南部某區域教學醫院新生兒病房沙門氏菌群突發感染事件調查

Investigating the outbreak of Salmonella group B infection in a newborn baby center

2017年於南部某區域教學醫院新生兒病房與兒科病房發生沙門氏菌的群突發感染，期間共有9位病人糞便檢體培養出B群沙門氏菌，9位患者皆有腹瀉症狀。臨床醫師於新生兒病房出現第3及第4例個案時，通報感染管制室介入調查，並加強病房落實手部衛生與清潔消毒。惟仍陸續出現第6，7例個案，故感管室增加以下改善措施：1.落實隔離政策；2.病人區及照護區清楚區分；3.流行期間照護工作人員固定區域不輪替；4.每日監測工作人員手部衛生；5.加強教育訓練。並進行65處病房環境監測，檢測結果皆為陰性。之後再無個案發生。全部個案對抗生素治療反應良好並康復出院。經疾病管制署協助做菌株鑑定及基因分型，以確認感染相關性。九個個案有八名證實感染鼠傷寒沙門氏菌（Salmonella enterica serotype Typhimurium），7株有相同的DNA指紋圖譜。而這7株細菌6株有做抗生素敏感試驗，其中5株對第三代頭孢菌素有抗藥性，比例為83％（5／6）。經感染管制室調查後，發現本次群突發是因為第一位指標個案入住新生兒病房時，因症狀經治療緩解後未採隔離措施，以及工作人員照護時，手部衛生與環境清消未落實而發生了交叉感染，造成群突發。總結我們建議感染沙門氏菌後症狀緩解之帶菌患者，特別是易感宿主，住院期間採取隔離措施應當成為醫院的照護政策。期望本案可供相關醫療院所感染管制措施參考。

In 2017, in the neonatal ward of a regional teaching hospital in Southern Taiwan, a Salmonella infection outbreak occurred. All the patients had diarrhea symptoms, and the cultures stool samples were positive for Salmonella. The infection control department immediately intervened in the third and fourth cases, and asked the ward to strengthen hand hygiene and clean disinfection. When the sixth and seventh cases emerged, the infection control department strengthened the following improvement measures: (1) isolation monitoring; (2) distinction between patient and care areas; (3) restricting the rotation of staffs in the designated area; (4) daily monitoring of staff hand hygiene, and (5) education for physicians and specialist nurses. The hospital obtained 65 ward environmental samples on September 22, and the results were all negative. All the patients recovered and were discharged. The strain was sent to the Center for Research, Diagnostics and Vaccine Development of Taiwan CDC for further pulsed field gel electrophoresis identification. Five cases in the neonatal ward and 2 in the 8A ward were confirmed to be Salmonella enterica serotype typhimurium homologous strain. The results of the antibiotic susceptibility test in the 5 patients showed resistance to third-generation cephalosporins, and the ratio of drug resistance was 83% (5/6). After the investigation of the infection control department, the reasons for the outbreak were identified as follows: (1) lack of attention to isolation monitoring, and (2) lack of attention to environmental cleaning and disinfection, and failure of medical staffs to comply with hand hygiene. We suggest that a health-care policy be established in the hospital to isolate asymptomatic patients with Salmonella infection during hospitalization. This case can be used as a reference for relevant medical institutions.