目的 探讨妊娠晚期合并新型冠状病毒Omicron变异株感染患者的临床表现、母婴垂直传播风险及感染预防与控制.方法 回顾性分析3例于某三甲医院分娩的新型冠状病毒Omicron变异株感染产妇及其新生儿的临床特征、母婴结局及感染预防与控制措施.结果 3例新型冠状病毒Omicron变异株感染产妇平均年龄29岁,平均孕周38+4周.初始临床症状为咳嗽、咳痰1例,其余2例患者无新型冠状病毒肺炎的临床表现.所有患者行剖宫产终止妊娠,对产妇乳汁、阴道分泌物、脐血、羊水行新型冠状病毒核酸检测,结果均为阴性.新生儿出生后立即母婴分离,其中2例转入新生儿重症监护病房隔离病室单间治疗,住院期间每日进行新型冠状病毒核酸检测,结果均为阴性;另1例间隔24 h连续2次核酸结果阴性,转至隔离点隔离观察.产妇和新生儿均预后良好.结论 本研究尚未发现新型冠状病毒Omicron变异株感染孕晚期产妇母婴垂直传播的证据.对于孕周足月或呼吸道症状加重产妇,建议及时终止妊娠,新生儿出生后立即母婴分离并严格隔离,以确保新生儿的安全.

俯卧位机械通气(prone position ventilation,PP)是指在实施机械通气过程中协助患者采取俯卧式体位[1],该体位可以使腹腔内压下降,膈肌向胸腔的移位减少增加功能残气量,有利于分泌物的引流、改善肺依赖区的通气/血流比,减少纵隔和心脏对肺的压迫、改变胸壁的顺应性,改善氧合状态[2].

目的 观察汽化过氧化氢(VHP)对ICU空气、物体表面自然菌及多重耐药菌(MDR)的消毒效果,为医院制定个性化消毒方案提供依据.方法 按《消毒技术规范》(2002版)进行实验,对ICU空气、物体表面自然菌及MDR进行消毒前后的监测,评价VHP的消毒效果.结果 MDR消毒结果表明VHP对耐碳青霉烯类肺炎克雷伯菌(CRKP)、耐碳青霉烯类鲍曼不动杆菌(CRAB)、耐碳青霉烯类大肠埃希菌(CRECO)、耐碳青霉烯类铜绿假单胞抗菌(CRPA)的杀灭对数值均≥5,对耐甲氧西林金黄色葡萄球菌(MRSA)的平均杀灭对数值为4.27.空气消毒结果表明VHP对放置于窗台、病床、洗手池、治疗盘、储物柜自然菌消亡率均为100％.物体表面消毒结果表明VHP对床沿、输液吊塔、窗台、输液泵、微量泵表面自然菌消亡率均为100％,对洗手池表面自然菌消亡率为94.4％.结论 汽化过氧化氢对医院病房各种微生物的的消毒效果均符合消毒技术规范要求,可考虑在医院推广此消毒技术.

Objective To investigate and control the outbreak of infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in a gastroenterology intensive care unit (ICU), so as to provide reference for the prevention and control of clinical multidrug-resistant organisms (MDROs).Methods Epidemiological investigation was conducted on 3 patients with CRKP infection in a gastroenterology ICU on January 21-31, 2018, specimens were collected with environmental biology monitoring method, CRKP in environment was searched, homology between patients and environmental isolates were analyzed by pulsed-field gel electrophoresis (PFGE).Results Three patients were all isolated CRKP from sputum and blood specimens, all were male, with adjacent beds in the same ward, and treated by the same doctor.The number of isolated CRKP and infection rate in January 2018 were higher than those in other months, infection rate was significantly different (χ2=13.67, P＜0.01).A total of 102 environmental specimens were collected, including air and surface of objects, only 1 of which (nurse's uniform) was isolated 1 strain of KP.PFGE typing of KP isolated from patients and environment showed that there were two genotypes A and B, KP isolated from uniform of a nurse, hydrops abdominis and blood specimen of patient at bed 07, blood specimen of patient at bed 08, as well as sputum and blood specimen of patient at bed 09 were all type A, KP isolated from sputum specimen of patient at bed 07 was type B, KP isolated from hydrops abdominis in patient at bed 09 was not be typed.After comprehensive intervention, CRKP was not no longer isolated from 3 patients, and there was no new case in the ward.Conclusion Imperfect implementation of prevention and control measures for MDROs by health care workers may be an important cause for the spread of CRKP.