一起ICU耐碳青霉烯类肺炎克雷伯菌感染暴发调查

Investigation on outbreak of one case of carbapenem-resistant Klebsiella pneumonia infection in intensive care unit

目的调查医院重症监护病房(ICU)耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发事件的原因,查找传染源和传播途径,为有效预防和控制医院感染提供依据。方法对2019年1-2月华中科技大学同济医学院附属同济医院ICU发生的CRKP感染病例进行现场流行病学调查和环境卫生学监测,并采取针对性的预防控制措施。结果共发生CRKP医院感染9例,罹患率为6.82%(9/132),与2018年同期相比差异有统计学意义(P<0.001);流行曲线疑似"间歇传播";病例分布在两个病区但床位相对集中;环境卫生学监测显示,环境物表CRKP检出率为4.69%(3/64),分别从19床治疗车,6床床头柜和6床床周地面检出,纤支镜CRKP检出率为100.00%;9株患者检出的CRKP菌株和5株环境检出的CRKP菌株药敏结果基本一致;采取病区大清洁、规范纤支镜清洗消毒流程、对纤支镜进行环氧乙烷灭菌等针对性措施后,此次事件得到有效控制。结论ICU内纤支镜清洗消毒不到位以及环境消毒不彻底是导致此次CRKP医院感染暴发的主要原因。早期识别感染暴发,查找原因,并采取针对性控制措施是控制医院感染暴发的关键。

OBJECTIVE To investigate the cause of nosocomial infection outbreak of carbapenem resistant Klebsiella pneumoniae(CRKP)in intensive care unit of a hospital,to find the source of infection and the route of transmission,so as to provide evidence for effective prevention and control of nosocomial infections.METHODS On-site epidemiological survey and environmental hygiene monitoring of CRKP infection cases that occurred in the ICU of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from Jan.to Feb.2019 were conducted,and targeted preventive and control measures were taken.RESULTS A total of 9 cases of CRKP nosocomial infections occurred,with an attack rate of 6.82%(9/132),which was significant compared with the same period in 2018(P<0.001);the epidemic curve is suspected of"intermittent transmission";the cases were distributed in two wards but the beds were relatively concentrated;environmental hygiene monitoring revealed that the detection rate of CRKP on the environmental object surface was 4.69%(3/64),which was detected from 19-bed treatment vehicle,6-bed bedside cupboard,and 6-bed surrounding ground,respectively.The detection rate of CRKP by fiberbronchoscope was 100.00%.The drug susceptibility results of 9 CRKP strains detected in patients and 5 CRKP strains detected in environmental were basically the same.The incidence was effectively controlled after taking specific measures such as ward cleaning,standardized the cleaning and disinfection process of fiberbronchoscope,and sterilization of fiberbronchoscope with ethylene oxide.CONCLUSION Inadequate cleaning and disinfection of fiberbronchoscope and incomplete environmental disinfection in the ICU were the main reasons for this outbreak of CRKP nosocomial infection.Early identification of an infection outbreak early,finding the causes and taking targeted control measures were the keys to control the nosocomial infection outbreak.