Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria.
Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria.
J Hosp Infect. 2018 Jan;98(1):90-95. doi: 10.1016/j.jhin.2017.09.019. Epub 2017 Sep 28.
In intensive care units (ICUs), inanimate surfaces and equipment may be contaminated by nosocomial pathogens, including multi-drug-resistant micro-organisms.
To assess the degree of environmental contamination close to and distant from patients, and contamination of healthcare workers' (HCWs) hands with nosocomial pathogens under real-life conditions and to investigate potential transmission events.
Over the course of three weeks, agar contact samples were taken close to and distant from patient areas and from HCWs' hands in eight ICUs of a tertiary care hospital in Innsbruck, Austria. Each ICU was visited once without announcement. Species identification and antimicrobial susceptibility testing were performed according to standard methods, and corresponding strains from patient, environment and hand samples were genotyped using pulsed-field gel electrophoresis.
Among 523 samples, HCWs' hands were most frequently contaminated with potentially pathogenic bacteria (15.2%), followed by areas close to patients (10.9%) and areas distant from patients (9.1%). Gram-positive bacteria were identified most often (67.8%), with Enterococcus spp. being the most prevalent species (70% vancomycin sensitive and 30% vancomycin resistant) followed by Staphylococcus aureus, of which 64% were classified as meticillin-resistant Staphylococcus aureus. Molecular typing documented identical strains among patient, environment and hand isolates.
This study found widespread contamination of the ICU environment with clinically relevant pathogens, including multi-drug-resistant micro-organisms, despite cleaning and disinfection. The bioburden might not be restricted to areas close to patients. The role of extended environmental disinfection of areas distant from patients in order to improve infection prevention needs further discussion.
在重症监护病房（ICU）中，无生命的表面和设备可能被医院获得性病原体污染，包括多药耐药微生物。
在实际情况下评估靠近和远离患者的环境污染程度，以及医护人员（HCWs）手上的医院获得性病原体污染程度，并调查潜在的传播事件。
在奥地利因斯布鲁克的一家三级护理医院的八个 ICU 中，在三周的时间内，对靠近和远离患者区域以及 HCWs 手部的琼脂接触样本进行了采集。每个 ICU 均在未经通知的情况下进行了一次访问。根据标准方法进行物种鉴定和抗菌药物敏感性测试，并使用脉冲场凝胶电泳对来自患者、环境和手部样本的相应菌株进行基因分型。
在 523 个样本中，HCWs 的手最常被潜在致病性细菌污染（15.2%），其次是靠近患者的区域（10.9%）和远离患者的区域（9.1%）。最常鉴定出革兰氏阳性细菌（67.8%），其中肠球菌属最为常见（70%对万古霉素敏感，30%对万古霉素耐药），其次是金黄色葡萄球菌，其中 64%被归类为耐甲氧西林金黄色葡萄球菌。分子分型记录了患者、环境和手部分离物之间的相同菌株。
尽管进行了清洁和消毒，但本研究发现 ICU 环境中广泛存在具有临床相关性的病原体污染，包括多药耐药微生物。生物负荷可能不仅限于靠近患者的区域。需要进一步讨论对远离患者的区域进行广泛的环境消毒以改善感染预防的作用。
