某區域教學醫院外科加護病房心臟外科病患MRSA群突發的調查與處理

Investigation and Control of a Methicillin-resistant Staphylococcus aureus Outbreak in a Surgical Intensive Care Unit: Experience from a Regional Hospital

某區域醫院外科加護病房於2011年3月1日至2011年4月19日共發生11件醫療照護相關感染，其中5件為MRSA（methicillin-resistant Staphylococcus aureus），4月份共8件醫療照護相關感染個案，感染發生密度為16.2‰（8／493*1,000）超出閾值（12.0‰），以Z-Test統計不具統計意義（p=0.09），但其中4件為MRSA，佔50%，並集中於心臟外科病患，進一步將MRSA菌株與前6個月比較以Z-Test統計即具統計意義（p=0.0019），故感染管制室介入調查及處理。感染管制室採取以下感染管制措施：（1）工作人員採檢；（2）落實接觸隔離措施及換藥車使用規則改變；（3）加強手部衛生宣導；（4）加強多重抗藥菌種隔離防護教育；（5）MRSA感染與移生病人集中照護（cohort care）與隔離；（6）共用環境及設備清潔消毒；（7）加強病房終期消毒；（8）不定時至單位進行稽核。經由感染管制措施介入，該單位自2011年5月中旬後，無MRSA的感染新案發生，5、6月感染密度分別為11.3‰、11.4‰，有效的阻止此次群突發。本研究所採取之感染管制措施為有效之方法，控制MRSA群突發之經驗可供相關醫療院所參考。

This study aimed at describing the occurrence of a nosocomial methicillin-resistant Staphylococcus aureus (MRSA) outbreak in the intensive care units (ICUs) of a regional teaching hospital from March 1 to April 19, 2011. Compared to the rates obtained during the previous 6 months, MRSA infection rates were significantly increased (p = 0.0019, p < 0.001). To control the spread of MRSA in our ICUs, we implemented a stepwise series of infection control measures. The intervention included the following steps: (1) 10 healthcare workers were screened for MRSA colonization; (2) treatment trolleys were banned from entering the rooms of infected patients; (3) the importance of hand hygiene was reinforced, and the use of alcohol-based hand-rubs was introduced; (4) healthcare professionals were educated; (5) cohort care for the colonized patients was introduced; (6) twice-daily environmental cleaning was implemented; (7) curtains that had been used by patients colonized with MRSA were exchanged; (8) a stringent tracking-control policy was implemented. Complete cessation of transmission occurred after the initiation of this infection-control policy. This study illustrates the risk of nosocomial outbreak associated with the colonization of healthcare personnel. The importance of adherence to strict hygiene control measures should be emphasized.