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目的分析某综合性医院神经内科病房耐甲氧西林金黄色葡萄球菌(MRSA)定植及感染实时监测中医疗环境的作用,并提出防控措施。方法对某综合性医院神经内科住院患者进行MRSA定植与感染的实时监测筛查,同期采集医护人员、环境标本(床头桌表面、门把手、医师工作站鼠标等);稀有限制性位点PCR(IRS-PCR)基因分型法对标本中分离的MRSA进行同源性分析。结果在2007年7-12月,住院患者MRSA定植率为5.3%,感染率为3.8%,医护人员MRSA鼻前庭检出率为4.5%,手部检出率为6.6%,环境采样点总检出率为6.9%,其中床头桌检出率为8.8%,医师工作站的鼠标检出率为5.2%,门把手检出率为7.8%;对同一时期在患者鼻前庭、医护人员鼻前庭和手、环境中分离的15株MRSA进行IRS-PCR同源性分析,结果发现14株同为A型,分为4个亚型,1株为B型,具有高度同源性;对同一病区不同病房,不同时间的7株环境MRSA同源性分析发现同为A型的2个亚型,也显示出高度同源性。结论医疗环境在住院患者MRSA定植与感染过程中有着重要作用,制定综合性防控策略,边监测边干预,可以及时有效地控制MRSA的流行。
Objective To analyze the effect of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in real-time monitoring of the medical environment in neurology wards of a general hospital and to put forward prevention and control measures. Methods In-hospital MRSA colonization and infection were monitored in real time in inpatients with neurology in a general hospital. During the same period, medical staff and environmental specimens (bedside table, door handle, physician workstation mouse, etc.) were collected. Rare restriction sites PCR IRS-PCR) genotyping method for homology analysis of MRSA isolated from specimens. Results From July to December 2007, the MRSA colonization rate was 5.3% and the infection rate was 3.8%. The detection rate of nasal vestibular MRSA in medical staff was 4.5% and the detection rate of hand was 6.6%. The total environmental sampling points Out rate of 6.9%, of which the bedside table detection rate was 8.8%, the physician workstation mouse detection rate was 5.2%, door handle detection rate of 7.8%; for the same period in patients with nasal vestibule, medical staff nasal vestibule and 15 strains of MRSA separated by hand and environment were analyzed by IRS-PCR. The results showed that 14 strains were type A, divided into 4 subtypes and 1 strain was type B with high homology. Homology analysis of seven MRSA isolates in different wards and different times showed that two subtypes of the same type A also showed high homology. Conclusion The medical environment plays an important role in the inoculation and infection of MRSA in hospitalized patients. To develop a comprehensive prevention and control strategy, while monitoring the side intervention, can effectively control the prevalence of MRSA.