Bertini Giovanna, Nicoletti PierLuigi, Scopetti Franca, Manoocher Pourshaban, Dani Carlo, Orefici Graziella
Division of Neonatology, Department of Critical Care Medicine and Surgery, Careggi University Hospital, University of Florence School of Medicine, Viale Morgagni, 85, 50134, Florence, Italy,
Eur J Pediatr. 2006 Aug;165(8):530-5. doi: 10.1007/s00431-006-0121-4. Epub 2006 Apr 7.
The risk of nosocomial infection due to Staphylococcus aureus in fullterm newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection control techniques. We report on an outbreak of skin infection in a Maternity Nursery (May 21, 2000) and the measures undertaken to bring the epidemic under control. These measures included: separating neonates already present in the nursery on August 23, 2000 from ones newly arriving by creating two different cohorts, one of neonates born before this date and one of neonates born later; restricting healthcare workers caring for S. aureus- infected infants from working with non-infected infants; disallowing carrier healthcare workers from caring for patients; introducing contact and droplet precautions (including the routine use of gowns, gloves, and mask); ensuring appropriate disinfection of potential sources of contamination. A representative number of isolates were typed by genomic DNA restriction length polymorphism analysis by means of pulsed-field gel electrophoresis (PFGE). Among the 227 cases of skin lesions, microbiological laboratory analyses confirmed that 175 were staphylococcal infections. The outbreak showed a gradual reduction in magnitude when the overcrowding of the Nursery was reduced by separating the newborns into the two different Nurseries (two cohorts). The genotyping of the strains by PFGE confirmed the nurse-to-newborn transmission of S. aureus. The measures adopted for controlling the S. aureus outbreak can, in retrospect, be assessed to have been very effective.
在医院条件下，如果新生儿重症监护室过度拥挤且感染控制技术不足，足月儿感染金黄色葡萄球菌的医院感染风险会更高。我们报告了一起发生在产科新生儿重症监护室（2000年5月21日）的皮肤感染暴发事件以及为控制疫情所采取的措施。这些措施包括：通过创建两个不同的队列，将2000年8月23日已在新生儿重症监护室的新生儿与新入院的新生儿分开，一个队列是在此日期之前出生的新生儿，另一个队列是在此日期之后出生的新生儿；限制护理感染金黄色葡萄球菌婴儿的医护人员护理未感染的婴儿；禁止携带病菌的医护人员护理患者；采取接触和飞沫预防措施（包括常规使用隔离衣、手套和口罩）；确保对潜在污染源进行适当消毒。通过脉冲场凝胶电泳（PFGE）对基因组DNA限制性片段长度多态性分析对代表性数量的分离株进行分型。在227例皮肤病变病例中，微生物实验室分析证实175例为葡萄球菌感染。当通过将新生儿分为两个不同的新生儿重症监护室（两个队列）来减少新生儿重症监护室的过度拥挤时，疫情的规模逐渐缩小。通过PFGE对菌株进行基因分型证实了金黄色葡萄球菌从护士到新生儿的传播。回顾来看，为控制金黄色葡萄球菌暴发所采取的措施被评估为非常有效。
