急性后期护理环境中传播的快速评估和遏制-加利福尼亚州奥兰治县，2019 年。
Rapid Assessment and Containment of Transmission in Postacute Care Settings-Orange County, California, 2019.
机构信息
Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.).
Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
出版信息
Ann Intern Med. 2021 Nov;174(11):1554-1562. doi: 10.7326/M21-2013. Epub 2021 Sep 7.
BACKGROUND
, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of that were detected in urine specimens to enhance surveillance of , and was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified at 3 associated facilities.
OBJECTIVE
To assess the prevalence of and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC.
DESIGN
Point prevalence surveys (PPSs), postdischarge testing for detection, and assessments of IPC were done from March to October 2019.
SETTING
All LTACHs ( = 3) and vSNFs ( = 14) serving adult patients in OC.
PARTICIPANTS
Current or recent patients in LTACHs and vSNFs in OC.
INTERVENTION
In facilities where was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided.
MEASUREMENTS
Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness.
RESULTS
Initial PPSs at 17 facilities identified 44 additional patients with in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019.
LIMITATION
Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated.
CONCLUSION
Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of .
PRIMARY FUNDING SOURCE
Centers for Disease Control and Prevention.
背景
耐多药酵母 可以在配备呼吸机的熟练护理机构（vSNFs）和长期急性护理医院（LTACHs）中迅速传播。2018 年，加利福尼亚州南部为 LTACH 服务的一个实验室开始鉴定尿液标本中检测到的 物种，以加强对 的监测，并于 2019 年 2 月在加利福尼亚州橙县（OC）的一家 LTACH 患者中鉴定出 。进一步的调查在 3 家相关设施中发现了 。
目的
评估 OC 地区 LTACH 和 vSNF 中 的流行率和感染预防与控制（IPC）实践。
设计
2019 年 3 月至 10 月进行了点患病率调查（PPS）、出院后 检测和 IPC 评估。
地点
OC 地区所有为成人患者服务的 LTACH（n=3）和 vSNF（n=14）。
参与者
OC 的 LTACH 和 vSNF 的现患或近期患者。
干预措施
在发现 的设施中，每 2 周重复进行 PPS。提供持续的 IPC 支持。
测量
抗真菌药敏试验和全基因组测序，以评估分离株的亲缘关系。
结果
17 家设施的初始 PPS 共发现 3 家（100%）LTACH 和 6 家（43%）vSNF 中 44 例新增 患者，首例血流感染报告于 2019 年 5 月。到 2019 年 10 月，通过连续的 PPS 和出院检测共发现 182 例 患者。对 81 株测序的分离株均为 III 型且高度相关。IPC 评估发现了手卫生、基于传播的预防措施和环境卫生方面的差距。到 2019 年 10 月，疫情已控制在 2 家设施内。
局限性
未评估急性护理医院，且无法严格评估 IPC 随时间的改进情况。
结论
强化实验室监测以及在 IPC 支持下的快速调查使 得以快速识别和控制。
主要资金来源
疾病控制与预防中心。
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