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目的通过对血液科病房碳青霉烯类耐药肺炎克雷伯菌(CRKP)致3例血流感染病例的调查及感控干预,为预防医院感染暴发流行提供参考依据。方法 2013年6月事件发生期间设定为A组107例,2013年7月-12月设置为B组629例,2014年设置为C组1 081例,2015年设置为D组1 161例;对2013年6月3例CRKP致血流感染的患者进行临床及分子流行病学调查分析,并采取消毒隔离等干预措施,根据事件发生期、干预后分组并追踪30个月,运用χ~2检验分析不同组间感染发生率差异。结果 3例菌株属同一基因克隆,经启动消毒隔离等干预措施,观察干预后仅发生1例CRKP新病例,事件发生期、干预后CRKP感染率差异有统计学意义(P<0.05),无暴发流行事件。结论接触传播是此次事件的主要疑似因素;落实接触隔离措施、提高医护人员手卫生依从性、严格执行无菌操作、加强环境及物体表面的清洁与消毒、强化终末消毒,将有效预防医院感染的发生。
Objective To investigate the case of bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in hematology department and provide a reference for the prevention and control of the outbreak of nosocomial infection. Methods A total of 107 patients in group A were enrolled during the June 2013 incident, 629 in group B from July to December 2013, 1,081 in group C in 2014 and 1,161 in group D in 2015; According to the clinical and molecular epidemiological investigation of 3 cases of CRKP-induced bloodstream infection in June 2013, the interventions such as disinfection and isolation were performed. According to the incidence and intervention period, the patients were grouped and followed up for 30 months. Test analysis of differences in infection rates between groups. Results Three strains of the same strain were cloned. After interventions such as disinfection and isolation were initiated, only one new case of CRKP was observed after the intervention. The incidence of CRKP was significantly different between the two groups (P <0.05) Popular events. Conclusion Contact transmission is the main suspect factor in this incident. Implementation of contact isolation measures to improve hand hygiene compliance of medical staff, strict aseptic handling, enhanced environmental and object surface cleaning and disinfection, and enhanced terminal disinfection will effectively prevent hospitals The incidence of infection.