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An outbreak of meticillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit: use of a case-control study to investigate and control it and lessons learnt.
Journal of Hospital Infection ( IF 6.9 ) Pub Date : 2019-05-24 , DOI: 10.1016/j.jhin.2019.05.009
N M Brown 1 , M Reacher 2 , W Rice 2 , I Roddick 2 , L Reeve 2 , N Q Verlander 3 , S Broster 4 , A L Ogilvy-Stuart 4 , A D'Amore 4 , J Ahluwalia 4 , S Robinson 4 , R Thaxter 4 , C Moody 4 , A Kearns 5 , J Greatorex 6 , H Martin 4 , M E Török 7 , D A Enoch 1
Affiliation  

AIM To describe the investigation and management of a meticillin-resistant Staphylococcus aureus (MRSA) outbreak on a neonatal intensive care unit (NICU) and the lessons learnt. METHODS This was an outbreak report and case-control study conducted in a 40-cot NICU in a tertiary referral hospital and included all infants colonized/infected with gentamicin-resistant MRSA. INTERVENTION Standard infection-control measures including segregation of infants, barrier precautions, enhanced cleaning, assessment of staff practice including hand hygiene, and increased MRSA screening of infants were implemented. Continued MRSA acquisitions led to screening of all NICU staff. A case-control study was performed to assess staff contact with colonized babies and inform the management of the outbreak. FINDINGS Eight infants were colonized with MRSA (spa type t2068), one of whom subsequently developed an MRSA bacteraemia. MRSA colonization was significantly associated with lower gestational age; lower birthweight and with being a twin. Three nurses were MRSA colonized but only one nurse (45) was colonized with MRSA spa type t2068. Multivariable logistic regression analysis identified being cared for by nurse 45 as an independent risk factor for MRSA colonization. CONCLUSIONS Lack of accurate recording of which nurses looked after which infants (and when) made identification of the risk posed by being cared for by particular nurses difficult. If this had been clearer, it may have enabled earlier identification of the colonized nurse, avoiding subsequent cases. This study highlights the benefit of using a case-control study, which showed that most nurses had no association with colonized infants.

中文翻译:

新生儿重症监护病房中耐甲氧西林金黄色葡萄球菌定植的爆发:使用病例对照研究进行调查和控制,并汲取经验教训。

目的描述在新生儿重症监护病房(NICU)上耐甲氧西林金黄色葡萄球菌(MRSA)暴发的调查和管理,以及汲取的经验教训。方法这是在一家三级转诊医院的40床新生儿重症监护病房中进行的暴发报告和病例对照研究,其中包括所有定植/感染了庆大霉素抗性MRSA的婴儿。干预措施实施了标准的感染控制措施,包括隔离婴儿,隔离措施,加强清洁,评估员工手部卫生习惯(包括手部卫生)以及增加MRSA婴儿筛查。对MRSA的持续收购导致对所有NICU员工进行了筛选。进行了一项病例对照研究,以评估工作人员与定居婴儿的接触情况,并告知疫情暴发管理人员。研究结果将8例婴儿定植MRSA(t2068温泉型),其中一名随后发展为MRSA菌血症。MRSA定植与较低的胎龄显着相关。降低出生体重,并成为双胞胎。MRSA定居了3名护士,但t2068型MRSA spa定植了一名护士(45)。多变量logistic回归分析确定护士45照顾的是MRSA定殖的独立危险因素。结论缺乏准确记录哪些护士照看哪些婴儿(以及何时)使识别特定护士照料所带来的风险变得困难。如果情况更清楚,则可能可以更早地确定定植的护士,从而避免以后的情况。这项研究强调了使用案例对照研究的好处,
更新日期:2019-05-24
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