Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong, China.
Department of Microbiology, Queen Mary Hospital, Hong Kong, China.
J Hosp Infect. 2021 Oct;116:78-86. doi: 10.1016/j.jhin.2021.08.005. Epub 2021 Aug 14.
To describe the nosocomial transmission of Air, multidrug-resistant, Acinetobacter baumannii, nosocomial, COVID-19 Acinetobacter baumannii (MRAB) in an open-cubicle neurology ward with low ceiling height, where MRAB isolates collected from air, commonly shared items, non-reachable high-level surfaces and patients were analysed epidemiologically and genetically by whole-genome sequencing. This is the first study to understand the genetic relatedness of air, environmental and clinical isolates of MRAB in the outbreak setting.
Of 11 highly care-dependent patients with 363 MRAB colonization days during COVID-19 pandemic, 10 (90.9%) and nine (81.8%) had cutaneous and gastrointestinal colonization, respectively. Of 160 environmental and air samples, 31 (19.4%) were MRAB-positive. The proportion of MRAB-contaminated commonly shared items was significantly lower in cohort than in non-cohort patient care (0/10, 0% vs 12/18, 66.7%; P<0.001). Air dispersal of MRAB was consistently detected during but not before diaper change in the cohort cubicle by 25-min air sampling (4/4,100% vs 0/4, 0%; P=0.029). The settle plate method revealed MRAB in two samples during diaper change. The proportion of MRAB-contaminated exhaust air grills was significantly higher when the cohort cubicle was occupied by six MRAB patients than when fewer than six patients were cared for in the cubicle (5/9, 55.6% vs 0/18, 0%; P=0.002). The proportion of MRAB-contaminated non-reachable high-level surfaces was also significantly higher when there were three or more MRAB patients in the cohort cubicle (8/31, 25.8% vs 0/24, 0%; P=0.016). Whole-genome sequencing revealed clonality of air, environment, and patients' isolates, suggestive of air dispersal of MRAB.
Our findings support the view that patient cohorting in enclosed cubicles with partitions and a closed door is preferred if single rooms are not available.
描述空气传播、多药耐药、鲍曼不动杆菌、医院获得性、COVID-19 鲍曼不动杆菌（MRAB）在天花板高度较低的开放式小病房中的医院感染。在 COVID-19 大流行期间，对 11 名高度依赖护理的患者进行了 363 天的 MRAB 定植，其中 10 名（90.9%）和 9 名（81.8%）分别存在皮肤和胃肠道定植。在 160 个环境和空气样本中，31 个（19.4%）为 MRAB 阳性。在队列患者护理中，MRAB 污染的常见共享物品的比例明显低于非队列患者护理（0/10，0%对 12/18，66.7%；P<0.001）。通过 25 分钟的空气采样，在队列小病房中，在更换尿布期间持续检测到 MRAB 的空气传播，但在更换尿布之前没有检测到（4/4，100%对 0/4，0%；P=0.029）。沉降板法在更换尿布期间发现了两份样本中的 MRAB。当队列小病房中同时有 6 名 MRAB 患者时，排气扇污染的比例明显高于当小病房中护理的患者少于 6 名时（5/9，55.6%对 0/18，0%；P=0.002）。当队列小病房中有 3 名或更多的 MRAB 患者时，无法到达的高海拔表面污染的比例也明显更高（8/31，25.8%对 0/24，0%；P=0.016）。全基因组测序显示空气、环境和患者分离物的克隆性，提示 MRAB 的空气传播。
我们的研究结果支持这样一种观点，即在无法提供单人房的情况下，如果可能，应选择在有隔断和关闭门的封闭小病房中对患者进行分组。
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