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目的分析对某大医院神经内科病房中耐甲氧西林金黄色葡萄球菌(MRSA)患者定植及感染的实时监测中暴发案例,推断MRSA传播途径并及时调整干预。方法采用前瞻性监测设计,对住院患者进行MRSA定植及感染的定期筛查,同期收集医护人员鼻前庭及手部标本并观察医护人员手卫生执行情况。IRS-PCR基因分型法对分离的MRSA菌株进行同源性分析。结果在07年10月至11月间,MRSA的定植或感染率为5%,其中入院后MRSA的定植或感染为4%;呈现暴发。同期医护人员手卫生总执行率为15.9%。对该期间住院患者临床标本、鼻前庭标本及医护人员手标本分离的共10株MRSA菌株进行IRS-PCR同源性分析,结果为同一亚型。并且,及时提出严格监督手卫生、护理MRSA阳性病人的医护分组、调整隔离病房等干预措施,制止了此次MRSA的进一步扩散。结论我们推断医护人员的手部是MRSA的暴发流行传播过程中的关键因素。并且开展MRSA的现场实时监测,对及时提出针对性的干预措施具有极大的借荐作用。
Objective To analyze the cases of outbreaks of colonization and infection of methicillin-resistant Staphylococcus aureus (MRSA) patients in the neurology ward of a large hospital ward, to infer the pathways of MRSA transmission and to adjust interventions in time. Methods The prospective surveillance design was used to carry out routine screening of inpatients with MRSA colonization and infection. At the same time, the nasal vestibule and hand specimens of medical staff were collected and the hand hygiene performance of medical staff was observed. Homology analysis of isolated MRSA strains was performed by IRS-PCR genotyping. Results The rate of colonization or infection of MRSA between October and November 2007 was 5%. Among them, MRSA colonization or infection was 4% after admission; the outbreak was reported. At the same period, the total hand hygiene implementation rate for medical staff was 15.9%. A total of 10 strains of MRSA isolates from hospitalized patients, nasal vestibular specimens and medical staff were analyzed by IRS-PCR. The results showed the same subtype. In addition, timely put forward strict supervision of hand hygiene, nursing care of patients with positive MRSA group, to adjust the isolation ward and other interventions to stop the further spread of the MRSA. Conclusions We conclude that the hand of a healthcare worker is a key factor in the spread of MRSA outbreaks. And to carry out on-site real-time MRSA monitoring, timely and targeted interventions have a great recommendation role.