Division of Infectious Diseases, University of Miami, and Jackson Memorial Hospital, Miami, Florida 33136-1096, USA.
Infect Control Hosp Epidemiol. 2010 Apr;31(4):341-7. doi: 10.1086/651097.
To determine the effect of a bundle of infection control interventions on the horizontal transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae during an outbreak.
Quasi-experimental study. Setting. Long-term acute care hospital. Intervention. On July 23, 2008, a bundled intervention was implemented: daily 2% chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures.
Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P < .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases--suspected to be due to horizontal transmission--were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention.
A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.
确定在暴发期间实施一组感染控制干预措施对产碳青霉烯酶肺炎克雷伯菌（KPC）的肺炎克雷伯菌水平传播的影响。
准实验研究。设置：长期急性护理医院。干预措施：2008 年 7 月 23 日，实施了一组干预措施：对患者进行每日 2%葡萄糖酸氯己定浴、强化环境清洁、入院时进行监测培养、连续点患病率监测（PPS）、隔离预防措施以及人员培训。在实施干预措施之前进行了基线 PPS。任何疑似产 KPC 的革兰氏阴性杆菌分离株均进行改良霍格试验，如果结果阳性，则进行聚合酶链反应确认试验。临床病例定义为患者样本在临床培养中产生 KPC 阳性革兰氏阴性杆菌。
2008 年 6 月 17 日进行的基线 PPS 显示，产 KPC 分离株定植率为 21%（39 名筛查患者中有 8 例）。实施干预措施后，每月进行 5 次 PPS，显示产 KPC 分离株定植率分别为 12%、5%、3%、0%和 0%（P<.001）。从 2008 年 1 月 1 日至干预前，共检测到 8 例疑似水平传播所致的 KPC 阳性临床病例。从实施干预措施到 2008 年 12 月 31 日，仅检测到 2 例 KPC 阳性临床病例，均发生在 2008 年 8 月。从 2008 年 1 月 1 日至 12 月 31 日，有 8 名患者在入院时被检测为产 KPC 分离株的携带者，其中 4 名患者在干预前，4 名患者在干预后。
尽管持续有定植产 KPC 者入院，一组感染控制干预措施仍成功地防止了长期急性护理医院中产 KPC 革兰氏阴性杆菌的水平传播。
