医护人员的手套、长袍和手上经常受到多重耐药鲍曼不动杆菌的污染。
Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers.
机构信息
Departments of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD 21201, USA.
出版信息
Infect Control Hosp Epidemiol. 2010 Jul;31(7):716-21. doi: 10.1086/653201.
BACKGROUND
Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.
OBJECTIVE
To determine the incidence of transmission of MDR Acinetobacter baumannii and Pseudomonas aeruginosa from patients to healthcare workers (HCWs) during routine patient care.
DESIGN
Prospective cohort study.
SETTING
Medical and surgical intensive care units. Methods. We observed HCWs who entered the rooms of patients colonized with MDR A. baumannii or colonized with both MDR A. baumannii and MDR P. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.
RESULTS
Sixty-five interactions occurred with patients colonized with MDR A. baumannii and 134 with patients colonized with both MDR A. baumannii and MDR P. aeruginosa. Of 199 interactions between HCWs and patients colonized with MDR A. baumannii, 77 (38.7% [95% confidence interval {CI}, 31.9%-45.5%]) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% [95% CI, 1.6%-7.4%]) resulted in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients colonized with MDR P. aeruginosa, 11 (8.2% [95% CI, 3.6%-12.9%]) resulted in HCW contamination of gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for contamination with MDR A. baumannii were manipulation of wound dressing (adjusted odds ratio [aOR], 25.9 [95% CI, 3.1-208.8]), manipulation of artificial airway (aOR, 2.1 [95% CI, 1.1-4.0]), time in room longer than 5 minutes (aOR, 4.3 [95% CI, 2.0-9.1]), being a physician or nurse practitioner (aOR, 7.4 [95% CI, 1.6-35.2]), and being a nurse (aOR, 2.3 [95% CI, 1.1-4.8]).
CONCLUSIONS
Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDR A. baumannii. MDR A. baumannii appears to be more easily transmitted than MDR P. aeruginosa and perhaps more easily transmitted than previously studied methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. This ease of transmission may help explain the emergence of MDR A. baumannii.
背景
多药耐药（MDR）革兰氏阴性杆菌是重要的医院病原体。
目的
确定在常规患者护理过程中，MDR 鲍曼不动杆菌和铜绿假单胞菌从患者传播到医护人员（HCW）的发生率。
设计
前瞻性队列研究。
地点
内科和外科重症监护病房。方法：我们观察了进入 MDR A.baumannii 定植患者房间的 HCW，以及同时定植 MDR A.baumannii 和 MDR P. aeruginosa 的患者。我们在进入房间前检查了他们的手，在完成患者护理后检查了他们的一次性手套和/或长袍，以及在脱下手套和/或长袍并进行手部卫生前检查了他们的手。
结果
与 MDR A.baumannii 定植患者的 199 次交互中，有 77 次（38.7%[95%置信区间{CI}，31.9%-45.5%]）导致 HCW 手套和/或长袍污染，9 次（4.5%[95%CI，1.6%-7.4%]）导致 HCW 手在手部卫生前脱下手套后污染。与 MDR P. aeruginosa 定植患者的 134 次交互中，有 11 次（8.2%[95%CI，3.6%-12.9%]）导致 HCW 手套和/或长袍污染，1 次导致 HCW 手污染。MDR A.baumannii 污染的独立危险因素包括伤口敷料的处理（调整后的优势比[OR]，25.9[95%CI，3.1-208.8]）、人工气道的处理（OR，2.1[95%CI，1.1-4.0]）、在房间内停留时间超过 5 分钟（OR，4.3[95%CI，2.0-9.1]）、是医生或护士从业者（OR，7.4[95%CI，1.6-35.2]）和是护士（OR，2.3[95%CI，1.1-4.8]）。
结论
HCW 的长袍、手套和未洗的手经常被 MDR A.baumannii 污染。MDR A.baumannii 似乎比 MDR P. aeruginosa 更容易传播，而且可能比以前研究的耐甲氧西林金黄色葡萄球菌或万古霉素耐药肠球菌更容易传播。这种易传播性可能有助于解释 MDR A.baumannii 的出现。
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