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某區域教學醫院外科加護病房心臟外科病患MRSA群突發的調查與處理

Investigation and Control of a Methicillin-resistant Staphylococcus aureus Outbreak in a Surgical Intensive Care Unit: Experience from a Regional Hospital

摘要


某區域醫院外科加護病房於2011年3月1日至2011年4月19日共發生11件醫療照護相關感染,其中5件為MRSA(methicillin-resistant Staphylococcus aureus),4月份共8件醫療照護相關感染個案,感染發生密度為千分之16.2(8/493*1,000),超出閾值(千分之12.0),以Z-Test統計不具統計意義(p=0.09),但其中4件為MRSA,佔50%,並集中於心臟外科病患,進一步將MRSA菌株與前6個月比較以Z-Test統計即具統計意義(p=0.0019),故感染管制室介入調查及處理。感染管制室採取下列感染管制措施:(1)工作人員採檢;(2)落實接觸隔離措施及換藥車使用規則改變;(3)加強手部衛生宣導;(4)加強多重抗藥菌種隔離防護教育;(5)MRSA感染具移生病人集中照護(cohort care)與隔離;(6)共用環境及設備清潔消毒;(7)加強病房終期消毒;(8)不定時至單位進行稽核。經由感染管制措施介入,該單位自2011年5月中旬後,無MRSA的感染新案發生,5、6月感染密度分別為千分之11.3、千分之11.4,有效的阻止此次群突發。本研究所採取之感染管制措施為有效之方法,控制MRSA群突發之經驗可供相關醫療院所參考。

並列摘要


This study aimed at describing the occurrence of a nosocomial methicillin-resistant Staphylococcus aureus (MRSA) outbreak in the intensive care units (ICUs) of a regional teaching hospital from March 1 to April 19, 2011. Compared to the rates obtained during the previous 6 months, MRSA infection rates were significantly increased (p=0.0019, p<0.001). To control the spread of MRSA in our ICUs, we implemented a stepwise series of infection control measures. The intervention included the following steps: (1) 10 healthcare workers were screened for MRSA colonization; (2) treatment trolleys were banned from entering the rooms of infected patients; (3) the importance of hand hygiene was reinforced, and the use of alcohol-based hand-rubs was introduced; (4) healthcare professionals were educated; (5) cohort care for the colonized patients was introduced; (6) twice-daily environmental cleaning was implemented; (7) curtains that had been used by patients colonized with MRSA were exchanged; (8) a stringent tracking-control policy was implemented. Complete cessation of transmission occurred after the initiation of this infection-control policy. This study illustrates the risk of nosocomial outbreak associated with the colonization of healthcare personnel. The importance of adherence to strict hygiene control measures should be emphasized.

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