推動環境清潔策略降低多重抗藥性鮑氏不動桿菌醫療照護相關感染之成效

Reducing Healthcare-associated Infections Caused by Multidrug-resistant Acinetobacter baumannii by Implementing Hospital-wide Environmental Cleaning Measures

趙伶惠(Lin-Hui Chao) ； 蘇麗香(Li-Hsiang Su) ； 湯雅芬(Ya-Fen Tang) ； 陳一伶(I-Ling Chen) ； 黃高彬(Kao-Pin Hwang) ； 劉建衛(Jien-Wei Liu)

《感染控制雜誌》 21卷2期 (2011/04) Pp. 83-94

https://doi.org/10.6526/ICJ.201104_21(2).0002

摘要

Multidrug-resistant Acinetobacter baumannii (MDRAB) may colonize the inanimate hospital environment if the environment is not properly disinfected. Environmental MDRAB isolates may become pathogenic as a result of therapeutic and nursing contact between healthcare personnel and patients. Root cause analysis of a cluster of MDRAB isolated from an intensive care unit (ICU) of a medical center indicated that the hospital management system was responsible. This led to the revision of the hospital environment cleaning policy with respect to cleaning instruments and the cleaning techniques used by ward cleaners. Different color-coded cleaning instruments were used for cleaning different areas of the ward, depending on their contamination level (i.e., clean, intermediately contaminated, and contaminated areas). A standard operating procedure (SOP) was established for guiding orderly environment cleaning practices. The SOP included practices such as cleaning the environment in a downward manner by starting the procedure at upper levels and in a forward manner by starting in clean areas (nurse station) and ending in the most contaminated areas (isolation room) of the ward. An education program was arranged to increase the ward cleaners' awareness of the SOPs and ensure its strict enforcement. This SOP was then applied to the cleaning of all ICUs in the hospital. Additionally, the environments in these ICUs were disinfected on a daily basis with household bleach (1:10 dilution of a 5% solution of sodium hypochlorite). Compared to the period when the cluster of MDRAB was identified (September 2007-February 2008), the overall healthcare-associated infection rate in the affected ICU decreased significantly (23.2% vs.15.8%, P=0.03) after implementation of the new environmental cleaning strategy (March-December 2008). Similarly, MDRAB healthcare-associated infection rate also reduced significantly (5.1% vs. 1.4%, P=0.02). One year after the revision of the hospital cleaning policy (March 2008-February 2009), we found that compared to the infection rates during March 2007-February 2008, when MDRAB-associated nosocomial infection rates were high, the MDRAB healthcare-associated infection rate was significantly reduced both in the ICU (0.4% vs. 0.9%, P＜0.001) and in the hospital as a whole (0.09% vs. 0.18%, P＜0.001). Our data emphasize the importance of environmental cleaning to prevent the spread of MDRAB within a hospital.

關鍵字

多重抗藥性鮑氏不動桿菌 ； 醫療照護相關感染 ； 環境清潔

並列摘要

Multidrug-resistant Acinetobacter baumannii (MDRAB) may colonize the inanimate hospital environment if the environment is not properly disinfected. Environmental MDRAB isolates may become pathogenic as a result of therapeutic and nursing contact between healthcare personnel and patients. Root cause analysis of a cluster of MDRAB isolated from an intensive care unit (ICU) of a medical center indicated that the hospital management system was responsible. This led to the revision of the hospital environment cleaning policy with respect to cleaning instruments and the cleaning techniques used by ward cleaners. Different color-coded cleaning instruments were used for cleaning different areas of the ward, depending on their contamination level (i.e., clean, intermediately contaminated, and contaminated areas). A standard operating procedure (SOP) was established for guiding orderly environment cleaning practices. The SOP included practices such as cleaning the environment in a downward manner by starting the procedure at upper levels and in a forward manner by starting in clean areas (nurse station) and ending in the most contaminated areas (isolation room) of the ward. An education program was arranged to increase the ward cleaners' awareness of the SOPs and ensure its strict enforcement. This SOP was then applied to the cleaning of all ICUs in the hospital. Additionally, the environments in these ICUs were disinfected on a daily basis with household bleach (1:10 dilution of a 5% solution of sodium hypochlorite). Compared to the period when the cluster of MDRAB was identified (September 2007-February 2008), the overall healthcare-associated infection rate in the affected ICU decreased significantly (23.2% vs.15.8%, P=0.03) after implementation of the new environmental cleaning strategy (March-December 2008). Similarly, MDRAB healthcare-associated infection rate also reduced significantly (5.1% vs. 1.4%, P=0.02). One year after the revision of the hospital cleaning policy (March 2008-February 2009), we found that compared to the infection rates during March 2007-February 2008, when MDRAB-associated nosocomial infection rates were high, the MDRAB healthcare-associated infection rate was significantly reduced both in the ICU (0.4% vs. 0.9%, P＜0.001) and in the hospital as a whole (0.09% vs. 0.18%, P＜0.001). Our data emphasize the importance of environmental cleaning to prevent the spread of MDRAB within a hospital.

並列關鍵字

Multidrug-resistant Acinetobacter baumannii ； healthcare-associated infections ； environmental cleaning