Abstract:

医疗废物是指医疗卫生机构在医疗、预防、保健以及其他相关活动中产生的具有直接或间接感染性、毒性以及其他危害性的废物，是病原微生物的潜在宿主［1］。针对医疗废物的处理处置，各类技术呈现出异彩纷呈的总体发展态势，但医疗废物的处置往往不是单一的，在处理处置医疗废物的同时，还要考虑技术的适用性，实施切实可行的源头分类，以便规避风险，减少二次污染，实现医疗废物无害化安全管理和处置。

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ObjectiveTo investigate the awareness status about HIV/AIDS and its influencing factors in the floating population in Hefei.MethodsConvenience sampling method was adopted to select floating population from construction sites, restaurants, markets, and enterprise. Subjects were surveyed with questionnaires, data were analyzed.ResultsA total of 819 persons were investigated, 758 (92.55%) effective questionnaires were available. The total awareness rate of HIV/AIDS prevention was 52.90% (401/758), restaurant workers 44.03% (59/134), market staff 45.41% (89/196), enterprise workers 63.64% (133/209), and construction workers 54.79% (120/219), the difference in the awareness rate of HIV/AIDSrelated knowledge among population of above four careers was statistically significant (χ2=18.63, P<0.001). The necessity to further understand HIV/AIDSrelated knowledge was highest among restaurant workers (85.07%); the awareness rate of correct use of condoms for preventing AIDS was highest among construction workers (64.84%); the percentage of being unwilling to contact with AIDS patients or not allowing AIDS patients continue to work was highest among restaurant workers(82.09%, 83.58%, respectively), the differences of above had statistical significance(P<0.05). Factors infuencing communication between floating people and AIDS patients were career and awareness rate of HIV/AIDS; influencing factors about whether floating people allowed AIDS patients continue to work were career, education degree, and awareness rate of HIV/AIDS.ConclusionThe awareness rate of HIV/AIDS prevention among floating population is low and should be enhanced; the knowledge of safe and protected sexual behaviour need to be propagated; the discrimination against AIDS patients should be eliminated.

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ObjectiveTo investigate the impact of oneyear highly active antiretroviral therapy （HAART） on antiviral effect and immune reconstruction in HIV/AIDS patients.MethodsThirtyfive HIV/AIDS patients were initially treated with HAART when CD4+T cells were <350/μL, blood samples were taken at the HAART time point 0,6,12 months, the virus load was tested by RTPCR, CD4+T cells, CD8+T cells, CD4+ naive cells, CD4+ memory cells and CD8+ activated cells were detected by flowcytometry.ResultsThe average virus load of 35 patients was (4.62±1.09)×106 copies/mL before HAART, and was lower than the lower limit of detection value after HAART for 6 months and 12 months. The levels of CD4+ T cells, CD4+ naive cells and CD4+ memory cells were (312±109.22) /μL,（150±57.34）/μL and （212±48.06）/μL respectively after HAART for 12 months, while they were （183±83.73）/μL, （73±20.40）/μL and （119±30.42）/μL respectively at the baseline （P＜0.01）, but they were still lower than healthy control group(［768±146.41］/μL,［424±87.06］/μL and ［442±61.40］/μL, respectively)（P＜0.05）;the level of CD8+ T cells were（427±99.79）/μL after HAART, which decreased significantly compared with （597±111.43）/μL of the baseline （P＜0.05）, but still higher than （208±37.39）/μL of healthy control group （P＜0.05）.ConclusionHAART can both inhibit virus replication rapidly and reconstruct HIV/AIDS patients’ immunity partially.

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ObjectiveTo evaluate the epidemiology, clinical features, treatment and prognosis of Penicilliosis marneffei (PSM) complicated in patients with acquired immunodeficiency syndrome (AIDS) in a hospital.MethodsClinical data of AIDS inpatients with PSM between January 2008 and August 2011 were studied retrospectively.ResultsClinical data of 33 patients were collected. Before the onset of disease, 54.55% of the patients had been living in Hunan, 45.45% came from or have ever been to Penicillium marneffei (PM) endemic areas of Guangdong, Guangxi, Yunnan, and Fujian. The major clinical manifestations were fever (96.97%), anaemia (93.94%), cough (66.67%), splenomegaly (63.64%), skin rash (57.58%), lymphadenectasis (39.39%) and diarrhea(33.33%). CD4+T lymphocyte count of all patients were <200/mm3, and the number of the patients with CD4+ count in 100-200/mm3，50-100/mm3 and <50/mm3 ranges were 1,7 and 25, respectively. After treated with amphotericin B and/or itraconazole,the total cure and improvement rate was 84.85%.ConclusionWith regard to PSM complicated in AIDS patients, early diagnosis and prompt treatment can achieve ideal therapeutic effet.

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ObjectiveTo investigate the positive rate of class Ⅰintegron in Acinetobacter baumannii (AB) isolated from an intensive care unit (ICU),analyze the homology of multidrugresistant AB (MDRAB), and explore the molecular mechanisms of class I integron involved in drug resistance and the spread.MethodsForty MDRAB isolates from the ICU between January 2008 and December 2009 were collected, drug resistance of all isolates were detected by KirbyBauer method, PCR and DNA sequencing were undertaken to clarify the context of gene cassette. Pulsedfield gel electrophoresis was used to analyze the homology of MDRAB.ResultsClassⅠintegron was detected in 75.00% (30/40) of all isolates, 2 types of gene cassettes were identified, namely aacA4catB8aadA1 and aacC1orfXorfXorfX’aadA1. Forty isolates were classified into 4 distinct genotypes by PFGE analysis，26 isolates belonged to clone B that were predominant epidemic strain.Conclusionclass Ⅰintegrons are widespread in MDRAB, and spread horizontally in ICU. The epidemic of AB in ICU maybe caused by MDRAB carrying aacA4catB8aadA1 cassette. 

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ObjectiveTo explore the effect of central line bundle (CLB) on the prevention of central venous catheterrelated bloodstream infection （CRBSI） in an intensive care unit(ICU).MethodsA combination method of retrospective and prospective survey was adopted to compare and analyze the occurrence of CRBSI in two groups of patients, 179 patients in treatment group with central venous catheters (CVCs) from March 2011 to February 2012 implemented CLB, 198 patients in control group with CVCs from January 2010 to December 2010 didn't implement CLB.ResultsThe incidence of CRBSI in treatment group was significantly lower than control group (3.34‰ vs 9.42‰;χ2=5.340,P=0.021); the length of hospital stay was significantly shorter than that in control group(［26.43±7.16］d vs［33.25±8.51］d;t=8.35,P＜0.001）,the onset of CRBSI was significantly later than that of control group (［10.11±2.34）］d vs（6.23±1.92）d; t=17.703,P＜0.001）, the consumption of hand disinfectant increased significantly in treatment group (41.2 mL/ patients day vs 3.5 mL/ patients day；t=34.469,P<0.001）.ConclusionThe implementation of central line bundle in ICU can effectively reduce the incidence of CRBSI, and is helpful for the prevention and control of CRBSI.

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ObjectiveTo investigate the hand hygiene compliance among healthcare workers(HCWs) in hospitals in Yichang, and evaluate the approach to improve hand hygiene compliance.MethodsQuestionnaires of hand hygiene compliance were filled out by HCWs at 37 hospitals.ResultsA total of 238 HCWs were surveyed, the overall hand hygiene compliance rate was 32.38%(125/386), and the rates varied significantly with the kinds of the hospitals as below: 46.81% in tertiary, 53.19% in secondary, 23.53% in private, 7.69% in township, and 17.95% in primary, hand hygiene compliance rate was significantly different among all hospitals(P<0.05). Of 6 time points for hand hygiene (before contact with patients, before aseptic procedure, after body fluid exposure, after contact with patients, after contact with environmental surface in the vicinity of patients, and after glove removal), hand hygiene compliance rates before aseptic procedure and after removing gloves were the highest, which was 89.58%(43/48) and 80.49%(33/41) respectively. Nurses’ hand hygiene compliance rate was 54.82%(74/135), which was significantly higher than in the other groups (P<0.01); of all departments, hand hygiene compliance rate of HCWs in obstetrics and gynecology was 83.78%(31/37), which was significantly higher than in the other departments (P<0.01). Of all hospitals, 18.92% equipped with nontouch taps and 43.24% equipped with handdrying facilities. After washing, 39.76% (33/83) HCWs used tissue or handdrying facilities, 13.25%(11/83) dried hands naturally, and 46.99%(39/83) wiped hands with their uniforms. The major factors influencing the hand hygiene compliance were heavy workload (42.86%), insufficient attention (38.24%) and hand hygiene facilities(36.56%).ConclusionThe overall hand hygiene compliance rate in Yichang is low, hand hygiene compliance need to be improved.

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ObjectiveTo investigate the daily antimicrobial use in patients at hospitals of different sizes in Guizhou province.MethodsAntimicrobial use in 108 hospitals on August 30， 2010 was investigated, all data were analyzed.ResultsA total of 29 358 inpatients were investigated, the usage rate of antimicrobial agents was 55.52%, 51.58% of which were for therapeutic purpose, 35.44% for prophylactic use, and 12.98% for both therapeutic and prophylactic application; 60.88% of patients received one agent， 35.80% received two, and 3.32% received three and more agents. Among patients who received antimicrobials for therapy， only 13.84% were sent specimens for pathogenic detection. The usage rates of antimicrobial agents were different among different hospitals， secondary hospital was 61.18%, and tertiary hospital was 47.35%(χ2=549.85，P＜0.05). Departments of pediatrics， respiratory diseases， and otolaryngology had higher antimicrobial usage rates, all were >75%. ConclusionInpatients in 108 hospitals have higher rate of daily antimicrobial use, prophylactic use and combined use, but pathogen detection rate is low. It is necessary to strengthen the management of rational use of antimicrobial use.

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ObjectiveTo evaluate clinical diagnosis and treatment of cirrhosis with spontaneous bacterial peritonitis (SBP).MethodsClinical data of 76 cases of cirrhosis with SBP in hospitalized patients between February 2007 and January 2010 were analyzed retrospectively.Results Of 76 patients, 67.11% (51 cases) had temperature >37℃, 43.42% (33 cases) had no abdominal pain, rebound tenderness and tenderness. Routine examination on abdominal cavity fluid showed that white blood cell count of 38.16%patients (29 cases) were >0.3×109/L,polymorphonuclear leukocyte of 55.26% (42 cases) patients were >25%， 21.05% (16 cases) had positive blood culture, 25.00% (19 cases) had positive culture of abdominal cavity fluid. After patients received general treatment, such as liver protection, diuresis,supportive treatment and rational antimicrobial use, the total cure and improvement rate reached up to 76.32%(58 cases).Conclusion Clinical manifestations of cirrhosis with SBP is atypical, positive rate for bacterial culture is low, early abdominal cavity fluid examination and dynamic observation on peripheral white blood cell count is significant for the diagnosis. The key to the ideal curative effect on SBP is active diagnosis and treatment.

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ObjectiveTo investigate an outbreak of healthcareassociated infection(HAI) caused by multidrugresistant Burkholderia cepacia (B.cepacia)， trace the sources and transmission routes of infection, and provide reference for the prevention and control of HAI.MethodsSpecimens from patients and environment were taken and cultured, outbreak was determined based on HAI diagnostic criteria, regional distribution, and exposure time.ResultsFour B.cepacia isolates were isolated from sputum specimens of infected patients, all were multidrugresistant strains. Four infected patients were all from the same ward of the intensive care unit(ICU), their beds were adjacent, onset time was from 16 January to 22 January,2011. Five B.cepacia isolates were isolated from environment specimens, including patients’ward bedside cabinets, ventilator tubes, dressing trolleys, quilts, hands of health care workers, but B.cepacia was not detected from environment in the other wards. Drugresistant spectrum of B.cepacia  from both patients and environment was basically identical.ConclusionThe outbreak of multidrugresistant B.cepacia HAI is due to the contamination of B.cepacia on ICU medical supplies.

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ObjectiveTo observe the sequential prevalence rate of antiHCV and the rate of seroconversion to antiHCV positive for a year in maintenance hemodialysis (HD)patients, and evaluate the effect of prevention and control measures.MethodsFrom March 2010 to May 2011， 75 patients who received HD in a hospital for at least one month were followed up for 14 months. Patients were divided into 2 groups, group 1: 32 patients were under observation from March 2010; group 2: 43 patients were under observation subsequently. HCV infection in two groups were compared.ResultsThe positive rate of HCV in 75 patients was 6.67%(5/75). The positive in group 1 and group 2 was 9.38%(3/32) and 4.65%(2/43) respectively, there was no significant difference between two groups(χ2=0.645, P>0.361).The yearly seroconversion rate to antiHCV positive of two groups was 8.25%.ConclusionHCV seroconversion rate in HD patients in this hospital is high, strict control and prevention measures for HCVinfected patients are of great importance for the prevention of HCV transmission among hemodialysis patients．

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ObjectiveTo evaluate the prevalence of healthcareassociated infections(HAIs) in 15 hospitals in Changzhou, so as to provide basis for making policy for preventing and controlling HAIs.MethodsOn August 30, 2011, HAIs in 15 hospitals in Changzhou were surveyed by combination of bedside checking and medical record reviewing.Results9 695 patients should be surveyed, 9 691 (99.96%) were actually surveyed,362 patients developed 382 episodes of HAIs, the prevalence rate and case infection rate was 3.74% and 3.94% respectively. A total of 213 pathogenic isolates were detected, 70.42% were gramnegative bacteria, 17.37% were grampositive bacteria, 11.27% were fungi， and 0.94% were Mycoplasma. The highest prevalence of department was intensive care unit (38.98%). The top five infection sites were lower respiratory tract (43.72%),upper respiratory tract (14.14%),urinary system (11.26%),surgical sites (9.69%), and skin and soft tissue (5.50%).High risk factors for HAIs included the use of ventilator(RR 95%CI,11.37-23.34), vascular access (RR 95%CI,3.91-6.85), and urinary catheterization (RR 95%CI,3.57-5.79). A total of 3 562 patients used antimicrobial agents,the daily antimicrobial usage rate was 36.76%, 1 831 (51.40%) of whom received curative use of antimicrobials, and 1 651 (46.35%) received prophylactic use, 80(2.25%) used antimicrobial agents without indication.ConclusionPrevalence survey of HAIs is helpful for realizing the occurrence of HAI, improving the accuracy of surveillance,recognizing the risk factors for HAI and multidrugresistance bacterial infection, and strengthening the targeted surveillance on the key departments.

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ObjectiveTo realize the condition of healthcareassociated infection(HAI)in a hospital，so as to provide reference for preventing and controlling HAI effectively．MethodsAccording to the nationwide HAI prevalence survey project established by ministry of health，HAI prevalence rates were investigated on September 22, 2009, September 10, 2010, and September 7, 2011,respectively, data of three years were compared．ResultsThe prevalence rate of HAI was 4.93%,2.57%, and 2.46% respectively in three years (χ2=8.790，P=0.011), HAI case rate was 5.15%,2.77%, and 3.07% respectively (χ2=7.846，P=0.020), the highest was in 2009，there was significant difference among 3 years. Lower respiratory tract infection was the most common infection, which accounting for 70.37% in 2010, secondly 65.95% in 2009 and 40.00% in 2011. The main pathogens in HAI in 2009 were Pseudomonas aeruginosa (24.00%) and fungi(24.00%)，in 2010 were Klebsiella pneumonia(42.10%) and Staphylococcus aureus (26.31%), and in 2011 were Escherichia coli (20.00%) and Proteus spp.(20.00%); the usage rate of antimicrobial agents was 54.22%,57.45%,and 39.10% respectively in three years；specimen delivery rate was 53.89%,24.11%,and 34.68% respectively.ConclusionSurvey on prevalence rate of HAI is beneficial to realizing the occurrence of HAI, and plays an important role in reducing the occurrence of HAI through monitoring on main departments and main sites of HAI.

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ObjectiveTo evaluate risk factors for surgical site infections (SSIs) after appendectomy, and provide reference for developing infection control strategies. MethodsData of 512 patients who received appendectomy between August 2010 and December 2011 were reviewed and analyzed.ResultsFortytwo of 512 patients developed SSIs, infection rate was 8.20%, all were superficial incisional SSIs. Univariate analysis showed that SSIsrelated factors were patients’ age, subcutaneous tissue thickness, diabetes, types of anesthesia, duration of surgery, season of surgery, types of incision, pathology of appendix (all P<0.05). Multivariate Logistic regression analysis showed that the risk factors for SSIs were types of incision(OR 95%CI, 2.75-67.45), subcutaneous tissue thickness(OR 95%CI, 4.54-45.81), diabetes(OR 95%CI, 5.13-29.91), types of anesthesia(OR 95%CI, 1.79-53.28), duration of surgery(OR 95%CI, 8.10-78.63), and pathology of appendix (OR 95%CI:5.51-54.74) (all P<0.05).ConclusionInfection of SSIs should be intensified according to risk factors, so as to prevent the occurrence of SSIs after appendectomy.

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ObjectiveTo investigate the distribution and change in antimicrobial resistance of Acinetobacter baumannii (AB) in healthcareassociated infection(HAI) in a hospital,so as to provide reference for rational use of antimicrobial agents.MethodsAB isolated from clinical specimens between January 2008 and December 2011 were identified with Vitek 2compact microbiology analyzer, antimicrobial susceptibility testing was performed by KirbyBauer disk diffusion method.ResultsA total of 597 AB isolates were isolated. The percentage of AB in gramnegative bacilli from 2008 to 2011 was 7.00%,8.35%,9.75%, and 12.66% respectively，percentage in 2011 rose obviously compared with 2008（χ2=32.77，P<0.05）. The major specimen was sputum (70.86%), AB distributed mainly in elderly ward（177 isolates，29.65%）, oncology department（115 isolates，19.26%）, and neurology department（93 isolates，15.58%）. Antimicrobial resistant rate of AB increased yearly during four years （P<0.05）,and resistant rate in 2011 to meropenem,cefoperazone/sulbactam and minocycline was low (8.56%,6.95%,5.35%,respectively).ConclusionInfection and antimicrobial resistant rate of AB rise constantly, strengthening the monitoring on AB is beneficial to guide rational use of antimicrobial agents in clinical practice and reduce the emergence and spread of drugresistant strains.

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目的了解某院医务人员锐器伤职业暴露发生情况，以探讨防治措施。方法2011年11月，对该院739名在岗职工发放《医务人员锐器伤职业暴露筛查表》，调查其1—10月是否发生职业暴露，筛查出发生职业暴露的人员，再填写《医务人员锐器伤职业暴露危害因素调查表》。对资料进行分析。结果739名在岗职工发生锐器伤职业暴露83例，107例次，锐器伤职业暴露发生率为11.23%，例次率为14.48%。锐器伤职业暴露以护士的发生率最高，达17.23%；工作年限以5～10年的工作人员发生率最高，达24.68%；发生的环节主要是将针头放入利器盒（26.17%）、双手回套针帽（18.69%）；暴露场所居前3位的是普通病房（57.95%）、手术室（12.15%）和急诊科（10.28%）；锐器伤涉及的主要医疗器具是针头（93.46%）。结论对医务人员锐器伤职业暴露现状进行调查，有利于了解其职业暴露情况，对建立和健全职业暴露的监测体系提供科学依据。

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目的评价导管相关感染信息化管理模式对降低重症监护室（ICU）导管相关感染的作用。方法回顾性调查某院ICU 2010年1—9月（未采用信息化管理系统）导管相关感染人数及感染率，与2011年同期（采用信息化管理系统）导管相关感染情况进行比较。结果深静脉、导尿管、人工气道导管置管时间，2010年分别为2 045、3 346、1 893 d，感染率分别为2.93‰、5.08‰、20.07‰；2011年上述导管置管时间分别为2 087、3 046、2 116 d，感染率分别为1.44‰、2.93‰、13.23‰。2011年总导管相关感染率为5.52‰，较2010年的8.37‰下降，差异有统计学意义（χ2=4.30，P=0.038）；2011年不同类型导管的相关感染率较2010年下降，但差异无统计学意义（P＞0.05）。结论导管相关感染信息化管理模式对降低导管相关感染率具有明显效果。

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目的探讨某基层医院医院感染现患率调查中存在的问题与对策。方法通过与全国医院感染监控管理培训基地（中南大学湘雅医院）医院感染现患率调查方法进行比较，发现某基层医院医院感染现患率调查方法的不足。结果通过比较，发现该基层医院在调查人员、表格审阅、感染诊断审核、数据录入等方面存在缺陷，常见问题有：项目填写不全、实查人数和个案表不相符、调查日期输入错误、床旁调查结果与个案调查结果不相符等。结论该基层医院医院感染现患率调查存在诸多缺陷，需要改进。

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目的评价在消毒供应中心应用压力蒸汽灭菌指示标签打印系统，对提高无菌医疗包质量管理及工作效率的影响。方法应用压力蒸汽灭菌指示标签打印系统打印包外化学指示标签，替代传统的手工书写方式，并对两种方法进行比较。结果2011年1—5月共准备各种医用无菌包75 000个，实际打印标签75 263张，错打、误打标签263张，浪费率0.35%。打印标签系统自动生成22位编码,记录无菌产品的信息,包括使用科室、医疗无菌包品名、灭菌日期、洗涤人员、包装人员、灭菌人员、发放人员编号及锅号/锅次等，涵盖了卫生部行业标准《清洗消毒及灭菌技术操作规范》中所要求的具有可追溯性的六要素，实现了无菌产品的可追溯性。结论在消毒供应中心应用包外指示打印标签,降低了操作人员的劳动强度，提升了医疗无菌包的管理质量和工作效率。

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目的探讨隔离标识在感染性疾病科临床应用的效果。方法设计制作床尾和病室隔离标识应用于临床，采用随机抽样的方法,对医务人员、患者、陪护和探视者发放问卷调查表，调查隔离标识使用前（2006年7月—2009年6月）和使用后（2009年7月—2012年5月）的相关情况。结果医务人员在使用隔离标识后，戴口罩合格率为98.70%，显著高于使用前的90.61%（χ2=14.69，P＜0.01）；手卫生执行率由隔离标识使用前的86.83%提高至使用后的91.35%，差异有统计学意义（χ2=7.41，P＜0.01）。对患者、陪护和探视者的调查显示，认为使用隔离标识增强了对传染病防护意识的患者、家属和探视者分别占90.77%（118/130）、100.00%（33/33）、100.00%（36/36）；认为增强了个人卫生行为者分别占83.85%（109/130）、87.88%（29/33）、97.22%（35/36）。结论隔离标识的应用提高了医务人员戴口罩、手卫生的依从性，患者、陪护和探视者增强了自我保护意识及个人卫生行为，对有效防止医院感染的发生有重要作用。

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目的探讨色系管理方法在消毒供应中心(CSSD)的应用效果。方法介绍色系管理方法在CSSD各项工作环节中的应用。结果医用纸塑袋、各类无菌治疗包、化学指示胶带、清洗筐、各工作区域及其工作人员的工作鞋与防护服均采用色系管理，即用不同的颜色作为标识记号，通过肉眼直观识别，将不同物品进行直接分类处理。结论色系管理方法简便、快捷，能有效提高工作效率，值得推广使用。

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肺上皮样血管内皮瘤(pulmonary epithelioid hemangioendothelioma, PEH)是一种发生于肺部的罕见血管源性肿瘤。1975年，Dail和Liebow首次报道，1982年由Weiss和Enzinger首次描述并正式命名［1-2］。目前，世界报道PEH病例仅120例［3］。本院1例以“双肺弥漫性粟粒状病变查因”入院患者，入院后误诊为肺结核，后经病理活检最终确诊为PEH。现就该患者临床资料进行分析，以提高临床对该疾病的认识。

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葡萄球菌性烫伤样皮肤综合征（staphylococcal scalded skin syndrome，SSSS）是由凝固酶阳性，嗜菌体Ⅱ组71型金黄色葡萄球菌产生的表皮剥脱毒素(exfoliative toxin, ET)所致。本病多发生于6岁以下的儿童，尤其是刚出生的婴幼儿，成人较少见, 可能与成人肾脏代谢和排泄毒素能力较强有关，伴有免疫缺陷及肾衰等疾病的成人也较易发生本病［1］。SSSS按临床表现可分为局限型和泛发型。