一起疑似医院不同病原菌血流感染暴发的应对

目的报告一起疑似医院血流感染暴发流行病学调查过程及防控措施效果。方法采用临床资料调查和现场采样相结合的方法对某院一起疑似医院血流感染暴发进行流行病学调查,确定传播源和传播途径,评价防控效果。结果 2014年4月21—28日某院神经内科病房共6例患者突发寒战、高热,其中4例外周血培养阳性(检出肺炎克雷伯菌2株,鲍曼不动杆菌和阴沟肠杆菌各1株),确诊为医院血流感染。共采标本170份,集中暴发期采样合格率(64. 91%,37/57)低于采取综合防控措施之后(93. 81%,106/113),差异有统计学意义(χ~2=23. 675,P=0. 000)。检出的致病菌主要分布在手最常接触的位置,患者周边物体表面、陪护人员手所携带的细菌与患者感染的致病菌存在一致性。采取综合干预措施后,无新发病例出现,6例患者均经治疗后痊愈。结论此次事件为疑似医院血流感染暴发,病房环境污染和经手播散是主要传播源和传播途径。实施环境去污染和手卫生管理的针对性防控措施能有效控制医院感染暴发。

Coping with a suspected outbreak of healthcare associated bloodstream infection due to different pathogens

ObjectiveTo report the epidemiological investigation process as well as prevention and control measures for a suspected outbreak of healthcare associated bloodstream infection(HAI BSI).MethodsAn epidemiological investigation on a suspected outbreak of HAI BSI in a hospital was carried out by means of clinical data investigation and on site sampling, sources and transmission routes were determined, efficacy of prevention and control was evaluated.ResultsFrom April 21 to 28, 2014, a total of 6 patients in the neurological wards of a hospital suffered from chill and high fever, 4 cases were positive for peripheral blood culture (2 strains were Klebsiella pneumoniae, 1 strain was Acinetobacter baumannii and 1 strain was Enterobacter cloacae), HAI BSI was diagnosed. A total of 170 specimens were collected, the qualified rate of specimen detection result during centralized outbreak sampling period was lower than that after taking comprehensive prevention and control measures (64.91%［37/57］ VS 93.81%［106/113］, χ2=23.675，P=0.000）. Pathogens were mainly found in the area where most frequently touched by hands, bacteria on object surface in the vicinity of patients as well as bacteria on hands of caregivers were consistent with the pathogens causing infection in patients. After comprehensive intervention was taken, no new case occurred, and 6 patients all recovered after treatment.ConclusionThis event is a suspected outbreak of HAI BSI, environmental contamination in wards and transmission through hands are the main sources and transmission routes. The implementation of targeted prevention and control measures of environmental decontamination and hand hygiene management can effectively control the outbreak of HAI.