目的 调查儿童重症监护病房（pediatric intensive care unit,PICU）一起由耐碳青霉烯类鲍氏不动杆菌（car-bapenem-resistant Acinetobacter baumannii,CRAB）引起疑似医院感染暴发的流行病学特征,为有效控制医院感染提供依据。方法 对2021年5月20日—6月6日该PICU CRAB感染病例进行流行病学调查和现场环境卫生学监测,分析各种危险因素并采取相应的预防控制措施。结果 累计6例患儿检出CRAB阳性,最终确定4例为定植,2例为院内感染。物体表面细菌菌落数合格率为44.44%（16/36）。单因素分析显示,昏迷、气管插管、纤维支气管镜检查和常规吸痰是重要的危险因素。通过采取一系列控制措施,2021年6月7日后未再出现新发CRAB阳性病例,CRAB疑似暴发得到有效控制。结论 此次疑似医院感染暴发可能原因为纤维支气管镜检查吸痰操作横向传播,污染环境后通过医务人员的手间接将病原菌带给其他患儿。重症监护病房环境物体表面的清洁消毒和手卫生管理对于预防医院感染至关重要。
Objective To investigate the epidemiological features of a suspected healthcare-associated infection outbreak of carbapenem-resistant Acinetobacter baumannii（CRAB） in Pediatric Intensive Care Unit（PICU）,and facilitate the prevention and control of hospital associated infection effectively. Methods Subjects infected with CRAB in PICU from May 20th 2021 to June 6th 2021 were investigated epidemiologically and environmental hygiene was monitored. Risk factors were analyzed and corresponding preventive control methods were taken. Results CRAB was detected in 6 cases with 4 cases being identified as colonization and 2 cases as nosocomial infection. The qualified rate of bacterial count on the surfaces of objects was 44.44%（16/36）. Univariate analysis revealed that coma,endotracheal intubation,bronchoscopy and conventional sputum suction were relevant risk factors. There were no new infected cases occurred in PICU after a series control methods were taken since June 7th 2021. Conclusion This CRAB HAI may be spread transversely through environmental surfaces and hands of medical staffs in the process of sputum suction with bronchoscopy. Cleaning and disinfection of the surfaces of objects and hand hygiene management in PICU are vital for preventing hospital infection.
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