor leads and tee joints were higher in patients with ambient pollution(56.1%,50.7%and 49.6%,respectively).Conclusion In the ICU of neurosurgery,the protection of medical personnel in the operation of dressing change,sheet arranging,sputum aspiration and oral care should be strengthened,and the three-way connector,pillow and monitor lead should be replaced in time to avoid cross-infection.