Lingnau W, Allerberger F
Univ.-Klinik für Anaesthesie und Allgemeine Intensivmedizin, Universität Innsbruck, Austria.
Infection. 1994;22 Suppl 2:S135-9. doi: 10.1007/BF01793578.
Infections are a major cause of death in critically ill patients. As gram-positive organisms are more widespread and methicillin-resistant staphylococci (MRSA, MRSE) are easily distributed in overcrowded Intensive Care Units (ICU), extended hygienic procedures for infection control are most important. We hypothesize that strict regulations and educational programs for medical and nursing personnel are able to control the spread of resistant bacteria. In a four-room 16-bed medico-surgical ICU, we reinforced hygienic procedures and introduced the separation of clean postoperative and multiply injured patients from those with infectious complications, subsequent to an outbreak of MRSA in 1991. MRSA and MRSE isolated from surveillance cultures of bronchial secretions were reduced from an annual rate of 60.0% to 37.7% and 36.4% to 6.2% respectively between the years 1991 and 1992. Accordingly, the number of lower respiratory tract infections and the crude mortality could be reduced. We conclude that prompt implementation of control measures and continuous education of medical personnel are able to control an outbreak of infection with resistant staphylococci in an ICU setting.
感染是重症患者死亡的主要原因。由于革兰氏阳性菌更为普遍，耐甲氧西林葡萄球菌（MRSA、MRSE）易于在过度拥挤的重症监护病房（ICU）中传播，因此加强感染控制的卫生程序至关重要。我们假设，针对医护人员的严格规定和教育计划能够控制耐药菌的传播。在一个拥有四个病房、16张床位的内科-外科ICU中，1991年发生MRSA暴发后，我们加强了卫生程序，并将术后清洁患者和多处受伤患者与有感染并发症的患者分开。从支气管分泌物监测培养中分离出的MRSA和MRSE，在1991年至1992年间，年发生率分别从60.0%降至37.7%，从36.4%降至6.2%。相应地，下呼吸道感染的数量和粗死亡率得以降低。我们得出结论，在ICU环境中，迅速实施控制措施并持续对医务人员进行教育能够控制耐药葡萄球菌感染的暴发。
