支气管肺泡灌洗液中检出荧光假单胞菌的假暴发事件调查与处置
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Investigation and disposal of a pseudo-outbreak of Pseudomonas fluorescens detected from bronchoalveolar lavage fluid
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    摘要:

    目的 调查某医院儿科送检支气管肺泡灌洗液(BALF)中连续检出荧光假单胞菌的原因,制定并评估干预措施的效果,为完善纤维支气管镜全流程感染控制提供依据。方法 对2024年5月3—6日BALF检出荧光假单胞菌的3例患儿开展流行病学调查,综合采用病例回顾、现场流程跟踪、环境卫生学监测、消毒剂实验室杀菌效果检验、纤维支气管镜结构维修检测等方法,识别风险点并实施针对性干预。结果 4 d内儿科行纤维支气管镜检的5例患儿中,3例BALF检出荧光假单胞菌,检出率为60.0%。患儿年龄为5~8岁,均因大叶性肺炎入院,于入院后当天~第2天接受纤维支气管镜检查,临床判定该菌为污染菌。环境采样显示,纤维支气管镜、酶液缸等采样点位荧光假单胞菌检出率为15.7%(8/51);实施干预后,未再检出目标菌,差异有统计学意义(P<0.05)。2024年1月1日—5月2日,71例儿科送检BALF中未检出荧光假单胞菌;5月3—6日5例送检BALF中3例检出荧光假单胞菌;干预后(5月16日—12月31日)未检出。结论 本次事件是一起因纤维支气管镜破损、清洗消毒流程执行不规范导致的假暴发,通过多部门协作调查与及时干预,有效控制了事件发展。

    Abstract:

    Objective To investigate the causes for the continuous detection of Pseudomonas fluorescens (P. fluorescens) from bronchoalveolar lavage fluid (BALF) in pediatric department of a hospital, formulate intervention measures and evaluate its effectiveness, and provide basis for improving the whole process infection control of fiber bronchoscopy. Methods Epidemiological investigation was conducted on three children from whose BALF P. fluorescens were detected in May 3-6, 2024. The comprehensive methods were adopted, including case reviewing, on-site process tracking, environmental hygiene monitoring, laboratory testing on disinfectant sterilization effect, fiber bronchoscope structure maintenance and checking, etc. Risks were identified and targeted interventions were implemented. Results Among the 5 pediatric patients who underwent fiber bronchoscopy within 4 days, P. fluorescens was detected from BALF of 3 cases, with a detection rate of 60.0%. The children were 5-8 years old and were admitted to the hospital due to lobar pneumonia. They underwent fiber bronchoscopy from the day of admission to the second day, and bacterial strains were clinically determined to be contaminated strains. Environmental sampling showed that the detection rate of P. fluorescens at sampling points such as fiber bronchoscope and enzyme solution storage tank was 15.7% (8/51). After implementing intervention, no target bacteria were detected again, and the difference was statistically significant (P<0.05). From January 1 to May 2, 2024, 71 BALF from pediatric department were not detected P. fluorescens; From May 3 to 6, among 5 detected BALF, 3 were detected P. fluorescens; After intervention (May 16 to December 31), no specimen was detected P. fluorescens. Conclusion This event is a pseudo-outbreak caused by fiber bronchoscope damage as well as improper cleaning and disinfection procedures. Through collaborative investigation and timely intervention by multiple departments, the event was effectively controlled.

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陈凤,刘迪军,黄仁建,等.支气管肺泡灌洗液中检出荧光假单胞菌的假暴发事件调查与处置[J]. 中国感染控制杂志,2025,24(9):1307-1313. DOI:10.12138/j. issn.1671-9638.20252170.
CHEN Feng, LIU Dijun, HUANG Renjian, et al. Investigation and disposal of a pseudo-outbreak of Pseudomonas fluorescens detected from bronchoalveolar lavage fluid[J]. Chin J Infect Control, 2025,24(9):1307-1313. DOI:10.12138/j. issn.1671-9638.20252170.

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  • 收稿日期:2025-02-27
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  • 在线发布日期: 2025-09-23
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