摘要
目的对甲状腺癌根治术手术部位感染(SSI)聚集病例进行流行病学调查,为医院感染防控提供依据。方法对某三甲医院2019年4月27日-6月7日甲状腺癌根治术后发生的SSI患者进行流行病学调查,采取干预措施,评价防控效果。结果该院短期内出现4例甲状腺癌根治术SSI,其中2例手术部位分泌物培养结果为耐甲氧西林金黄色葡萄球菌(MRSA),且药敏谱表型一致。分别对手术组医生、病区护士、工勤人员(均采集鼻腔、额部、手3个部位)进行采样,同时对换药室、治疗室及相关床单元的环境物体表面进行采样,并从手术医生C的鼻腔及手标本中分离出MRSA,且与患者手术部位分泌物中培养出的MRSA药敏谱吻合。采取干预措施,暂停C医生手术资格,并予莫匹罗星去定植,10 d后复查,未培养出MRSA,去定植后1个月内,未发现相关感染病例,证实防控措施有效。结论MRSA未有效脱定植可导致SSI聚集,应鼓励临床科室主动上报感染事件,减少感控风险隐患。
Objective To perform epidemiological survey on aggregated cases of surgical site infection(SSI)after radical thyroidectomy for thyroid cancer,provide evidence for prevention and control of healthcare-associated infection(HAI).Methods Epidemiological survey was conducted on SSI patients after radical thyroidectomy for thyroid cancer in a tertiary first-class hospital between April 27,2019 and June 7,2019,intervention measures were given,efficacy of prevention and control was evaluated.Results There were 4 cases of SSI after radical thyroidectomy for thyroid cancer in this hospital during a short period of time,secretion cultures of surgical sites of 2 cases were methicillin-resistant Staphylococcus aureus(MRSA),and antimicrobial susceptibility profile was consistent.Surgeons,nurses and workers in the operation group were sampled(nasal cavity,forehead and hand),and the surface of environmental objects in the dressing room,treatment room and related bed units were also sampled,MRSA was isolated from the nasal cavity and hand specimens of surgeon C,susceptibility profile was consistent with MRSA cultured from the secretion of surgical site of patients.Intervention measures were given,operation qualification of doctor C was suspended,and mopirocin was used for decolonization,re-examination 10 days later,no MRSA was cultured,within one month after decolonization,no related infection cases were found,which confirmed the effectiveness of prevention and control measures.Conclusion Non-effective decolonization of MRSA can lead to aggregation of SSI,clinical departments should be encouraged to report infection events on their own initiative to reduce the risk of infection.
作者
李占结
陈文森
刘成成
张翔
刘根焰
张永祥
刘云
李松琴
LI Zhan-jie;CHEN Wen-sen;LIU Cheng-cheng;ZHANG Xiang;LIU Gen-yan;ZHANG Yong-xiang;LIU Yun;LI Song-qin(Healthcare -associated Infection Management Office,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Laboratory Department,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Hospital President’s Office,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2019年第9期824-829,共6页
Chinese Journal of Infection Control
基金
国家重点研发计划(2018YFC1314900、2018YFC1314901)
中国老年医学学会感染防控研究基金资助项目(GRYJXL2018009、GRYJ-XL2018016)
江苏省科技厅重点研发计划(BE2016002-4)
江苏省医院管理创新研究基金资助项目(JSYGY-3-2019-448)
关键词
手术部位感染
甲状腺癌根治术
聚集
流行病学调查
surgical site infection
radical thyroidectomy
aggregation
epidemiological survey
