白内障术后感染性眼内炎聚集性事件的调查与防控实践

Investigation as well as prevention and control of infectious endophthalmitis cluster events after cataract operation

摘要:

目的 调查某眼科医院白内障超声乳化联合人工晶体植入术(简称Phaco+Iol植入术)后医院感染聚集性事件发生的原因及干预措施,为预防与控制医院感染提供参考依据。方法 对2020年7月25日—8月27日34 d内Phaco+Iol植入术后发生的4例眼内炎感染病例开展流行病学调查,对手术环境开展环境卫生学监测,并采取综合性干预措施(10—11月),避免医院感染的扩散。结果 34 d内共有Phaco+Iol植入术患者1 219例,发生眼内炎4例,感染发病率为0.32%。4例感染患者平均年龄74岁,分别植入了三种不同品牌型号的人工晶体,于术后第2日至第9日内不同时间段确诊为眼内炎,初步怀疑为医院感染聚集性事件。手术室环境卫生学监测共有13份标本检测不合格,采取感染防控措施,干预前后环境卫生学监测合格率比较,差异有统计学意义(P＝0.006)。4例患者的玻璃体、房水采样细菌培养鉴定出3种不同的菌种(产色葡萄球菌、表皮葡萄球菌、粪肠球菌),有1例患者玻璃体采样细菌培养结果阴性。感染防控策略实施后,未再出现类似感染病例。结论 通过强化医院感染预防控制意识,加强医院内手术室及相关科室的综合监测管理,采取及时和有针对性的预防控制措施,可以有效控制医院感染聚集性事件的发生。

Abstract:

Objective To investigate the causes and intervention measures of healthcare-associated infection (HAI) cluster events after cataract phacoemulsification combined intraocular lens(Phaco+Iol) implantation in an eye hospital, and provide reference for the prevention and control of HAI. Methods Epidemiological investigation was carried out on 4 cases of endophthalmitis after Phaco+Iol implantation within 34 days from July 25 to August 27, 2020. Environmental hygiene monitoring on surgical environment was carried out, and comprehensive intervention measures were taken ( from October to November) to avoid the spread of HAI. Results Within 34 days, a total of 1 219 patients underwent Phaco+Iol implantation, and 4 patients developed endophthalmitis, with an infection rate of 0.32%. The 4 infected patients, with an average age of 74 years, were implanted with three different brands and models of intraocular lenses respectively. They were diagnosed with endophthalmitis at different periods from the 2nd to the 9th day after surgery, which was initially suspected to be a cluster event of HAI. A total of 13 environmental hygiene monitoring specimens from operating room were unqualified. After taking infection prevention and control measures, the qualified rate of environmental hygiene monitoring before and after intervention was compared, difference was statistically significant (P=0.006). Three different bacterial species (Staphylococcus chromogenes, Staphylococcus epidermidis, and Enterococcus faecalis) were identified from vitreous and aqueous humor specimens of 4 patients. Bacteria culture results of vitreous specimens from 1 patient was negative. After the implementation of the infection prevention and control strategy, no similar infection occurred. Conclusion Improving the awareness on HAI prevention and control, strengthening the comprehensive monitoring and management of the operating room and related departments in the hospital, as well as taking timely and targeted preventive and control measures can effectively control the occurrence of HAI cluster events.