纤维支气管镜污染致多重耐药菌感染原因分析

Analysis of Causes of Multidrug Resistance Bacteria Infection Caused by Fiberbronchoscope Contamination

背景随着医疗技术的快速发展,支气管肺泡灌洗术(BAL)对支气管、肺部疾病的诊疗技术得到不断普及与提高,诊疗的病例越来越多,经内镜传播病原微生物造成院内感染,已逐渐成为医学界、患者及舆论传媒关注的热点问题。耐碳青霉烯类微生物(CRO)污染诊疗环境、器械可导致医源性感染的聚集和暴发,由于其具有高度耐药性和快速传播能力,危害很大。目的分析某院纤维支气管镜污染导致多重耐药菌感染的原因,为临床预防和控制医院感染提供依据。方法收集2020-05-09至2020-05-24邯郸市第一医院急诊科采用纤维支气管镜行BAL的住院患者的灌洗液,细菌培养均为耐碳青霉烯类肺炎克雷伯菌(CRE),且近70%患者的检出结果与临床症状不相符。医院感控科立即进行流行病学调查和原因分析,并进行干预。对期间所有接受过经纤维支气管镜行BAL的患者进行个案调查,同时进行环境卫生学检测。结果2020-05-09至2020-05-24急诊科检出11例CRE感染,其中经纤维支气管镜行BAL后留取灌洗液培养5例、痰培养6例。在对18种环境物体表面的卫生学检测中,消毒灭菌时间超过4 h和24 h的急诊科支气管镜内壁均检出肺炎克雷伯菌,呼吸科纤维支气管镜未检出细菌。将11例CRE感染标本与2份环境卫生学检测标本得到的肺炎克雷伯菌进行药敏结果对比,结果显示,2份环境卫生学检测标本与5例经纤维支气管镜行BAL后留取灌洗液培养检出的CRE耐药谱相同。医院感控科判断经消毒灭菌后纤维支气管镜内部存在CRE定植,由厂家对纤维支气管镜进行更进一步鉴定,结果在患者咬损处内壁发现细小裂纹,检查患者咬损处管壁外侧光滑完整,致使测漏未检出漏气,但因内壁裂纹细小,毛刷未能清洗到位,造成急诊科纤维支气管镜污染,从而引发多例患者感染CRE。根据以上情况,医院感控科采取了一系列措施有效地控制和切断了感染途径。结论此次多重耐药菌感染是由纤维支气管镜污染导致的,此类事件应引起临床的高度重视,而采用必要措施切断传播流行是预防患者发生感染的关键。

Background With the rapid development of medical technology,bronchoalveolar lavage(BAL)diagnosis and treatment technology for bronchial and pulmonary diseases has been popularized and improved,and more and more cases have been diagnosed and treated.The transmission of pathogenic microorganisms through endoscopy has gradually caused nosocomial infections.It has become a hot issue of concern to the medical profession,patients and the media.Carbapenem-resistant microorganisms(CRO)polluting the diagnosis and treatment environment and equipment can lead to the accumulation and outbreak of iatrogenic infections.Due to their high drug resistance and rapid transmission ability,they are very harmful.Objective To analyze the causes of multidrug resistance bacteria infection caused by fiberbronchoscope contamination in a hospital,so as to provide basis for clinical prevention and control of nosocomial infection.Methods From 2020-05-09 to 2020-05-24,the lavage fluid cultures of inpatients who underwent BAL with fiberoptic bronchoscopy in the Emergency Department of Handan First Hospital were all carbapenem-resistant Klebsiella pneumonia(CRE).And nearly 70%of patients had detected results that were not consistent with clinical symptoms.Department of Infection Control of the hospital immediately carried out epidemiological investigation,cause analysis and intervention.During this period,all patients who underwent BAL through fiberoptic bronchoscopy were investigated for case studies,and environmental hygiene tests were performed at the same time.Results From 2020-05-09 to 2020-05-24,11 cases of CRE infection were detected in the Emergency Department.Among them,5 cases were cultured with lavage fluid and 6 cases were cultured with sputum after BAL was performed by fiberoptic bronchoscopy.In 18 environmental hygiene tests,Klebsiella pneumoniae was detected in the inner wall of bronchoscope in Emergency Department after disinfection and sterilization for more than 4 h and 24 h,and no bacteria was detected in fiberoptic bronchoscope in Respiratory Department.The drug sensitivity results of 11 CRE samples and 2 environmental hygiene test samples of Klebsiella pneumoniae were compared.The results showed that the drug resistance spectrum of CRE in 2 environmental hygiene test samples was the same as that in 5 cases after BAL through fiberbronchoscope.Department of Infection Control of the hospital judged that there was CRE colonization in the fiberoptic bronchoscope after disinfection and sterilization,and the manufacturer further identified the fiberoptic bronchoscope.As a result,small cracks were found on the inner wall of the patient's bite,and the outer side of the tube wall of the patient's bite was smooth and complete,so that no air leakage was detected in the leak detection,but the brush could not be cleaned in place due to the small cracks on the inner wall,it caused the contamination of fiberoptic bronchoscope in Emergency Department,resulting in multiple patients infected with multidrug-resistant bacteria.According to the above situation,Department of Infection Control of the hospital had taken a series of measures to effectively control and cut off the route of infection.Conclusion This multi-drug-resistant bacterial infection is caused by fiber bronchoscope contamination.This type of event should arouse clinical attention.Taking necessary measures to cut off the spread is the key to preventing infection in patients.