目的 对某医院重症监护病房(ICU)疑似耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发和控制进行调查分析,为提升医院感染控制水平提供参考。方法 对某医院ICU中检出CRKP的患者进行流行病学调查,对ICU病房进行环境卫生学检测,并采取相应的措施。结果 8例患者中6例检出的CRKP对抗生素耐药性一致,所有病例住院时间和床位均存在重叠与相邻,6例患者的保洁人员均为同一人负责。在保洁员手、呼吸机表面、监护仪表面与窗栏检出的CRKP与6例患者检出的CRKP药敏结果一致。通过采取提高病房环境清洁消毒频率、加强手卫生执行力度以及加强科室人员管控与医院感染防控培训等措施后,医院感染得到了有效控制。结论 保洁人员对手卫生执行不规范以及病房环境清洁消毒不到位是导致此次ICU疑似CRKP院内感染暴发的主要原因。为及时研判疫情性质,开展暴发原因调查,并采取相应防控策略能够有效地控制医院感染的暴发。

Objective To investigate and analyze the outbreak and control of suspected carbapenem-resistant Klebsiella pneumoniae (CRKP) hospital infection in the intensive care unit (ICU) of a hospital,and to provide reference for improving nosocomial infection control. Methods This study conducted an epidemiological investigation of CRKP patients in the ICU and carried out environmental hygiene inspections of the ICU ward.Then the corresponding measures were taken. Results The results showed that six out of eight patients detected with CRKP had consistent antibiotic resistance.All cases had overlapping hospitalization time and adjacent bed.The janitor for the six patients served as the same person in charge.The CRKP detected on the cleaner's hand,ventilator and monitoring instrument surfaces,and window rails were consistent with the drug sensitivity results of the six patients.After implementing measures such as increasing the frequency of environmental cleaning and disinfection,strengthening hand hygiene,and enhancing personnel management and hospital infection prevention and control training,the outbreak of hospital infection was effectively controlled. Conclusion The study concludes that the improper execution of hand hygiene by the cleaning staff and inadequate environmental cleaning and disinfection in the ward are the main reasons for the suspected CRKP hospital infection outbreak in the ICU.Timely judgment and cause investigation and the adoption of appropriate prevention and control strategies can effectively control hospital infection outbreaks.