在新生儿重症监护病房中控制耐甲氧西林金黄色葡萄球菌爆发和持续传播的逐步方法。

A stepwise approach to control an outbreak and ongoing transmission of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit.

机构信息

Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

出版信息

Am J Infect Control. 2010 Oct;38(8):607-11. doi: 10.1016/j.ajic.2010.02.017. Epub 2010 Jun 8.

DOI:10.1016/j.ajic.2010.02.017

PMID:20570396

Abstract

BACKGROUND

Preventing methicillin-resistant Staphylococcus aureus (MRSA) transmission in health care facilities where MRSA is endemic is challenging yet critical.

OBJECTIVE

We sought to determine the effectiveness of 2 bundles of interventions for preventing MRSA transmission in a neonatal intensive care unit (NICU).

METHODS

This retrospective cohort study included infants admitted to our NICU between September 1, 2004, and March 31, 2009. Following a MRSA outbreak between September 2004 and September 2005, preventing ongoing MRSA transmission remained a challenge. In July 2006, bundle-I, including culture-based active surveillance, preemptive contact precaution for up to 72 hours for new admissions, and cohorting assignment of direct caregivers was introduced for eradicating MRSA transmission. Bundle-II began in April 2007 and included bundle-1 measures except that the real-time polymerase chain reaction test replaced culture for the detection of MRSA.

RESULTS

This study identified 218 infants who developed MRSA infection or colonization and 151 instances of MRSA transmission during the study period. After instituting bundle-II, the transmission rate declined from 2.9 to 2.1 per 1000 patient-days-at-risk (incidence rate ratio, 1.4; 95% confidence interval: 0.9-2.2), and hospital-acquired MRSA infections declined from 1.3 to 0.5 per 1000 patient-days-at-risk (incidence rate ratio, 2.5; 95% confidence interval: 1.1-5.8).

CONCLUSION

Despite an increasing incidence of MRSA in community settings, preventing MRSA transmission within a NICU is achievable through implementation of optimal intervention strategies.

摘要

背景

在耐甲氧西林金黄色葡萄球菌（MRSA）流行的医疗机构中预防 MRSA 传播具有挑战性，但至关重要。

目的

我们旨在确定 2 套干预措施在新生儿重症监护病房（NICU）中预防 MRSA 传播的有效性。

方法

这项回顾性队列研究纳入了 2004 年 9 月 1 日至 2009 年 3 月 31 日期间入住我们 NICU 的婴儿。在 2004 年 9 月至 2005 年 9 月发生 MRSA 暴发后，防止持续的 MRSA 传播仍然是一个挑战。2006 年 7 月，引入了 bundle-I，包括基于培养的主动监测、新入院者长达 72 小时的先发制人的接触预防以及直接护理人员的分组分配，以消除 MRSA 传播。bundle-II 于 2007 年 4 月开始，包括 bundle-1 措施，但用于检测 MRSA 的检测方法为实时聚合酶链反应试验而非培养。

结果

这项研究确定了在研究期间发生了 218 例婴儿 MRSA 感染或定植以及 151 例 MRSA 传播的病例。在实施 bundle-II 后，传播率从每 1000 个患者风险日 2.9 例降至每 1000 个患者风险日 2.1 例（发病率比，1.4；95%置信区间：0.9-2.2），医院获得性 MRSA 感染从每 1000 个患者风险日 1.3 例降至每 1000 个患者风险日 0.5 例（发病率比，2.5；95%置信区间：1.1-5.8）。