强化重症监护病房清洁对医院病原体临近环境污染的影响：两家医院重症监护病房的随机交叉研究。

The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals.

机构信息

Departments of Microbiology and Infection Control, University College London Hospitals, London, United Kingdom.

出版信息

Crit Care Med. 2011 Apr;39(4):651-8. doi: 10.1097/CCM.0b013e318206bc66.

DOI:10.1097/CCM.0b013e318206bc66

PMID:21242793

Abstract

OBJECTIVES

To determine the effect of enhanced cleaning of the near-patient environment on the isolation of hospital pathogens from the bed area and staff hands.

DESIGN

Prospective randomized crossover study over the course of 1 yr.

SETTING

Intensive care units at two teaching hospitals.

PATIENTS

There were 1252 patients staying during enhanced cleaning and 1331 staying during standard cleaning.

INTERVENTIONS

In each of six 2-month periods, one unit was randomly selected for additional twice-daily enhanced cleaning of hand contact surfaces.

MEASUREMENTS AND MAIN RESULTS

Agar contact samples were taken at five sites around randomly selected bed areas, from staff hands, and from communal sites three times daily for 12 bed days per week. Patients admitted in the year commencing April 2007 were analyzed for hospital-acquired colonization and infection. Over the course of 1152 bed days, 20,736 samples were collected. Detection of environmental methicillin-resistant Staphylococcus aureus per bed-area day was reduced during enhanced cleaning phases from 82 of 561 (14.6%) to 51 of 559 (9.1%) (adjusted odds ratio, 0.59; 95% confidence interval, 0.40-0.86; p = .006). Other targeted pathogens (Acinetobacter baumannii, extended-spectrum β-lactamase-producing Gram-negative bacteria, vancomycin-resistant enterococci, and Clostridium difficile) were rarely detected. Subgroup analyses showed reduced methicillin-resistant Staphylococcus aureus contamination on doctors' hands during enhanced cleaning (3 of 425; 0.7% vs. 11 of 423; 2.6%; adjusted odds ratio, 0.26; 95% confidence interval, 0.07-0.95; p = .025) and a trend to reduction on nurses' hands (16 of 1647; 1.0% vs. 28 of 1694; 1.7%; adjusted odds ratio 0.56; 95% confidence interval, 0.29-1.08; p = .077). All 1252 critical care patients staying during enhanced and 1,331 during standard cleaning were included, but no significant effect on patient methicillin-resistant Staphylococcus aureus acquisition was observed (adjusted odds ratio, 0.98; 95% confidence interval, 0.58-1.65; p = .93).

CONCLUSIONS

Enhanced cleaning reduced environmental contamination and hand carriage, but no significant effect was observed on patient acquisition of methicillin-resistant Staphylococcus aureus.

TRIAL REGISTRY

ISRCTN. Identifier: 06298448. http://www.controlled-trials.com/isrctn/.

摘要

目的

确定强化患者床旁环境清洁对分离医院病原体的影响，包括病床区和医护人员手部的医院病原体。

设计

前瞻性随机交叉研究，历时 1 年。

地点

两所教学医院的重症监护病房。

患者

强化清洁期间有 1252 名患者入住，标准清洁期间有 1331 名患者入住。

干预

在 6 个为期 2 个月的周期中，随机选择一个病房进行额外的每日两次强化清洁手接触表面。

测量和主要结果

每周 12 天每天 3 次，在随机选择的病床周围的 5 个部位、医护人员手部和公共部位采集琼脂接触样本。分析 2007 年 4 月开始的年度内入院患者的医院获得性定植和感染情况。在 1152 个床日中，共采集了 20736 个样本。在强化清洁阶段，每床区日检测到的环境耐甲氧西林金黄色葡萄球菌数从 561 例中的 82 例（14.6%）降至 559 例中的 51 例（9.1%）（校正优势比，0.59；95%置信区间，0.40-0.86；p=0.006）。其他目标病原体（鲍曼不动杆菌、产超广谱β-内酰胺酶的革兰阴性菌、万古霉素耐药肠球菌和艰难梭菌）很少被检出。亚组分析显示，在强化清洁期间，医生手部的耐甲氧西林金黄色葡萄球菌污染减少（425 名医生中 3 名，0.7%；423 名医生中 11 名，2.6%；校正优势比，0.26；95%置信区间，0.07-0.95；p=0.025），护士手部也有减少的趋势（1647 名护士中 16 名，1.0%；1694 名护士中 28 名，1.7%；校正优势比，0.56；95%置信区间，0.29-1.08；p=0.077）。所有 1252 名入住强化清洁期间和 1331 名入住标准清洁期间的重症监护患者均被纳入，但未观察到耐甲氧西林金黄色葡萄球菌获得对患者有显著影响（校正优势比，0.98；95%置信区间，0.58-1.65；p=0.93）。