Acinetobacter baumannii 污染洗澡水所引起之燒傷中心群突發事件處理經驗

An Outbreak of Multidrug-resistant Acinetobacter baumnnii due to Contaminated Bathing Water at a Burn Center

某區域教學醫院燒傷病房於2006年4到5月，4名病人的皮膚分泌物先後分離出多重抗藥性Acinetobacter baumannii，判斷可能是群突發事件，因而著手進行調查。環境採檢中，2個水龍頭檢體（2/8，25%）、2個病床床欄（2/5，40%）、一位病人的靜脈輸注幫浦（1/4，25%）、1個pulseoximeter（1/4，25%）及1本病歷（1/4，25%）有多重抗藥性A.baumannii•存在。工作人員及照顧家屬洗手前、後手部檢體共41件，未分離出A.baumannii。病房的水質採檢發現洗手用水有1件（1/5，20%）及洗澡用水有5件（5/5，100%）受到多重抗藥性九bauman-n//污染，洗澡用水之水源（逆滲透水）並未分離到此菌。脈衝式膠體電泳基因分型分析顯示4株臨床及9株環境A.baumannii屬於同一個流行株。此群突發可能係洗澡用水之逆滲透水管路受到污染而造成。因應措施為暫時改用未受污染之水療室的水進行病入清潔及用物清洗，用臭氧及70°C熱水消毒管路，刷子清潔水龍頭的出口，並進行環境消毒，配合病入之隔離措施及加強工作人員之洗手遵從性。一個月後追蹤，水龍頭及浴室用水均未再分離到A.baumannii，結束了這次的群突發事件。此事件提醒我們A. baumannii除了可在醫院醫療設備中存在，也可污染水管管路及水源，A.baumannii引起群突發事件的調查宜包括水質採檢。皮膚缺損病人之用水應注意是否受污染，以避免造成病人之傷口感染。

We isolated 4 multidrug-resistant Acinetobacter baumannii (MDRAB) isolates from wound pus or discharge cultures of 4 patients admitted to our burn center between April and May 2006. We suspected an outbreak due to the rapidly increasing number of cases involving MDRAB colonization; therefore, we conducted an investigation. Environmental surveillance revealed the MDRAB had contaminated 2 faucets (2/8, 25%), 2 bed-rails (2/5, 40%), 1 infusion pump (1/4, 25%), 1 pulse oximeter (1/4, 25%),and 1 medical chart (1/4, 25%). MDRAB was not detected in 41 specimens obtained from hands of nursing staff and their families before and after washing. However, MDRAB was detected in 1 hand-wash water specimen (1/5, 20%) and 5 bathing-water specimens obtained from different faucets. Further, MDRAB was not detected in a reverse-osmosis water specimen. The pulsed-field gel electrophoresis pattern indicated that the MDRAB belonged to the same clone. The outbreak was attributed to contamination in the reverse-osmosis water pipeline. After the environmental surveillance was conducted, we replaced bathing-water with non-contaminated water, disinfected water pipeline by using water at 70 °C and ozone, brushed the faucets, and disinfected the environment. The follow-up cultures of samples obtained from faucets and bathing water did not yield A. baumannii 1 month after the outbreak. In the subsequent 3 months, new colonies of A. baumannii were not formed and no new cases of infection were detected at our burn center. Thus, these findings indicate that A. baumannii may be present not only in medical equipments and instruments but also in water and the water pipeline. The outbreak may be attributed to the use of contaminated water. Thus, the use of sterilized water for the treatment of patients with burn injury or skin defect will help in the prevention of wound infection.