CAJ | 학술논문

目的介绍内科重症监护病房(ICU)对泛耐药鲍曼不动杆菌(XDRABA)定植与感染的监测控制情况,总结院内感染筛查、控制的有效措施.方法观察2009年9月至2013年4月入住北京大学人民医院内科ICU＞48 h的非手术患者,记录每月XDRABA定植与感染的患者数及其一般临床特征.XDRABA定植与感染的控制措施分3个阶段:①暴发阶段:2009年9月至2010年8月,感染控制的方法包括加强手卫生、物体表面消毒、使用一次性呼吸机管路及改进抗菌药物的使用;②环境控制阶段:2010年9月至2012年4月,感染控制的方法包括现场调查、XDRABA定植与感染患者的隔离及环境的终末消毒;③微生物筛查监测阶段:2012年5月至2013年4月,入ICU时对患者进行咽、鼻及腋下拭子微生物培养.结果 2009年9月至2013年4月内科ICU共有193例XDRABA定植与感染患者,死亡64例(病死率为33.2％),机械通气133例(68.9％);病情严重程度[急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(20.3±6.7)分]较重,ICU住院时间[(34.6±13.8) d]较长.暴发阶段,每月新发XDRABA定植与感染患者5～9例;环境控制阶段,每月新发XDRABA定植与感染患者3～6例;微生物筛查监测阶段,每月带入XDRABA定植与感染患者2～4例,主要来源为急诊科(占59.5％),ICU获得病例由每月2～3例逐渐减少至0～1例.结论需采用集束化措施对内科ICU的XDRABA定植与感染进行控制,如加强微生物监测、强调医务人员手卫生、隔离XDRABA定植与感染患者以及彻底的环境消毒.
목적 개소내과중증감호병방(ICU)대범내약포만불동간균(XDRABA)정식여감염적감측공제정황,총결원내감염사사、공제적유효조시.방법 관찰2009년9월지2013년4월입주북경대학인민의원내과ICU＞48 h적비수술환자,기록매월XDRABA정식여감염적환자수급기일반림상특정.XDRABA정식여감염적공제조시분3개계단:①폭발계단:2009년9월지2010년8월,감염공제적방법포괄가강수위생、물체표면소독、사용일차성호흡궤관로급개진항균약물적사용;②배경공제계단:2010년9월지2012년4월,감염공제적방법포괄현장조사、XDRABA정식여감염환자적격리급배경적종말소독;③미생물사사감측계단:2012년5월지2013년4월,입ICU시대환자진행인、비급액하식자미생물배양.결과 2009년9월지2013년4월내과ICU공유193례XDRABA정식여감염환자,사망64례(병사솔위33.2％),궤계통기133례(68.9％);병정엄중정도[급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분(20.3±6.7)분]교중,ICU주원시간[(34.6±13.8) d]교장.폭발계단,매월신발XDRABA정식여감염환자5～9례;배경공제계단,매월신발XDRABA정식여감염환자3～6례;미생물사사감측계단,매월대입XDRABA정식여감염환자2～4례,주요래원위급진과(점59.5％),ICU획득병례유매월2～3례축점감소지0～1례.결론 수채용집속화조시대내과ICU적XDRABA정식여감염진행공제,여가강미생물감측、강조의무인원수위생、격리XDRABA정식여감염환자이급철저적배경소독.
Objective To describe the monitoring and control of pan-drug resistant Acinetobacter baumannii (XDRABA) colonization and infection in a medical intensive care unit (ICU),and to summarize the effective measures of surveillance of nosocomial infection and control.Methods Nonsurgical patients admitted to medical ICU of Peking University People's Hospital from September 2009 to April 2013 with length of ICU stay over 48 hours were surveyed.Number of cases of colonization and infection of XDRABA per month was recorded,and the clinical features of patients with XDRABA colonization and infection were observed.The control of XDRABA colonization and infection was divided into three stages:① Outbreak stage,from September 2009 to August 2010,the infection control measures included stringent hand hygiene and surface disinfection,use of disposable ventilator tubes and improvement in antibiotics use.② Environmental control stage,from September 2010 to April 2012,the infection control measures consisted of on-the-spot investigation,isolation of patients with XDRABA colonization and infection,tubes terminal environment disinfection.③ Microbial screening stage,from May 2012 to April 2013,throat,nose and axillary swabs were obtained when the patients admitted.Results From 2009 September to 2013 April there was a total of 193 patients colonized or infected with XDRABA,and 64 patients died (mortality rate was 33.2％),and 133 (68.9％) patients were on mechanical ventilation.Patients with XDRABA colonization and infection had severer illness [acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score 20.3 ±6.7],longer ICU stay [(34.6 ± 13.8) days].In outbreak stage,number of cases with XDRABA colonization and infection was 5-9 per month.In environmental control stage,case number of XDRABA colonization and infection was 3-6 per month.In microbial screening stage,case number of XDRABA colonization and infection,which were already present,was 2-4 per month,and they were mainly admitted from emergency department (59.5％).The number of cases of ICU acquired XDRABA colonization and infection decreased from 2-3 to 0-1 per month.Conclusion To control the colonization and infection of XDRABA,monitoring of microorganism,hand hygiene,isolation of patients with XDRABA colonization and infection,and stringent environment disinfection were very necessary.