呼吸照護病房非結核分枝桿菌感染管制監控

The Infection Control Program for the Nontuberculous Mycobacteria outbreak/pseudo-outbreak in the Respiratory Care Ward (RCW)

黃建文(Chien-Wen Huang) ； 沈光漢(Gwan-Han Shen)

《中南盟研究年刊》 3卷1期 (2010/03) Pp. 27-35

https://doi.org/10.6850/JCSMA.201003_3(1).0003

摘要

目的：希望研究呼吸照護病房的非結核分枝桿菌傳播與感染，針對其感染源與感染途徑加以分析，並進一步研究感染管制措施來減少這些非結核分枝桿菌的傳播。方法：本研究選定豐原醫院之呼吸照護病房，並結合中部地區其他設有呼吸照護病房之醫院內呼吸照護病患，配合醫院定期的痰液檢查，收集住院病患痰液檢驗，若有培養出分枝桿菌者，其菌株皆加以收集鑑定並進行分子鑑定與分子流病學之研究。結果：在中部呼吸照護病房非結核分枝桿菌的分離率相當高，高達26.47北，且百分之百皆為快速生長分枝桿菌，99.32%為膿瘍分枝桿菌，1.78%為M. fortuitum。結核分枝桿菌在呼吸照護病房的分離率僅佔0.178%，兩者的分離率相差100倍以上，所以除了結核分枝桿菌的防治之外，對於非結核分枝桿菌中尤其是膿瘍分枝桿菌更是重要。而我們在某呼吸照護病房的水龍頭，潮濕瓶及病患的呼吸器吐氣孔，也發現有快速生長分枝桿菌的蹤跡，我們發現呼吸照護病房的非結核分枝桿菌的傳播為院內感染，必須實施更嚴格的院內感控措施。結論：我們建議呼吸照護病房所使用的呼吸器，在其吐氣末端必須追加Hepa filter（過濾器），因為Hepa filter（過濾器）可以有效的阻隔結核分枝桿菌及非結核分枝桿菌，如此才能有效的阻絕空氣與飛沬傳染的機會，至於另一個傳染途徑揭藉由醫療用水的傳播，這一部分為接觸傳染，必須落實醫療人員無蘭的概念，凡接觸病患之後皆必須更換手套或使用乾式的洗手液洗手，任何病患使用過的器皿皆需擦拭、烘乾，以杜絕非結核分枝悍菌，尤其是膿瘍分枝桿菌的傳播。

關鍵字

呼吸照護病房 ； 非結核分枝桿菌 ； 膿瘍分枝桿菌 ； 感染控制

並列摘要

Objectives. To evaluate the isolation rate of nontuberculous mycobacteria in the chronic respiratory care ward (RCW) and survey the infection sources and the pathway of transmission.
Methods. Totally 10 RCWs including Fong-Yuan Hospital were enrolled in this study. Totally 600 patients had sent one specimen for acid fast stain and mycobacteria culture in their reguar scheduled check up. If any mycobacteria was isolated, the isolates would be further identified by biochemistry methods or molecular diagnosis. Further molecular typing method such as PFGE was performed to understand whether outbreak or pseudo-outbreak or not.
Results. The isolation rate for nontuberculous mycobacteria (NTM) in RCWs was 26.47%. More than 100 fold, compared with the isolation rate of M. tuberculosis complex (0.178%). All (100%) the NTM strains were identified to be rapid growing mycobacteria. Nearly all (99.32%) were M. abscessus. Most of the M. abscessus strain were identical within the same hospital. But some had variable PFGE patterns. The RGM strains could be isolated from the hospital water supply system, ventilator humidifier and the surface of ventilator.
Conclusions. The outbreak of M. abscessus is nosocomial infection. The sources might come from the environment water system or patient. It might spread via the contact or aerosol transmission. Hepa filter was recommended to be added in outlet of ventilator to prevent the mycobacteria transmission. Standard and contact precaution of the health care worker are also very important.

並列關鍵字

Nontuberculous mycobacteria ； RCW ； M.abscessus ； infection control