目的 探讨烧伤病区医院感染耐甲氧西林金黄色葡萄球菌(MRSA)的危险因素与传播途径,以便采取有效的干预措施,防止耐药菌株的扩散流行,进一步加强医院感染管理.方法 采用前瞻性调查方法,对2007年1月至2008年6月的烧伤病区感染病例进行目标性监测.对同期进行医疗服务的医务人员和陪护人员的手进行随机采样.结果 383例烧伤患者当中发生医院感染39例,感染率10.18%;MRSA感染23例占58.97%,其中3例为脓毒症;有过气管插管、气管切开等插入性操作的10例伤员当中有4例肺部MRSA感染.对同时期医务人员的手采样324例,检出MRSA21株;陪护人员手采样67例,检出MRSA5株.结论 MRSA感染与患者的烧伤程度、住院时间长、侵入性操作及医护人员的手污染呈正相关,必须加强医院感染的监控力度,严格执行消毒隔离制度和"手卫生",做好危重患者及特殊感染患者的护理,防止交叉感染,缩短患者住院时间,减少侵入性操作,缩短插入操作停留时间.%Objective To explore the dangerous factors and dissemination of Methicillin-resistant Staphylococcus aureus (MRSA) hospital infection in burnt ward area in order to take effective intervention measures to prevent drug-resistant strains from spreading and to enhance the management of hospital infection. Methods Proactive investigation is applied to infected cases in burnt ward area during the period of January 2007 to June 2008. Random sampling is carried out from the hands of the medical staff and nursing team at the same time. Results Of all the 383 burnt cases, hospital infection accounts for 10.18 %, which is 39 cases. Among them, there are 23 MRSA infections, accounting for 58.97%. 3 of which are pyemia. Patients with invasive operation history of endotracheal intubation or tracheotomy, 4 out of 10 cases were found MRSA infected in the lung. At the same period of time, samples were taken from hands of medical staff 324 times. Among them, 21 MRSA strains were found. Of the 67 samples taken from the nursing team, 5 MRSA strains were found. Conclusions MRSA infection is positively correlated to the patient's degree of burn, time in hospital, incursive operation and medical staff's hand contamination. Measures must be taken to monitor the hospital infection, to enforce stringent sterilization isolation system and 'hand hygiene', and to better attend to serious patients and infected patients. Others like preventing cross-infection, minimizing the time in hospital, incursive operation and invasive operation duration time will also help.
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