CAJ | 학술논문

目的：调查某院乳腺外科一起由黏质沙雷菌引起导管相关血流感染(CRBSI)暴发的原因,为预防和控制医院感染提供依据。方法采用临床资料调查和现场采样相结合的方法,对此次医院感染暴发进行流行病学调查。结果乳腺外科2014年1月2-8日连续发生9例CRBSI。其中4例患者导管尖端和血液标本中均培养出黏质沙雷菌,5例患者导管尖端培养出黏质沙雷菌。检出的黏质沙雷菌耐药谱基本相同；仅头孢西丁药敏结果有差异,其中7株为中介,1株耐药,1株敏感,但相同患者导管尖端和血液标本中检出的黏质沙雷菌药敏结果完全相同。医务人员手、治疗室门把手、治疗车表面各检出1株黏质沙雷菌,其耐药谱与血培养菌株基本一致。9例感染患者经拔除导管,使用抗菌药物治疗后,感染得到有效控制；病区经严格消毒后,均未检出黏质沙雷菌,未再出现新发感染病例。结论乳腺外科环境污染,医务人员手卫生不规范,导管留置时间长等是此次感染暴发的主要原因。应加强医务人员手卫生依从性,重视环境及物体表面的消毒,有效预防和控制医院感染。
목적：조사모원유선외과일기유점질사뢰균인기도관상관혈류감염(CRBSI)폭발적원인,위예방화공제의원감염제공의거。방법채용림상자료조사화현장채양상결합적방법,대차차의원감염폭발진행류행병학조사。결과유선외과2014년1월2-8일련속발생9례CRBSI。기중4례환자도관첨단화혈액표본중균배양출점질사뢰균,5례환자도관첨단배양출점질사뢰균。검출적점질사뢰균내약보기본상동；부두포서정약민결과유차이,기중7주위중개,1주내약,1주민감,단상동환자도관첨단화혈액표본중검출적점질사뢰균약민결과완전상동。의무인원수、치료실문파수、치료차표면각검출1주점질사뢰균,기내약보여혈배양균주기본일치。9례감염환자경발제도관,사용항균약물치료후,감염득도유효공제；병구경엄격소독후,균미검출점질사뢰균,미재출현신발감염병례。결론유선외과배경오염,의무인원수위생불규범,도관류치시간장등시차차감염폭발적주요원인。응가강의무인원수위생의종성,중시배경급물체표면적소독,유효예방화공제의원감염。
Objective To investigate the causes of an outbreak of Serratiamarcescens (S.marcescens)catheter-related bloodstream infection(CRBSI)in a breast surgery department,and provide basis for the prevention and con-trol of healthcare-associated infection(HAI).Methods Epidemiological investigation was performed by analyzing clinical data and sampling.Results Nine cases of CRBSI occurred in a breast surgery department on January 2-8, 2014.Four patients isolated S.marcescens from their catheter tips and blood culture specimens,and 5 patients only isolated S.marcescens from their catheter tips.The resistant spectrum of S.marcescens were basically the same, but cefoxitin susceptibility results were different,7 strains were intermediate,1 resistant,and 1 sensitive,antimi-crobial susceptibility testing results of S.marcescens from catheter tips and blood culture specimens of the identical patients were the same.S.marcescens were detected from the hands of medical staff(n=1 ),door handle of the ther-apeutic room (n=1 ),and surface of the treatment trolley (n=1 ),the resistant spectrum were consistent with that of bacteria from blood culture.All infected patients were effectively controlled after catheter removal and antimicro-bial use.Wards were not detected S.marcescens and no new infection occurred again after strict disinfection. Conclusion The main causes of the outbreak are contamination of environment of breast surgery department,non-standardized hand hygiene,long time catheterization.Medical staff should strengthen hand hygiene compliance,pay attention to disinfection of environment and surface,effectively prevent and control HAI.