主動鼻腔篩檢措施對加護病房MRSA 感染率之影響

Use of Active Surveillance Cultures to Reduce the Incidence of Methicillin-Resistant Staphylococcus aureus Infections in Adult Intensive Care Units

Methicillin抗藥性金黃色葡萄球菌(methicillin-resistant Staphylococcus aureus; MRSA)是常見的醫療照護相關感染致病菌，會引起皮膚、傷口、骨髓 炎、肺炎、心內膜炎及菌血症等感染，會導致病人死亡及增加醫療工作負荷，因此降低MRSA醫療照護相關感染是目前重要的議題。分析某區域教學醫院全院 院內MRSA感染分布型態，發現MRSA感染有62.4％的病人發生在加護單位，因此將加護病房列為改善重點單位。研究執行對象為成人內外科加護病房病人，實施期間自2007年10月1日至2008年4月30日止。針對新入住加護病房病人進行主動鼻腔篩檢措施，當篩檢出MRSA陽性病人，立即通知臨床單位執行接觸隔離措施及去移生治療，去移生治療包含鼻腔塗抹mupirocin及給予含4％ chlorhexidine洗澡。執行前成人加護病房MRSA平均感染密度為2.44‰，措施執行後，MRSA平均感染密度1.05‰，執行主動鼻腔篩檢措施後，減少56.9％MRSA感染，將此感控措施納入常規後，MRSA感染密度更下降到0.29‰。本研究結果顯示執行主動鼻腔篩檢措施可有效使加護病房MRSA感染密度降低，建議將主動鼻腔篩檢措施納入常規加護病房感染管制政策，以落實早期發現病人、早期接觸隔離及去移生治療之感染管制政策，期能改善加護病房MRSA感染情形，進而維護病人安全，提升醫療服務品質。

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen causing health care-associated infections, such as infections of the skin and wounds, osteomyelitis, pneumonia, endocarditis, and bacteremia. Studies have also revealed that infection caused by MRSA increases patient mortality rates and the workload of hospital staff. It is important to reduce health care-associated infections caused by MRSA. We analyzed the epidemiology of nosocomial MRSA infection in a regional hospital and found that 62.4% of MRSA infections occurred in adult intensive care units (ICUs). From the data reported in the literature, we attempted to bring about a 40% reduction in the MRSA infection rate in ICUs. Active nasal MRSA surveillance culture was performed in both adult medical and surgical ICUs from October 1, 1996 through April 30, 1997 for every new patient. The infection control unit notified the ICUs to carry out contact isolation, and decolonization therapy was started for MRSA-positive patients. Eventually, the MRSA infection rate in the ICUs dropped from 2.44% (January to September 2007) to 1.05% (October 2007 to April 2008). Research confirmed that the active nasal screening culture policy, contact isolation measures, and eradication of MRSA colonization could bring about a reduction of 40% in MRSA infection.