頁籤選單縮合
題名 | 外科加護病房Serratia marcescens院內感染群突發調查=Investigation of an Outbreak of Serratia Marcescens Infection in a Surgical Intensive Care Unit |
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作者 | 賴伊貞; 李維玲; 黃政華; | 書刊名 | 院內感染控制雜誌 |
卷期 | 8:5 1998.10[民87.10] |
頁次 | 頁629-639 |
分類號 | 419.38 |
關鍵詞 | 院內感染群突發; Serratia marcescens; Nosocomial outbreak; |
語文 | 中文(Chinese) |
中文摘要 | 本院外科加護病房,於86年1月至5月,共計有16位病患發生Serratia marcescens引起之院內感染,與前半年比較,具統計上之差異(p<0.001),為一院內感染群突發。院內感染部位有15位為血流感染,其中一位合併有下呼吸道感染,另一位為外科部位感染及泌尿道感染,這些病人均使用多項侵入性治療。在環境採檢中發現一感染個案之動脈導管供抽血之三路活塞處及該床旁之水龍頭及護理站共用之500亳升瓶裝生理食鹽水中均培養出S. marcescens。利用細菌DNA聚合�t連鎖反應分型分析,除其中3位個案及動脈導管供抽血之三路活塞處之菌株未保留,其餘個案中有12位和環境中之菌株相同,顯示為同一感染源。在感染流行期間對該單位人員做一份無菌技術之問卷調查,結果發現有部分人員在由動脈導管供抽血之三路活塞處抽血及抽取生理食鹽水時未遵守無菌技術。在一回溯性個案對照研究中發現病患感染前入加護病房日數、接受侵入性治療日數及使用中心靜脈導管為造成感染的危險因子。除加強人員無菌技術之再教育及環境之清潔消毒,並將共用之500亳升瓶裝生理食鹽水改為20亳升小包裝,酒精棉球改為無菌方式製作及取用,使此次院內感染得以控制。 |
英文摘要 | During the period of Jan. 1997 to May 1997, there were sixteen cases of Serratia marcescens infection in the surgical ICU at Cathay General Hospital, Taipei. The prevalence was significantly higher than that of the previous 6 months period (P value less than 0.001). Fifteen of the 16 cases manifested as blood stream infection (among them one case had combined S. marcescens lower respiratory tract infection), and the remainder presented with coexistence of S. marcescens surgical site and urinary tract infection. Microbiologic surveillance revealed positive isolation from one of the 3-way stopcocks of the arterial line. bedside faucet and a bottle of normal saline as multidose vial usage. Twelve of the thirteen collected S. marcescens strains and those from the environmental surveillance were proved having the same DNA finger print by DNA polymerase chain reaction. The returned questionaire survey analysis revealed that some nurses did not follow the strictly aseptic technique during blood sampling from the A-line and might have used the same bottle of normal saline as a multidose vial. A retrospective case-control matched study was conducted for this outbreak, which revealed following risk factors with a statistical significance: length of ICU stay, the duration of catheterization the and presence of central venous catheter. The outbreak was controlled finally by the reinforcement of aseptic techniques, a thorough environmental disinfection and a switch to the use of small disposable packages of normal saline. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。