重症监护病房中耐碳青霉烯类鲍曼不动杆菌暴发的管理与控制
Management and control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit.
作者信息
Alfandari S, Gois J, Delannoy P-Y, Georges H, Boussekey N, Chiche A, Meybeck A, Patoz P, Blondiaux N, Senneville E, Melliez H, Leroy O
机构信息
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
出版信息
Med Mal Infect. 2014 May;44(5):229-31. doi: 10.1016/j.medmal.2014.03.005. Epub 2014 May 17.
OBJECTIVE
We had for aim to describe the identification and management of a 14-clonal carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, following admission of a known CRAB-infected patient in an ICU.
METHODS
We reviewed the carriers' files and outbreak management procedures.
RESULTS
The index patient was admitted with strict isolation precautions. The outbreak started 2 months after his discharge. It persisted despite reinforcement of strict isolation precautions, staff and patient cohorting, and extensive environmental decontamination including 2 rounds of routine terminal cleaning and disinfection or 1 round of cleaning and disinfection followed by hydrogen peroxide treatment. A second epidemic peak, after 4 weeks without any case, led to another wide environmental sampling and decontamination rounds. The source of the CRAB outbreak was suspected to be the blood pressure cuffs Velcro. Switching to cuffs submersible in a disinfectant stopped the outbreak.
CONCLUSIONS
CRAB outbreaks are difficult to manage and sources of persistent colonization can be unexpected.
目的
在一名已知感染耐碳青霉烯鲍曼不动杆菌（CRAB）的患者入住重症监护病房（ICU）后，我们旨在描述一起14克隆CRAB暴发的识别与管理情况。
方法
我们查阅了携带者的病历及暴发管理程序。
结果
首例患者入院时采取了严格的隔离预防措施。在其出院2个月后暴发开始。尽管加强了严格的隔离预防措施、医护人员和患者分组管理以及广泛的环境去污，包括两轮常规终末清洁和消毒，或一轮清洁和消毒后进行过氧化氢处理，但暴发仍持续。在4周无病例后出现了第二个流行高峰，导致再次进行广泛的环境采样和去污。CRAB暴发的源头怀疑是血压计的尼龙搭扣袖带。改用可浸泡在消毒剂中的袖带后暴发停止。
结论
CRAB暴发难以管理，持续定植的源头可能出乎意料。
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