1Healthcare-associated Infections Control Center, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan People's Republic of China.
Healthcare-associated Infections Control Center, Affiliated Chinese Medicine Hospital of Southwestern Medical University, LuZhou, Sichuan People's Republic of China.
Antimicrob Resist Infect Control. 2019 Dec 30;8:205. doi: 10.1186/s13756-019-0635-y. eCollection 2019.
On January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant (CRAB) in the neurosurgical intensive care unit (NSICU). A follow-up epidemiological investigation was conducted, and an emergency response was initiated. We aimed to study the clonal transmission of CRAB and its possible source.
A matched case-control (1:2) study was performed to identify the possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. We collected environmental samples from patients' rooms and living area of the staff. CRAB isolates were tested for genetic relatedness by Pulsed-Field Gel Electrophoresis (PFGE).
Environmental sampling showed that a faucet aerator was contaminated with . Molecular typing revealed the only outbreak strain, which was isolated from tracheal aspirate cultures of the first case of community-acquired infection and 3 cases of HAI. In environmental samples, the outbreak strain was found only in the faucet aerator of the dining room. This CRAB outbreak was discovered in time, and further progress of this outbreak was prevented through a pre-set emergency response procedure.
The faucet aerator acted as a reservoir for bacteria in the outbreak, and contamination of the faucet aerator might have occurred from splashes originating from handwashing by the healthcare workers (HCWs). In high-risk areas, such as NSICU, the faucet aerators should not be used during an outbreak or they should be regularly cleaned and disinfected. The start-up criteria for the emergency response played a key role in controlling the CRAB outbreak, and its settings should be discussed more widely.
2019 年 1 月 7 日，我们观察到神经外科重症监护病房（NSICU）发生了由耐碳青霉烯肠杆菌（CRAB）引起的医源性感染（HAI）爆发。随后进行了后续的流行病学调查，并启动了紧急应对措施。我们旨在研究 CRAB 的克隆传播及其可能的来源。
我们进行了病例对照（1:2）研究，以确定可能的诱发因素。实施了多方面的干预措施来控制疫情。我们从患者房间和员工生活区采集环境样本。通过脉冲场凝胶电泳（PFGE）检测 CRAB 分离株的遗传相关性。
环境采样显示，水龙头空气净化器受到污染。分子分型显示，唯一的暴发菌株是从社区获得性感染的首例病例和 3 例 HAI 的气管抽吸培养物中分离出来的。在环境样本中，仅在餐厅水龙头空气净化器中发现暴发菌株。及时发现了这次 CRAB 暴发，并通过预先设定的应急响应程序防止了暴发的进一步进展。
水龙头空气净化器是疫情中细菌的储存库，水龙头空气净化器的污染可能是由于医护人员（HCWs）洗手时的溅水造成的。在 NSICU 等高危区域，疫情期间不应使用水龙头空气净化器，或应定期进行清洁和消毒。应急响应的启动标准在控制 CRAB 暴发方面发挥了关键作用，其设置应更广泛地进行讨论。
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