集束化干预急性出血性结膜炎聚集性事件的效果

Efficacy of bundle intervention in cluster events of acute hemorrhagic conjunctivitis

摘要:

目的调查某院眼科病房急性出血性结膜炎聚集性事件发生的原因，为医院感染综合防控提供依据。方法回顾性调查2016年1—11月该院眼科病区发生的急性出血性结膜炎病例，对病区开展现场流行病学及环境卫生学调查。调查2016年1—8月（督导前）和2016年9—11月（督导后）该病区医务人员的手卫生依从性。并通过ATP快速荧光检测仪对该病区医务人员手、常规诊疗仪器及高频接触环境物体表面进行采样，制定集束化干预策略进行医院感染防控。结果2016年8月4日—9月17日共11例急性出血性结膜炎患者，其中住院患者9例，门诊复诊患者2例；医务人员3例。仅采集到I病区2例患者眼部分泌物，经病毒学检测证实为腺病毒感染所导致。ATP检测医务人员手卫生合格率为28.57%，环境物体表面合格率为34.38%。督导前病区医务人员手卫生依从率为50.00%，督导后为78.52%，差异有统计学意义（ χ2=4.89，P=0.03）。督导期间裂隙灯、眼压计等公用检查设备消毒措施执行率76.64%。集束化干预策略实施后，眼科病房自10月中旬后几个月未再发现出血性结膜炎感染病例。结论做好手卫生和环境清洁消毒仍是重要的感染防控手段，采取及时、可行的集束化干预策略能够有效的控制感染的暴发或流行。

关键词:

急性出血性结膜炎; 医院感染; 聚集性事件; 集束化干预; 暴发

Abstract:

ObjectiveTo investigate the causes of clustered event of acute hemorrhagic conjunctivitis(AHC) in the ophthalmology department of a hospital, and provide basis for comprehensive prevention and control of healthcareassociated infection(HAI). MethodsAHC occurred in the ophthalmology department of a hospital from January to November 2016 were investigated retrospectively, onsite epidemiological and environmental hygienic investigation was carried out. Hand hygiene compliance among health care workers(HCWs) in this department during JanuaryAugust 2016(before supervision)  and SeptemberNovember 2016 (after supervision) were surveyed. Hands of HCWs, instruments for routine diagnosis, and frequently touched object surface were taken sampling by ATP fluorescence rapid detector, bundle intervention strategies for HAI prevention and control were formulated. ResultsA total of 11 patients developed AHC from August 4, 2016 to September 17, 2016, 9 of whom were inpatients, and 2 were outpatients; 3 HCWs had AHC. Eye secretion was taken only from two patients in ward I, virological examination confirmed that it was caused by adenovirus infection. ATP examination showed that the qualified rate of HCWs’ hand hygiene and hygiene of environmental object surface were 28.57% and 34.38% respectively. Compliance rates of hand hygiene of HCWs before and after supervision were 50.00% and 78.52% respectively, difference was statistically significant (χ2=4.89, P=0.03). During the supervision period, the implementation rate of disinfection for equipment such as slit lamp, tonometer, and other common equipment was 76.64%. After the implementation of bundle intervention strategies, no case of hemorrhagic conjunctivitis was found in the ophthalmology department since midOctober. ConclusionGood hand hygiene and environmental cleaning and disinfection are still important means of infection prevention and control, timely and feasible bundle intervention strategies can effectively control the outbreak or epidemic of infection.

Key words:

acute hemorrhagic conjunctivitis; healthcare associated infection; cluster event; bundle intervention; outbreak