Risser Clémence, Pottecher Julien, Launoy Anne, Ursenbach Axel, Belotti Laure, Boyer Pierre, Willemain Rosalie, Lavigne Thierry, Deboscker Stéphanie
Service D'hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France.
Microorganisms. 2022 Mar 27;10(4):720. doi: 10.3390/microorganisms10040720.
We describe bundle measures implemented to overcome a protracted carbapenem-resistant (CRAB) outbreak in an 18-bed trauma Intensive Care Unit (ICU) at Strasbourg University Hospital, a tertiary referral center in France. Outbreak cases were defined by a positive CRAB sample with OXA-23 profile during or after ICU say. To sustain the capacity of the busy trauma ICU, infection control bundles were purposely selected to control the outbreak without closing the ICU. During the outbreak, from May 2015 to January 2019, 141 patients were contaminated by CRAB, including 91 colonized and 50 infected patients. The conventional infection and prevention control (IPC) measures implemented included weekly active surveillance of patients' samples, enhancement of environmental cleaning, interventions to improve hand hygiene compliance and antibiotic stewardship with audits. Supplemental measures were needed, including environmental samplings, health care workers' (HCWs) hand sampling, chlorhexidine body-washing, relocation of the service to implement Airborne Disinfection System (ADS), replication of crisis cells, replacement of big environmental elements and improvement of HCW organization at the patient's bedside. The final measure was the cohorting of both CRAB patients and HCW caring for them. Only the simultaneous implementation of aggressive and complementary measures made it possible to overcome this long-lasting CRAB epidemic. Facing many CRAB cases during a rapidly spreading outbreak, combining simultaneous aggressive and complementary measures (including strict patients and HCW cohorting), was the only way to curb the epidemic while maintaining ICU capacity.
我们描述了为克服法国斯特拉斯堡大学医院（一家三级转诊中心）18张床位的创伤重症监护病房（ICU）中持续爆发的耐碳青霉烯类鲍曼不动杆菌（CRAB）疫情而实施的综合措施。疫情病例定义为在ICU住院期间或之后，OXA - 23型CRAB样本检测呈阳性。为了维持繁忙的创伤ICU的运转能力，特意选择了感染控制综合措施来控制疫情，而不关闭ICU。在2015年5月至2019年1月的疫情期间，有141名患者被CRAB污染，其中91名患者为定植，50名患者为感染。实施的常规感染预防与控制（IPC）措施包括每周对患者样本进行主动监测、加强环境清洁、采取干预措施以提高手卫生依从性以及通过审核进行抗生素管理。还需要采取补充措施，包括环境采样、医护人员（HCWs）手部采样、洗必泰全身清洗、将科室迁至安装空气消毒系统（ADS）的地方、设立危机处理小组、更换大型环境设施以及改善医护人员在患者床边的工作安排。最后一项措施是将CRAB患者及其护理的医护人员进行分组管理。只有同时实施积极且互补的措施，才有可能克服这场持久的CRAB疫情。在疫情迅速蔓延期间面对众多CRAB病例时，同时采取积极且互补的措施（包括严格的患者和医护人员分组管理）是在维持ICU运转能力的同时遏制疫情的唯一方法。
