疫情期间收治新冠肺炎患者医院感染对象医院环境病毒、细菌污染特征

I. Egorov, S. Smirnova, V. Mishchenko, I. V. Vialykh, A. Y. Markarian, N. N. Zhuikov, S. V. Romanov, A. V. Ponomareva, I. V. Chistiakova, A. S. Kiliachina, O. Averianov, V. Smirnova, А. N. Bolshakova, E. V. Vernik, N. A. Pushkareva, A. Semenov
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Sample collection was performed during three days (Tuesday, Thursday, Sunday) at 20 unified sampling points: in the area where patients general hospital area as well as from the outer surface of personal protective equipment for medical personnel (overalls, gloves). The study used epidemiological (descriptive­evaluative and analytical), molecular genetic (SARS-­CoV­-2 PCR­RT, sequencing), bacteriological (isolation, cultivation and MALDI­TOF identification of bacterial cultures) methods. Statistical significance of differences was assessed by Fisher's point test (φ). Differences were considered significant at p≤0.05. Statistical data processing was carried out using the Microsoft Office 2010 application package, the online resource https://medstatistic. ru/, ST Statistica 10.Results. 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引用次数: 1

摘要

的相关性。由于COVID -19大流行,全国传染病医院网络已经部署,以治疗感染SARS-CoV -2的患者。它们的形成原则严格划分为“传染”区和“清洁”区,尽管有流行病学的理由,但导致形成一个动态的人工创造的封闭生态系统。在这样一个生态系统中,一方面,接受各种侵入性和侵袭性治疗和诊断操作的患者和医务人员长期停留,另一方面,能够适应医院条件并形成耐药菌株的病毒和细菌性质的病原体循环。因此,医院和患者本身的环境物体污染的高风险,这可能导致外源性医院感染的发展。研究新冠肺炎大流行期间收治SARS -CoV -2患者的传染病医院医院环境中物体的病毒和细菌污染特征。材料和方法。对某传染病医院计划工作期间治疗COVID -19患者的外部环境样本343份进行了研究。采集时间为3天(周二、周四、周日),在20个统一采样点:患者所在的综合医院区域以及医务人员个人防护装备(工作服、手套)的外表面采集样本。该研究使用了流行病学(描述性-评估性和分析性)、分子遗传学(SARS- CoV -2 PCR-RT,测序)、细菌学(细菌培养物的分离、培养和MALDI-TOF鉴定)方法。采用Fisher点检验(φ)评价差异的统计学意义。p≤0.05认为差异有统计学意义。统计数据处理使用Microsoft Office 2010应用程序包,在线资源https://medstatistic。10.结果。该研究表明,传染病医院重症监护室环境物体的病毒和细菌污染水平很高,用于治疗COVID -19患者- 11.1%,其中综合医院环境物体- 9.3%(医生工作场所- 16.7%);患者定位区占13.9%(电泵占27.8%,机械通气、操作台各占16.7%);人员手套外表面- 21.1-38.9%;人员防护服外表面- 44.4-50.0%。从医院外部环境中分离到的SARS -CoV -2属于B.1.617.1 DELTA遗传变异,与采样期流行病学情况相符。条件菌群结构以粪肠球菌(38.1%)、肺炎克雷伯菌(21.4%)和大肠杆菌(16.7%)为主,对3组及以上抗生素均表现出较高的耐药水平。最初,感染SARS- CoV- 2的医院环境物体的主要传染源最有可能是患者。由于医务人员的直接参与,传染病医院环境物进一步受到病毒和机会性微生物群的污染。目前的情况需要审查COVID -19大流行期间传染病医院消毒规则、个人防护装备使用和员工手部消毒处理的方法,以及工作人员工作时间的长短。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Characteristic of Viral and Bacterial Contaminationin Objects of the Infection Hospital Environment of the Hospital for the Treatment of Patients with COVID-19 During the Pandemic Period
Relevance. Due to the COVID­-19 pandemic a infectious diseases hospitals nationwide network has been deployed to treat patients infected with SARS­CoV­-2. The principles of their formation with a strict division into «infectious» and «clean» zones, despite the epidemiological justification, lead to the formation of a dynamic artificially created closed ecosystem. In such an ecosystem, on the one hand, patients who undergo a wide range of invasive and aggressive therapeutic and diagnostic manipulations, and medical personnel stay for a long time, on the other hand, pathogens of a viral and bacterial nature that can adapt to hospital conditions and form resistant strains circulate. As a result, high risks of contamination of environmental objects of hospitals and patients themselves are created, which can lead to the development of exogenous nosocomial infection.Aims. To study the features of viral and bacterial contamination of objects in the hospital environment of the infectious diseases hospital for the treatment of patients infected with SARS­-CoV­-2 during the COVID­-19 pandemic.Materials and methods. A study was conducted on 343 samples from the external environment of the infectious diseases hospital for COVID­-19 patients’ treatment during its planned work. Sample collection was performed during three days (Tuesday, Thursday, Sunday) at 20 unified sampling points: in the area where patients general hospital area as well as from the outer surface of personal protective equipment for medical personnel (overalls, gloves). The study used epidemiological (descriptive­evaluative and analytical), molecular genetic (SARS-­CoV­-2 PCR­RT, sequencing), bacteriological (isolation, cultivation and MALDI­TOF identification of bacterial cultures) methods. Statistical significance of differences was assessed by Fisher's point test (φ). Differences were considered significant at p≤0.05. Statistical data processing was carried out using the Microsoft Office 2010 application package, the online resource https://medstatistic. ru/, ST Statistica 10.Results. The study demonstrated a high level of viral and bacterial contamination of environmental objects in the intensive care unit of the infectious diseases hospital for COVID­-19 patients treatment – 11.1%, incl. objects of the general hospital environment – 9.3% (doctor's workplace – 16.7%); patient location area – 13.9% (electric pump – 27.8%, mechanical ventilation, manipulation table – 16.7% each); the outer surface of personnel gloves – 21.1–38.9%; the outer surface of protective overalls for personnel – 44.4–50.0%. SARS­-CoV­-2 isolated from the objects of the external environment of the hospital belonged to the genetic variant B.1.617.1 DELTA, which corresponded to the epidemiological situation at sampling collection period. The opportunistic microflora structure was dominated by Enterococcus faecalis (38.1%), Klebsiella pneumoniaе (21.4%) and Escherichia coli (16.7%), which demonstrated a high level of resistance (to 3 or more groups of antibiotics).Conclusion. Initially, the main sources of the infectious diseases hospital environmental objects contamination with SARS-­CoV-­2 are most likely patients. Further contamination of the infectious diseases hospital environmental objects with viruses and opportunistic microflora occurs with the medical personnel direct participation. The current situation requires a review of approaches to the rules for disinfection, the PPE use and employees hands antiseptic treatment in infectious diseases hospital during the COVID­-19 pandemic, as well as the length of staff work period length.
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