一起NICU导管相关血流感染的流行病学调查及处置

Epidemiologic investigation of catheter-associated bloodstream infections in NICU

目的对新生儿重症监护病房(NICU)导管相关血流感染(CRBSI)疑似医院感染暴发进行流行病学调查,为感染防控提供科学依据。方法对2023年5月28日-6月24日感染患儿三间分布进行调查,采集NICU环境卫生学标本、主动筛查医务人员鼻腔及手,查找金黄色葡萄球菌(SA),与患儿血培养检测出的菌株进行脉冲场凝胶电泳(PFGE)检测,分析同源性。结果NICU患儿CRBSI感染率为2.29%,医务人员鼻腔SA阳性率为32.35%,手阳性率为1.47%;PFGE检测分析,2例患儿血培养菌株与一护士鼻腔菌株有91.30%的相似度,1例患儿血培养菌株与另一护士手菌株有91.30%的相似度。结论3例CRBSI患儿与医务人员鼻腔定植SA、手卫生有关,为2个感染路径,排除医院感染暴发。应高度重视NICU医务人员鼻腔SA定植,及时去定植管理,严格落实手卫生,积极降低医院感染发生率。

OBJECTIVE To investigate the epidemiology of catheter-related bloodstream infections(CRBSI)in a neonatal intensive care unit(NICU),and in order to provide a scientific basis for infection prevention and control.METHODS The three-room distribution of infected children from May 28 to Jun 24,2023 was investigated.Environmental hygiene samples were collected from the NICU.The nasal passages and hands samples of medical staff were actively screened to find Staphylococcus aureus(SA).And pulsed-field gel electrophoresis(PFGE)was performed to analyze the homology with the strains detected by blood culture of the children.RESULTS The rate of CRBSI infection in children in NICU was 2.29%o,nasal SA-positive rate among medical staff was 32.35%,and hand SA-positive rate was 1.47%.PFGE test analysis showed that strains isolated from blood culture of two children's specimens had 91.30%similarity to one strain from a nurse's nasal specimen,and one strain from child's blood culture was 91.30%similar to a strain from another nurse's hand.CONCLUSION Three children with CRBSI were related to nasal colonization of SA and hand hygiene of medical staff,which are the two pathways of infection,excluding outbreak of nosocomial infection.Great attention should be paid to the nasal SA colonization of NICU medical staff,and timely de-colonization management,strict implementation of hand hygiene should be carried out,in order to actively reduce the incidence of hospital infections.