重症监护病房鲍曼不动杆菌感染患者周边环境污染情况调查

Investigation on pollution of surrounding environment of patients with Acinetobacter baumannii infection in intensive care unit

目的了解上海市某医院的重症监护病房中鲍曼不动杆菌感染患者周边环境物体表面的污染情况,分析造成污染的范围和影响因素。方法采样并检测感染患者周边环境物体表面样品中的鲍曼不动杆菌,选出与患者痰液样品耐药谱一致的菌株。结果 41件(14. 2%,41/288)样品检出鲍曼不动杆菌,32件(11. 1%,32/288)样品检出的鲍曼不动杆菌与相应患者痰液样品的鲍曼不动杆菌耐药谱一致。氧气湿化瓶/呼吸机、被褥和病床扶手是最常见的污染部位。病房内检出率(15. 8%)高于病房外(7. 7%);主要接触者为医护人员、清洁员、患者的检出率依次为5. 4%、12. 5%、23. 6%;表面材质为金属硬质、织物与非金属硬质的检出率依次为3. 8%、11. 7%、14. 7%,差异均有统计学意义。病房内不同表面材质的检出率差异无统计学意义(P=0. 324),病房外不同表面材质的检出率差异有统计学意义(P=0. 043)。结论非金属硬质物品表面和病房内的织物呈现出较高的鲍曼不动杆菌检出率,应加强环境清洁和消毒,做好主动监测。

Objective To investigate the pollution on the surface of the surrounding environment of patients with Acinetobacter baumannii infection in ICU of a hospital in Shanghai,and to analyze the scope of pollution and influencing factors.Methods The surface samples of objects in the surrounding environment of infected patients were sampled and tested for Acinetobacter baumannii,and the strains with the same drug resistance spectrum as the sputum samples of patients were selected. Results 41 samples( 14. 2%,41/288) were positive for Acinetobacter baumannii,and 32 samples( 11. 1%,32/288) were detected for Acinetobacter baumannii which had the same drug resistance spectrum as the sputum samples of the corresponding patients. Oxygen humidifiers/ventilators,beddings and bed handrails were the most common contaminated sites. The detection rate in the ward( 15. 8%) was higher than that outside the ward( 7. 7%);the detection rates of the main contacts of medical staff,cleaners and patients were 5. 4%,12. 5% and 23. 6%,respectively;the detection rates of the surface materials of metallic hard,fabric and non-metallic hard were 3. 8%,11. 7% and 14. 7%,respectively. The differences were all statistically significant. There was no statistically significant difference in the detection rates of different surface materials in the ward( P = 0. 324),and the difference in the detection rates of different surface materials outside the ward was statistically significant( P = 0. 043). Conclusion The surface of non-metallic hard objects and the fabrics in the ward showa high detection rate of Acinetobacter baumannii. Environmental cleaning and disinfection should be strengthened,and active monitoring should be done.