多重耐药革兰氏阴性菌接触预防措施解读的区域性差异：一项横断面调查。
Regional variation in the interpretation of contact precautions for multi-drug-resistant Gram-negative bacteria: a cross-sectional survey.
机构信息
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Department of Medical Microbiology, Maasstad General Hospital, Rotterdam, The Netherlands.
出版信息
J Hosp Infect. 2024 Oct;152:1-12. doi: 10.1016/j.jhin.2024.06.020. Epub 2024 Jul 26.
BACKGROUND
Contact precautions are recommended when caring for patients with carbapenemase-producing Enterobacterales (CPE), carbapenemase-producing Pseudomonas aeruginosa (CPPA), and extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E).
AIM
Our aim was to determine the interpretation of contact precautions and associated infection prevention and control (IPC) measures in the non-ICU hospital setting for patients with CPE, CPPA or ESBL-E in 11 hospitals in the Southwest of the Netherlands.
METHODS
A cross-sectional survey was developed to collect information on all implemented IPC measures, including use of personal protective equipment, IPC measures for visitors, cleaning and disinfection, precautions during outpatient care and follow-up strategies. All 11 hospitals were invited to participate between November 2020 and April 2021.
FINDINGS
The survey was filled together with each hospital. All hospitals installed isolation precautions for patients with CPE and CPPA during inpatient care and day admissions, whereas 10 hospitals (90.9%) applied isolation precautions for patients with ESBL-E. Gloves and gowns were always used during physical contact with the patient in isolation. Large variations were identified in IPC measures for visitors, cleaning and disinfection products used, and precautions during outpatient care. Four hospitals (36.4%) actively followed up on CPE or CPPA patients with the aim of declaring them CPE- or CPPA-negative as timely as possible, and two hospitals (20.0%) actively followed up on ESBL-E patients.
CONCLUSION
Contact precautions are interpreted differently between hospitals, leading to regional differences in IPC measures applied in clinical settings. Harmonizing infection-control policies between the hospitals could facilitate patient transfers and benefit collective efforts of preventing transmission of multi-drug-resistant Gram-negative bacteria.
背景
当照顾产碳青霉烯酶肠杆菌科（CPE）、产碳青霉烯酶铜绿假单胞菌（CPPA）和产超广谱β-内酰胺酶肠杆菌科（ESBL-E）的患者时，建议采取接触预防措施。
目的
我们的目的是确定在荷兰西南部的 11 家医院的非 ICU 医院环境中，对于 CPE、CPPA 或 ESBL-E 患者，接触预防措施及相关感染预防和控制（IPC）措施的解释。
方法
开发了一项横断面调查，以收集所有实施的 IPC 措施的信息，包括个人防护设备的使用、访客的 IPC 措施、清洁和消毒、门诊护理和随访策略的预防措施。所有 11 家医院均于 2020 年 11 月至 2021 年 4 月期间受邀参与。
结果
该调查是与每家医院一起填写的。所有医院在住院和日间住院期间对 CPE 和 CPPA 患者实施隔离预防措施，而 10 家医院（90.9%）对 ESBL-E 患者实施隔离预防措施。在隔离状态下与患者进行身体接触时，始终会使用手套和长袍。访客的 IPC 措施、使用的清洁和消毒产品以及门诊护理的预防措施存在较大差异。四家医院（36.4%）积极随访 CPE 或 CPPA 患者，以尽快宣布他们为 CPE 或 CPPA 阴性，两家医院（20.0%）积极随访 ESBL-E 患者。
结论
医院之间对接触预防措施的解释不同，导致临床环境中应用的 IPC 措施存在区域性差异。协调医院之间的感染控制政策可以促进患者的转院，并有利于防止多重耐药革兰氏阴性菌传播的集体努力。
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