兒科加護病房Acinetobacter Baumannii院內血流感染群突發的調查及處理

Investigation of an Outbreak of Nosocomial Bloodstream Infections Caused by Acinetobacter Baumannii in a Neonatal Intensive Care Unit

曾寶慧(Pao-Hui Tseng) ； 蘇玲慧(Lin-Hui Su) ； 黃玉成(Yhu-Chering Huang) ； 呂學重(Hsieh-Shong Leu) ； 邱月璧(Yueh-Pi Chiu) ； 暨感染管制小組(Infection Control Group)

《院內感染控制雜誌》 12卷1期 (2002/02) Pp. 1-9

摘要

某醫學中心兒科加護病房於89年8月8日至9月21日之間共發生6件由Acinetobacter baumannii引起之院內血流感染，在流行病學方面，本次感染的個案都屬於早產兒，體重小於1500公克，出生時即放置氣管內管合併呼吸監視器使用，並放置過至少3種動、靜脈導管。在環境方面：共採檢94件檢體，其中A . baumannii陽性件數共5件，皆是位於水槽邊的醫療物品，分別是床欄、輻射加熱器、保溫箱、呼吸監視器表面與海綿刷子各一件。在醫護人員方面：共採檢43件手部檢體，陽性率為23.3%，分別來自護理人員（7/26）、醫師及實習醫師（1/7）、呼吸治療師（1/6）、助理員（1/3）等。以低頻切位聚合酵素鏈鎖反應（infrequent-restriction-site polymerase chain reaction；IRS-PCR）的方法，將所收集到的菌株作基因分型，發現6株血流感染菌株及3株手部培養菌株的分型結果完全相同。藉此，推測兒科加護病房院內血流感染的可能因素，應與在不同病人之間，藉醫護人員的手傳播。為遏止此菌的散播，建議加強洗手、及提供乾性洗手劑在緊急時使用，並以低濃度漂白水作環境表面消毒。而與單位人員的討論，建立適宜的感染管制措施，並能確實執行，得以控制感染的蔓延。

關鍵字

Acinetobacter baumannii ； 院內血流感染 ； 兒科加護病房

並列摘要

Between August and September 2000, 6 infants hospitalized in a neonatal intensive care unit (NICU) developed nosocomial bloodstream infections (BSIs) associated with Acinetobacter baumannii. All 6 infants were premature, had a birth weight less than 1500 grams, presented with respiratory distress requiring ventilator support at birth, and had at least 3 intravascular catheters insertion. For the epidemiological investigation, 94 environmental specimens were examined. A. baumannii was found in 5 of the specimens, one each from the surface of bed rails, a radiant warmer, an incubator, a respirator, and a sponge brush. All these 5 objects were close to the sinks. Fluids collected hand-washing of all 43 health care workers (HCWs) involved in the NICU were also examined, ten (23.3%) specimens were positive for the A. baumannii. Infrequent-restriction-site polymerase chain reaction was used to analyze the isolates. The test revealed that all 6 isolates from infected infants as well as 3 isolates from hand-washings of HCWs were of the same genotype. Another genotype was also prevalent in some HCWs and 4 environmental objects. These results suggest that the outbreak of A. baumannii nosocomial BSIs was caused by a particular strain and possibly via cross-infection by HCWs. Strict hand-washing with appropriate disinfectants before and after the contact of patients can not be overemphasized.

並列關鍵字

Acinetobacter baumannii ； nosocomial bloodstream infections ； neonatal intensive care unit