五联感染控制措施根除 ICU 中定植的碳青霉烯类耐药鲍曼不动杆菌
A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit.
机构信息
Infectious Disease Clinic, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy.
Medicine Preventive-Infection Control Team, Hospital Vega Baja, Orihuela-Alicante, Spain.
出版信息
Antimicrob Resist Infect Control. 2021 Aug 19;10(1):123. doi: 10.1186/s13756-021-00990-z.
BACKGROUND
Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions.
METHODS
A five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU. The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period.
RESULTS
From January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption. WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading.
CONCLUSION
A five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided.
背景
耐碳青霉烯鲍曼不动杆菌（CRAB）感染爆发难以控制，有时需要对 CRAB 阳性患者进行分组或暂时关闭病房进行环境清洁。我们旨在控制 2018 年在一个拥有 9 张床位的 220 平方米开放式 12 张床位重症监护病房（ICU）中爆发的致命 CRAB 疫情。我们实施了一种新的多模式方法，无需关闭病房、分组或暂时限制入院。
方法
2018 年引入了一个由五个组成部分的方案，包括加强手卫生和扩大筛查样本，对所有患者应用接触预防措施，加强环境采样和一次性应用整个 ICU 的循环激进环境清洁和消毒程序。在 6 年期间计算了 ICU-CRAB 发病率密度（ID）、ICU 酒精基洗手液消耗和抗生素使用，并进行了干预时间序列分析。在研究期间对临床和环境分离株进行了全基因组测序分析（WGS）。
结果
从 2013 年 1 月开始，医院 ICU-CRAB ID 从每 1000 名患者天 30.4 例 CRAB 病例降至每 1000 名患者天 0 例。我们的干预措施显示出显著的影响（每 1000 张床位天减少 2.9 例医院 ICU-CRAB 病例），而抗生素和酒精基洗手液（AHR）消耗没有影响。WGS 表明，CRAB 菌株与环境储库具有克隆相关性，这证实了环境在 CRAB ICU 传播中的主要作用。
结论
持续改进手卫生、扩大筛查时的采样（包括环境）、普遍接触预防措施和新型循环激进环境清洁和消毒方案的五组件方案被证明可有效防止 CRAB 在 ICU 内持续传播。避免了分组、限制入院或关闭 ICU。
Zotero 插件