| Objective:1.To investigate the prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in patients of the neurosurgical intensive care unit(NICU),and to discuss the relationship between infection and colonization as well as the risk factors for CRAB colonization/infection,based on which effective screening and isolation protocols can be developed.2.To explore the transmission of CRAB in nurses and the medical environment by NICU routine nursing operations and related influencing factors,so as to provide theoretical basis for the protection of medical personnel and the formulation of efficient environmental cleaning and disinfection measures.Methods:1.Patients admitted to the NICU of Tangdu Hospital of Air Force Military Medical University from December 1,2018 to February 28,2019 were selected as study subjects.2.Swab samples of the pharynx,axilla,groin and rectum were collected from the NICU patients who met the inclusion criteria,and these samples were analysed for the presence,location and timing of CRAB infections.Clinical information of the patients was also collected,from which some risk factors of CRAB colonization/infection were summarized.3.A cross-sectional study and convenience sampling method were used to include nursing staff who performed routine operations on CRAB colonization/infection patients in the NICU of Tangdu Hospital,Air Force Military Medical University from December 1,2018 to February 28,2019.The operation conditions of nurses entering the patient unit were recorded in detail,and samples and cultures were taken from the isolation clothes,gloves and the surface of high-frequency contact objects around the patients when the operators left the patient unit,so as to explore the pollution status and influencing factors of different operations on the nurses and patients’environment CRAB.4.Pulsed field gel electrophoresis(PFGE)was used to cluster analyse different CRAB strains collected from the patients,post-operational gloves and isolation clothing of the nurses,as well as from the surfaces of objects that are in frequent contact with the patients.When two strains are more than 85%homologous,they were treated as the same clone.Results:1.A total of 180 inpatients in the NICU were screened during the study period,and45 of them were detected to have CRAB infection,which yielded a 25%CRAB colonization rate.The colonization rate of each body part from high to low are as follows:pharynx(23.33%),axilla(13.89%),groin(8.33%)and rectum(5.00%).The results showed that the rate have increased significantly(P=0.005)by day 7 of hospitalization(31.94%),as compared to the rate upon admission(16.11%).No significance was yielded(χ~2=0.072,P=0.965)from comparing the rates on day 7(31.94%)and day 14(29.17%),nor from rates on day 21 and later(30.00%).2.The rate of CRAB colonization in current NICU patients(59.43%)was significantly higher(χ~2=22.027,P<0.001)than that in the same patients before admission into NICU(31.11%).3.Some risk factors of CRAB infections are:APACHE-Ⅱscore≥22,hospitalization in the ICU or the emergency treatment unit for 7 days or more,antimicrobial drug use for7 days or more,duration of the operation equal or greater than 3 hours,presence of mechanical ventilation,tracheotomy for more than 14 days,and presence of intravascular catheter detaining urethral catheter,ventricle drainage tube or nasogastric tube.All the above-mentioned risk factors yielded significance(P<0.05).Two clinical factors associated with these risk factors were also identified,namely the use of penicillium carbon alkene drugs and the presence of chronic diseases in the patients.After introducing all the 14 factors into a multiariable logistic regression model,two significant variables contributing to CRAB engraftment in the NICU were identified,namely the APACHE-Ⅱscore and the use of penicillium carbon alkene drugs.These variables were also found to be independent of each other.4.The environmental contamination rate of CRAB in the nurses and patients differs as depending on the type of nursing routine performed.Over the study period,317 cases of nurisng routines(including sputum aspiration,indwelling/replacement of various catheters,linen-making,intravenous infusion,oral care,etc.)by the NICU nurses were observed.Overally,5 types of nursing operations yielded significantly higher contamination rates to the patiens’surrounding environment(87.38%)than to the nurses’(53.63%),and this difference was statistically significant(P<0.001).In particularly,oral care had the highest pollution rate to the surrounding environment to both the nurses’and the patients’surrrounding environments(46.67%).As for contamination of patients alone,the pillow seemed to be the most polluted area,with a contamination rate of 53%.5.The presence of indwenting catheter,indwenting ventricular drainage tube and the use of carbapenems were independent risk factors for contamination of operator CRAB during nursing operations by nurses in NICU.Patients undergoing mechanical ventilation,indwelling catheter,indwelling ventricular drainage tube,and the use of carbapenems were independent risk factors for the pollution of CRAB in the surrounding environment of patients during nursing operations by nurses in NICU.6.PFGE analysis of 26 samples collected from clinical specimens of 8CRAB-infection patients,their environment,as well as from the post-operational clothing and gloves of eight nursing personnels showed that CRAB strains homologous to the ones found in the patient and their surroundings also existed in all of the eight nurses.More specifically,seven nursing personnels(88%)had strains closely related to the patients,and five had strains closely related to the patients’surrounding environment.Conclusion:1.Given a high rate of CRAB colonization,NICU patients should be routinely and actively screened.The screening should focus on the pharynx,and it should be done on the 7th day of hospitalization.2.For patients with an APACHE-Ⅱscore equal to or higher than 22,have been taking penicillium carbon alkene drugs,isolation measures should be taken upon their admission into the hospital in order to prevent and control the spread and contamination of CRAB infections.3.CRAB can potentially be transmitted between the patients and nurses through the surfaces of objects that are in frequent contact with the patients during a nursing routine.Therefore,in addition to isolate CRAB colonization/infection patients,it is also important to imrpove the occupational protection protocols and hand hygiene of nursing personnels,and disinfection measures should also be taken on the surrounding environment of the patients. |
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