一项针对重症监护病房污染水槽相关风险的前瞻性多中心监测研究。
A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit.
机构信息
Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France.
Service de Bactériologie, Virologie et Hygiène, Centre Hospitalier Universitaire, Tours, France.
出版信息
Clin Microbiol Infect. 2021 Sep;27(9):1347.e9-1347.e14. doi: 10.1016/j.cmi.2021.02.018. Epub 2021 Feb 25.
OBJECTIVES
The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting.
METHODS
A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey.
RESULTS
Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates ≥0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate ≥51%, prevalence of sinks with visible splashes ≥14%, prevalence of sinks close to the patient's bed ≥21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016).
DISCUSSION
Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.
目的
评估耐多药（MDR）铜绿假单胞菌和肠杆菌科引起的水槽污染的发生率、水槽污染和溅水的危险因素，以及它们与重症监护环境中临床感染的关系。
方法
这是一项前瞻性的法国多中心研究（2020 年 1 月 1 日至 5 月 30 日），包括每个重症监护病房（ICU）的水槽污染点患病率研究、水槽污染（水槽使用、消毒程序）和溅水（可见飞沫、水槽和床之间的距离和障碍物）危险因素的问卷调查，以及为期 3 个月的前瞻性感染调查。
结果
73 个 ICU 参与了该研究。共有 50.9%（606/1191）的水槽被 MDR 细菌污染：仅用于洗手的水槽中，41.0%（110/268）被污染；用于废物处理的水槽中，55.3%（510/923）被污染；每天用漂白剂消毒的水槽中，23.0%（62/269）被污染；每天暴露于季铵化合物（QAC）的水槽中，59.1%（126/213）被污染；未处理的水槽中，62.0%（285/460）被污染；459 个水槽（38.5%）出现可见溅水，30.5%（363/1191）靠近病床（<2 m），水槽周围无障碍物。与每 1000 个患者日发生≥0.70 例耐多药相关性血流感染的 ICU 相关的条件是：水槽污染率≥51%，可见溅水的水槽发生率≥14%，靠近患者病床的水槽发生率≥21%，且无每日漂白消毒（30 个 ICU 中，无、一个或两个因素者 6/30（20.0%），三个或四个因素者 14/28（50.0%）；p=0.016）。
讨论
我们的数据显示，ICU 中污染水槽与频繁和多因素的感染风险有关。
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