• Volume 12,Issue 1,2013 Table of Contents
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    • Article
    • Multilocus sequence analysis on polymerase chain reaction map and antimicrobial resistance of isolates with new staphylococcal cassette chromosome mec

      2013, 12(1):5-11. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo study the multilocus sequence characteristics of polymerase chain reaction (PCR) map of 3 isolates of methicillinresistant Staphylococcus aureus (MRSA) which carried a new staphylococcal cassette chromosome mec(SCCmec) .MethodsIn the previous PCR typing study on 58 MRSA isolates, 3 (5.17%) were found to carry a new SCCmec multilocus sequence containing 5 bands, which were band A,F,H, B and M. The above amplified products were sequenced, and then compared with the sequences of SCCmec type saved in the international GenBank and the Basic Local Alignment and Search Tool (BLAST).ResultsThe homology between the detected sequence and the known sequence was over 97%.ConclusionIt’s a new PCR pattern of multilocus sequence of SCCmec type, and maybe the recombinant of conventional SCCmec type I,II and III, which is not only a different PCR pattern, but also has multilocus mutation.

    • Analysis on homology of Staphylococcus aureus carried by  a mother and her newborn

      2013, 12(1):12-15. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo study the homology of Staphylococcus aureus (S.aureus) isolated from  a mother and her newborn,and to explore the possibility of transmission of S.aureus infection between mother and newborn.MethodsThree S.aureus isolates  from the umbilical secretion of a newborn with omphalitis and from the breast milk of the newborn’s healthy mother were performed  antimicrobial susceptibility testing,homology of S. aureus was analyzed through antimicrobial susceptibility testing phenotyping and  pulsedfield gel electrophoresis (PFGE) genotyping.ResultsThree S.aureus isolates from the mother and newborn had the same antimicrobial susceptibility pattern and PFGE type.ConclusionS.aureus isolated from the mother and newborn were identical strains,suggesting a possibility of S.aureus transmission between mother and newborn.

    • Feasibility of platestreaking method in monitoring total bacteria counts in dental unit waterlines

      2013, 12(1):16-18. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo study the feasibility of platestreaking method in monitoring total bacteria counts in dental unit waterlines (DUWLs).Methods50 water samples from DUWLs were taken and cultured by platestreaking method and pouredplate method, colony counts of two cultured methods was compared.ResultsThe difference in colony counts of DUWLs between pouredplate method and platestreaking method was not significant(T=315.50,P>0.05); the qualified rate of water was 58.00% and 52.00% respectively, there was no statistical difference in the qualified rate of water detected between two methods (χ2=0.57,P>0.05).ConclusionThe total colony counts detected by platestreaking method and pouredplate method is not different, platestreaking method is easy to be performed, it can instead pouredplate method to monitor the colony counts in DUWLs.

    • Survey on sharps injuries among health care workers at 39 hospitals of Guangdong province

      2013, 12(1):19-23. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate occupational exposure to blood among health care workers (HCWs) in Guangdong province, and provide scientific basis for developing preventive measures.MethodsA crosssectional survey on sharps injuries among HCWs at 39 hospitals in Guangdong province in June 2011 was conducted through questionnaires.ResultsA total of 32 617 questionnaires were distributed, and 32 297 (99.02%) were responded; and 32 007(99.10%) questionnaires were available for analysis. 1 460 HCWs had suffered 1 909 times of sharps injuries, and the incidence was 4.56% , the injury episode rate was 5.96%; the average number of injury per month was 0.06/person. 1 495 (4.67%,1 495/32 007) injury episodes were caused by contaminated sharps; contaminated sharps injuries accounted for 78.31%(1 495/1 909) of total sharps injuries, and 61.67%(922/1 495) of which could trace to the exposure sources, while 38.33%(573/1 495) couldn’t determine the infectivity. Among bloodcontaminated devices, 81.71%(67/82) were hepatitis B exposure, 14.63% (12/82) were syphilis exposure; 3.66%(3/82) were hepatitis C exposure, there was no HIV exposure. The locations where sharps injuries occurred mostly were general wards (47.72%) and operating rooms (20.27%); the procedures involved in high injury rates were dispensing(15.92%) , medical waste disposal (12.78%), and syringe needle removal(12.21%); the main medical devices that caused sharps injuries were disposable syringe needles(35.99%), scaple needles(19.43%) and suturing needles(13.41%). HCWs’ training rate of knowledge about bloodborne occupational exposure was 93.25%.ConclusionSharps injury is the main professional factor that cause bloodborne diseases. In order to reduce the risk of injuries caused by occupational exposures, medical institutions should establish corresponding organization and rules, and HCWs should standardize preventive and control behavior towards occupational exposures.

    • Value of sputum smear gram staining in the early diagnosis and treatment of hospitalacquired pneumonia in intensive care unit patients

      2013, 12(1):24-26. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo evaluate the significance of sputum smear gram staining in the early diagnosis and guidance for antimicrobial treatment of hospitalacquired pneumonia (HAP) in intensive care unit patients.MethodsFrom March 2011 to February 2012, sputum samples taken from lower respiratory tract of 289 patients with  suspected HAP were performed gram staining and culture, the isolated pathogens were identified, results of two methods were compared.ResultsA total of 890 sputum specimens were sent for detection , 790(88.76%)  specimens were qualified. A total of 520(65.82%) pathogenic strains were isolated , 330 isolates were gramnegative bacteria, 130 were grampositive bacteria, and 60 were fungi. The concordance between the results of two methods was 72.15%(570/790), there was no significant difference between two methods(χ2=1.818,P=0.2000). The sensitivity and specificity of sputum smear gram staining was 80.77% (420/520)and 55.56% (150/270)respectively, the positive predictive value and negative predictive value was 77.78% (420/540)and 60.00% (150/250)respectively.ConclusionGram staining of the qualified sputum samples of lower respiratory tract is helpful in early diagnosis and treatment of HAP.

    • Risk factors for secondary pulmonary fungal infection in elderly patients with chronic obstructive pulmonary disease

      2013, 12(1):27-30. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo evaluate the risk factors for secondary pulmonary fungal infection in patients with chronic obstructive pulmonary disease (COPD).MethodsClinical data of 52 cases of secondary pulmonary fungal infection associated with COPD were analyzed retrospectively through casecontrol study , 52 cases of COPD patients without secondary pulmonary fungal infection were randomly selected as control, and risk factors were analyzed.ResultsFungi which isolated from 52 infected patients included Candida albicans(40 cases, 76.92%), Candida glabrata(3 cases, 5.77%), Candida tropicalis(7 cases, 13.46%), Mucor(1 case, 1.92%), and Aspergillus(1 case, 1.92%) . Univariate analysis showed that the factors associated with secondary pulmonary fungal infection included duration of broadspectrum antimicrobial use>14 d, cumulative amount of systemic glucocorticoid use >500 mg, hypoalbuminemia, typeⅡrespiratory failure, mechanical ventilation and diabetes mellitus. Multivariate Logistic regression analysis showed that cumulative amount of systemic glucocorticoid use >500 mg, duration of broadspectrum antimicrobial use >14 d, mechanical ventilation and typeⅡrespiratory failure were high risk factors for secondary pulmonary fungal infection in patients with COPD.ConclusionThe knowledge of the risk factors for secondary pulmonary fungal infection associated with COPD can promote to take proper preventive measures, and reduce the occurrence of deep fungal infection .

    • Vascular catheterrelated bloodstream infection outbreak due to the contamination of heparin sodium sealing solution by Burkholderia cepacia

      2013, 12(1):31-33. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the causes of an outbreak of Burkholderia cepacia(B. cepacia) vascular catheterrelated bloodstream infection(CRBSI) in an oncology department, and provide the basis for the prevention and control of healthcareassociated infection.MethodsEpidemiological investigation was performed by combination of clinical data analysis and onsite sampling .ResultsThe occurrence time of 11 B. cepacia CRBSI cases concentrated on February 18(1 case), 19 (1 case), 20 (6 cases), 21 (1 case), and 22 (2 cases) of 2008, respectively ; all patients were intubated in the femoral vein, isolated B. cepacia from blood cultures ,and used the same bag of heparin sodium sealing solution. Bacterial culture results of heparin sodium sealing solution , disposable syringes, and environmental samples were all qualified, only 1 tube of used heparin sodium sealing solution (all patients shared this tube) isolated B. cepacia, antimicrobial susceptibility test result was the same as B. cepacia from patients’ blood culture result. Measures were taken promptly, the deep venous catheters were removed, and antiinfective therapy was adopted ,none of the patient isolated bacteria from blood cultures 7 days later, and no identical case emerged again. ConclusionContamination of heparin sodium sealing solution by B. cepacia is the cause of this CRBSI ,through active treatment , infection is controlled.

    • Crosssectional survey on infection and antimicrobial application in patients in a hospital

      2013, 12(1):34-37. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the point prevalence of healthcareassociated infection(HAI) and communityassociated infection (CAI) in patients in a hospital, so as to provide basis for the prevention and control of HAI.MethodsBy combination of bedside survey and medical record reviewing, all patients who were hospitalized between 0:00 and 24:00 o’clock of September 26, 2011were investigated.Results1 331 patients should be surveyed, 1 309 (98.35%) were actually surveyed. 237 patients were infected,57 (4.35%) of whom developed 60 episodes(4.58%) of HAI ; 181 (13.83%) of whom developed 183 episodes (13.98%) of CAI; 1 patient developed both HAI and CAI. The top three infection sites of HAI were lower respiratory tract(48.33%), organ space (16.67%) and urinary tract (8.33%). CAI were common in the following three departments : department of respiration medicine(84.44%), pediatric department(71.43%) and intensive care unit(50.00%);the main infection sites of CAI were lower respiratory tract(45.36%) and skin and soft tissue(15.30%). A total of 65 pathogenic strains were isolated, 33 of which were HAI isolates and 32 were CAI isolates; Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae altogether accounted for 72.73%(24/33) of HAI and 78.13%(25/32)of CAI .The daily antimicrobial usage rate was 27.43%(359 cases), 52.92% of which were for prophylactic use, 43.45% for therapeutic use, and 3.62% for both prophylactic and therapeutic use; 88.02% of antimicrobial application were single dose, and 11.98% were the combination of two agents. Pathogen detection rate was 61.54%(104/169).ConclusionSurvey of point prevalence of infection is helpful to the realizing of the current state of HAI and CAI and application of antimicrobial agents, and is beneficial to the target surveillance of infection.

    • Risk factors for lower respiratory tract infection in patients in an intensive care unit

      2013, 12(1):38-40. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the risk factors for hospitalacquired lower respiratory tract infection(LRTI)in an intensive care unit (ICU) , so as to provide reference for making effective measures for controlling healthcareassociated infection(HAI).MethodsA retrospective analysis was conducted on medical records of 1 062 ICU patients who were admitted in ICU from December 2008 to December 2010, patients’ hopitalization time was >48 hours, ages were ≥18 years old, 68 patients who were confirmed LRTI was as case group; by 1:2 matched cases of same gender, same age group, and same admission time, 136 patients without HAI was as control group, risk factors for LRTI were analysed.ResultsUnivariate analysis showed that length of stay in ICU≥15 days , incision of trachea, endotracheal intubation/mechanical ventilation,use of antimicrobial agents >2 types and duration >2 weeks, aerosol inhalation were risk factors of LRTI in ICU patients; Multivariate Logistic regression analysis on 9 screened risk factors showed that length of stay in ICU ≥15 days (OR 95% CI, 1.153-4.912), incision of trachea (OR 95% CI, 1.836-9.967), endotracheal intubation/mechanical ventilation (OR 95% CI,1.163-5.774), use of antimicrobial agents >2 types and duration >2 weeks (OR 95% CI,1.016-5.813) were independent risk factors for LRTI.ConclusionMultiple factors contribute to the occurrence of LRTI in ICU patients,comprehensive preventive treatment based on the risk factors is helpful for reducing HAI.

    • Epidemiological investigation on an outbreak of 4 cases of measles in a pediatric ward

      2013, 12(1):41-43. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the causes of an outbreak of measles in a pediatric ward of a hospital , and provide scientific measures for the control of healthcareassociated infection.MethodsMedical data of 4 cases of measles in a pediatric ward from December 6-30,2008 were analyzed retrospectively.ResultsMeasles virus antibody IgM in 4 children were all positive, one child initially developed measles , all the other 3 children had history of contacting with the first case, the duration of measles was shorter than the average latent period of measles (about 2 weeks).ConclusionMeasles virus is the cause of this outbreak, infection outbreak can be reduced by establishing the early warning mechanism, adopting strict isolation measures, strengthening hand hygiene of healthcare workers, emphasizing disinfection of surface and environment ,and reducing patient care attendants and visitors.

    • Clinical study and  effectiveness evaluation on ethanol immersion disinfection of transparent PVC endotracheal tube

      2013, 12(1):44-46. DOI: 10.3969/j.issn.1671-9638.2013.

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      To evaluate the disinfectant efficacy of  ethanol on transparent PVC endotracheal tube , as well as  the best replacement time. MethodsPhase I: 58 patients with transparent PVC endotracheal tube  between April and  July 2011 were  selected , the concentration and bacterial count of ethanol used for immersion disinfection of transparent PVC endotracheal tube were detected at different time point (upon opening of the new ethanol and 12, 24, 48 and 72 h after opening ), ethanol was used continuously for 72 h . Phase II: 46 patients with transparent PVC endotracheal tube between July and  November 2011 were  selected and divided into experimental group (new process: immersion tank and ethanol were changed every 48 h) and control group (former process: immersion tank and ethanol were changed every 24 h), the frequency of change, manpower, cost and incidence of infection within one month between two groups were compared .ResultsThe difference between ethanol upon opening and 12, 24 as well 48 h after opening  were not statistically significant (all P>0.05);72 h after opening, ethanol concentration was significantly lower than the newly opened ([71.82±0.77]%vs [72.98±0.83]%,t=17.60,P<0.05). Disinfection efficacy of ethanol at different time points all met the required standards. Cost of experimental group was significantly lower than the control group (CNY[56.70±9.30] vs CNY[178.20±4.70]),  and manpower was also significantly lower than the control group ([37.20±5.80] persontime/month vs [120.30±6.70] persontime/month,all P<0.05); Incidence of infection was not statistically significant between two groups(13.04% vs 17.39%,t=0.17,P>0.05). ConclusionEthanol immersion disinfection is a effective, low cost, easy operation and safe disinfection method, ethanol can be used continuously for 48 hours before changed  if ethanol tank is sealed well and with low opening frequency.

    • A retrospective analysis on healthcareassociated infection in patients after extracorporeal circulation operations

      2013, 12(1):47-49. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the occurrence and  epidemiological characteristics of healthcareassociated infection (HAI) in patients with extracorporeal circulation operations.MethodsClinical data of 731 patients with extracorporeal circulation operations in a hospital from September 2010 to December 2011 were studied retrospectively.ResultsOf 731 patients ,  87 developed 103 episodes of HAI, HAI rate and episode rate was  11.90% and 14.09% respectively . HAI  rate in patients with  congenital heart disease, rheumatic heart disease and other cardiovascular disease was 9.74%, 10.69%, and 31.82% respectively(χ2=27.54,P<0.05) .  The most common infection site was lower respiratory tract (72.82%), followed by blood stream  (14.56%), urinary system (7.77%), pleural cavity (1.94%), gastrointestinal tract (1.94%), and  surgical sites (0.97%).   The pathogenic examination rate was 35.57%(260/731) ,  112 pathogenic strains were isolated , 89 (79.46%) of which were gramnegative bacteria ,18 (16.07%) were  grampositive bacteria  and 5 (4.46%) were fungi .There were 28 isolates of  multidrugresistant Acinetobacter baumannii, 3 methicillinresistant Staphylococcus aureus and 7 methicillinresistant coagulase negative Staphylococcus, all Klebsiella pneumonia and Escherichia coli isolates were βlactamaseproducing strains.ConclusionHAI rate in patients with  extracorporeal circulation operations are high, drug resistance of pathogen is high, monitor should  be intensified to reduce the occurrence  of HAI.

    • Comparison of the effectiveness of different disinfectants on blood donors  before donation

      2013, 12(1):50-51. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo compare disinfectant efficacy of different disinfectants on the skin of blood donors before donation.MethodsFrom May 2008 to April 2011, 240 volunteer blood donors were divided into 3 groups according to the different skin disinfectants used : iodine tincture and alcohol group, iodophor group, and Anerdian group, there were 80 donors in each group. Samples were taken respectively  before and after skin was disinfected , and disinfectant efficacy as well as disinfectant drying time were  compared.ResultsThe total number of bacteria on the skin was not significantly different among three groups before and after disinfection respectively (all P>0.05), after disinfection, bacteria number on the skin of iodine tincture and alcohol group, iodophor group, and Anerdian group were  (0.74±0.36)CFU/cm2  ,(0.82±0.38)CFU/cm2 and (0.65±0.31)CFU/cm2  respectively;the qualified  rates of disinfection were all 100%; disinfectant drying time of three group  were (76.23±5.31)seconds, (104.64±6.82)seconds and(20.41±3.53)seconds,  respectively(F=5.703,P<0.05), Anerdian group was  remarkably shorter  than  the other two groups.ConclusionAnerdian disinfectant is suitable for skin disinfection of blood donors before donation,disinfectant efficacy is ideal and disinfectant drying time is short.

    • Efficacy of management on perioperative  antimicrobial prophylaxis   in type I incision operations

      2013, 12(1):52-53. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the perioperative prophylactic use of antimicrobial  agents in type I incision operations in a hospital, and evaluate the rationality and intervention efficacy of antimicrobial application.Methods A retrospective study was conducted, data of patients with  type I incision operations between December 1, 2011 and February 29, 2012 (postintervention group) were analyzed and compared with that in April 2011(preintervention group).ResultsAfter intervention, a total of  612 cases of  type I incision operations were  surveyed, 112 (18.30%) patients  received antimicrobial agents within  30 minutes prior to incision; 101(90.18% ) patients used prophylactic antimicrobial  agents ≤ 24 hours; 9 kinds of antimicrobial  agents were used, 5 of which were the first and second generation cephalosporins; 3 patients with gynecological  operations  used two agents combined, the other patients all received single agent.  No incision infection occurred among  612 patients. Compared with preintervention group, antimicrobial use in postintervention group was more rational. ConclusionPerioperative  antimicrobial prophylaxis   in type I incision operation in this hospital is rational, and  basically meets the requirement of the Ministry of Health,  but  it still needs improvement to make sure the standard application of antimicrobial  agents in type I incision operation.

    • Distribution and antimicrobial resistance of major clinical pathogens isolated from 2008 to 2010

      2013, 12(1):54-58. DOI: 10.3969/j.issn.1671-9638.2013.

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      ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from patients in a hospital ,and provide basis for rational use of antimicrobial agents.MethodsData about bacterial strains isolated from inpatients and outpatients in a hospital from January 2008 to December 2010 were collected , distribution and antimicrobial resistance of pathogens were analyzed .ResultsA total of 7 008 bacterial strains were isolated, 3 961(56.52%) isolates were gramnegative bacteria , 1 582 (22.57%) were grampositive bacteria, and 1 465(20.91%) were fungi; the top three pathogens were Candida albicans (1 015 isolates, 15.00%) ,Pseudomonas aeruginosa(906 isolates, 12.93%),Escherichia coli(874 isolates, 12.47%). Methicillinresistant Staphylococcus aureus (MRSA) accounted for 85.07%(678/797) of all Staphylococcus aureus, methicillinresistant coagulasenegative Staphylococcus (MRCNS) accounted for 73.17%(150/205) of all CNS; the isolation rate of extendedspectrum βlactamase (ESBLS)producing Escherichia coli and Klebsiella pneumoniae was 64.19%(561/874) and 46.31%(301/650) respectively. Staphylococcus aureus isolates were sensitive to vancomycin and teicoplanin, the resistant rate to sulfamethoxazole/trimethoprim was 68.42%-74.51%, the resistant rate to the other agents were all <30%; isolates of CNS were sensitive to vancomycin and teicoplanin; Escherichia coli and Klebsiella pneumoniae had highest sensitive rate to imipenem and meropenem (95.52%-100.00%), the resistant rate of Escherichia coli to cefotaxime, ceftriaxone,cefoperazone , ciprofloxacin, and levofloxacin were all <30%. Pseudomonas aeruginosa had relative higher resistant rate to ceftazidime (60.31%-85.83%) and meropenem (59.38%-73.23%).ConclusionAntimicrobial resistance of major pathogens isolated from patients in this hospital were generally high . It should pay more attention to the monitoring of multidrug resistant strains, antimicrobial agents should be used rationally.

    • Effect of medical students’ general classroom training about knowledge of healthcareassociated infection

      2013, 12(1):59-61. DOI: 10.3969/j.issn.1671-9638.2013.

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      目的了解医学实习生进入临床之前医院感染知识的掌握情况,研究常规课堂培训对其知识掌握程度的影响。方法设计医院感染知识问卷,以客观题为主。将实习生随机单盲分为组A和组B。采用常规课堂教学方式对实习生进行医院感染知识培训,对组A(培训之前)和组B(培训之后)实习生进行医院感染知识测试。结果组A共纳入83人,组B共纳入80人,两组成员专业构成比较,差异无统计学意义(χ2=2.226,P>0.05)。组A对医院感染定义、标准预防概念、锐器伤之后的处置程序等知识掌握较差,知晓率为5.66%~43.33%;组B临床医学实习生上述3项知识点的知晓率分别为86.84%、36.84%、60.53%,检验、影像、麻醉及其他专业实习生上述3项知识点的知晓率分别为90.49%、33.33%、50.00%,均显著高于组A(均P<0.05)。结论医院感染定义、标准预防概念、锐器伤之后的处置程序等医院感染知识是实习生培训中的重点和难点。培训中应强化医院感染知识的重点和难点,采取更多授课方式针对各专业进行教学。

    • Efficacy of integrated interventions on improving hand hygiene compliance

      2013, 12(1):62-63. DOI: 10.3969/j.issn.1671-9638.2013.

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      目的探讨通过实施全方位综合干预措施,对增强医务人员手卫生意识和提高手卫生执行率的效果。方法分别于2009年9月和2010年9月对某院进行两次手卫生问卷调查。根据第1次调查结果,针对性采取全方位综合干预措施,对比分析采取手卫生综合干预措施后(第2次调查)手卫生的依从性。结果经过全方位综合干预后,医务人员参加手卫生知识培训率,由2009年的78.87%提高至2010年的94.83%(χ2=41.65,P<0.01);2010年医务人员工作一天洗手4~9次及遵循六步洗手法者所占比率分别为93.30%、76.80%,显著高于2009年的43.36%、44.35%(χ2分别为272.21、80.31,均P<0.01)。2010年手卫生专项检查分数和微生物监测合格率分别为(96.79±3.56)分、95.29%,较2009年的(92.49±4.72)分和69.57%显著提高(分别t=6.65,χ2=16.67;均P<0.01)。结论全方位强化手卫生措施使全院医务人员手卫生知识、手卫生执行率均明显提高。

    • Bacterial carriage of commonly used medical instruments during the process of application in an intensive care unit

      2013, 12(1):64-65. DOI: 10.3969/j.issn.1671-9638.2013.

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      目的了解某院重症监护室(ICU)日常使用的医疗器具病原菌携带情况,为制定相应对策提供依据。方法对该院ICU患者使用中的医疗器具进行采样,培养分离并鉴定细菌。结果选择使用中医疗器具11种,共采集标本300份,其中217份阳性,阳性率为72.33%。使用48 h病原菌检出率,以留置导尿管最高,为89.47%;其次为氧气湿化瓶,达89.29%。部分使用中的医疗器具分离出复数菌株。共分离病原菌242株,其中革兰阴性菌184株(76.03%),革兰阳性菌41株(16.94%),假丝酵母菌7株(2.89%),毛霉菌10株(4.13%)。结论该院ICU使用中的医疗器具病原菌携带较严重。应加强清洁消毒和医护人员对医院感染控制知识的学习;强化无菌观念及手卫生,定期、及时地对空气、环境消毒,防止其与医疗器具交叉污染,有效降低医院感染发生率。

    • Distribution and antimicrobial resistance of pathogens from patients with hospitalacquired pneumonia in an intensive  care unit

      2013, 12(1):66-67. DOI: 10.3969/j.issn.1671-9638.2013.

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      目的了解某基层医院重症监护室(ICU)住院患者医院获得性肺炎病原菌分布及耐药性。方法对该ICU 2008年5月—2011年5月收治的确诊发生医院获得性肺炎的156例患者病历资料进行回顾性分析。结果156例医院获得性肺炎患者共分离病原菌184株,其中革兰阴性(G-)菌108株(58.70%),革兰阳性(G+)菌60株(32.61%),真菌16株(8.70%)。G-菌中,铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌为主要致病菌;G+菌中,金黄色葡萄球菌为主要致病菌;真菌中,白假丝酵母菌为主要致病菌。主要G-菌对氨苄西林耐药率达85%以上,对头孢曲松的耐药率也达47.92%~75.00% ;主要G+菌普遍对青霉素耐药,且耐药率达68.75%~97.22%,但均对万古霉素敏感;主要真菌对氟康唑耐药率达50%以上。结论该基层医院ICU医院获得性肺炎病原菌以G-菌为主,耐药性较严重,提示应加强监测;患者进入ICU后,经验性治疗尽量控制在72 h内,之后根据微生物培养和药敏结果,给予患者更有效的治疗。

    • Application of antimicrobial agents in 276 urology outpatients

      2013, 12(1):68-69. DOI: 10.3969/j.issn.1671-9638.2013.

      Abstract (939) HTML (0) PDF 693.00 Byte (1342) Comment (0) Favorites

      Abstract:

      目的了解某院泌尿外科门诊患者抗菌药物使用情况。方法随机选择该院2011年3月份3天泌尿外科门诊患者276例,对其病历进行回顾性调查。结果276例泌尿外科门诊患者抗菌药物使用率为85.51%(236/276),其中静脉输液给药226例,占95.76%。联合用药占87.29%,其中二联用药194例,三联用药12例;二联用药以奥硝唑+甲磺酸帕珠沙星(55.15%)和奥硝唑+左氧氟沙星(21.65%)为主。奥硝唑和甲磺酸帕珠沙星应用频率最高,分别占43.17%和25.99%。泌尿外科门诊抗菌药物使用构成比居前2位的疾病为前列腺炎(48.31%)和术后包皮畸形(22.03%);其次为包皮过长、包皮环切术后、包茎、早泄、龟头软疣非细菌感染疾病用药,合计40例,占16.95%;尿道炎、龟头炎及泌尿系感染用药占12.71%。结论该院泌尿外科门诊存在抗菌药物使用不合理现象,需强化规范抗菌药物的使用。

    • Survey on sharps injuries among health care workers in a basic level hospital

      2013, 12(1):70-71. DOI: 10.3969/j.issn.1671-9638.2013.

      Abstract (973) HTML (0) PDF 701.00 Byte (1525) Comment (0) Favorites

      Abstract:

      目的了解某院不同科室医务人员锐器伤发生现状,为制定预防措施提供依据。方法2011年7月,对该院重症监护室(ICU)、急诊科、外科、内科、手术室、供应室工作满4年的340名医务人员进行回顾性问卷调查。结果共发放问卷340份,收回有效问卷332份,有效率97.65%。医务人员锐器伤发生率为38.25%(127/332),其中医生为30.00%(30/100),护士为41.81%(97/232),护士锐器伤发生率显著高于医生(χ2=4.13,P<0.05)。不同科室医务人员锐器伤发生率不同,差异有统计学意义(χ2=49.29,P<0.01),其中急诊科医务人员锐器伤发生率最高(73.08%)。结论医务人员发生锐器刺伤的概率较高,应强化职业安全防范意识,规范操作行为,最大限度地减少职业伤害,实现暴露后零感染目标。

    • Effect and management strategy of logistics service in healthcareassociated  infection control

      2013, 12(1):72-73. DOI: 10.3969/j.issn.1671-9638.2013.

      Abstract (1010) HTML (0) PDF 680.00 Byte (1375) Comment (0) Favorites

      Abstract:

      目的 规范后勤管理,使后勤工作在预防医院感染中发挥重要作用。方法通过培训、严格区域划分,规范后勤工作流程及制度。结果通过对后勤工作人员进行培训及监督检查,使后勤各项工作均能按标准执行,在预防医院感染的发生中起到重要作用。结论规范后勤工作流程,将各项规章制度落到实处,切实落实医院感染管理,有助于降低医院感染的发生。

    • Conducting inservice education on hand hygiene and enhancing health care workers’ hand hygiene awareness

      2013, 12(1):74-75. DOI: 10.3969/j.issn.1671-9638.2013.

      Abstract (902) HTML (0) PDF 731.00 Byte (1440) Comment (0) Favorites

      Abstract:

      目的开展手卫生在职教育活动,强化医务人员手卫生意识,进一步规范医务人员手卫生的执行。方法对某院2011年12月在岗的工作人员开展以“预防院感,从手开始”为主题的在职教育活动。活动形式包括现场承诺签名,门诊、住院大厅设置宣传画展板,院内局域网上传学习手卫生知识及技能培训,洗手明星理论与操作竞赛。结果此次在职教育活动参加总人数达622人,包括医生、护士、药剂、检验、行政后勤人员等。评选出五星、四星、三星洗手明星科室(分别为1、2、3个)和个人(分别为5、10、15人),其中洗手为五星的明星科室是耳鼻咽喉科,5位五星的明星个人分别来自妇产科、烧伤泌尿外科、耳鼻咽喉科、骨科、功能科室。结论通过开展手卫生在职教育活动,使全院各级各类人员正确理解了手卫生规范要求,改变了错误的手卫生观念,营造出良好的手卫生氛围,使手卫生受到全员重视。

    • Nephrotic syndrome associated with acute miliary tuberculosis of lung: a case report

      2013, 12(1):76-77. DOI: 10.3969/j.issn.1671-9638.2013.

      Abstract (989) HTML (0) PDF 769.00 Byte (1431) Comment (0) Favorites

      Abstract:

      我国结核病感染人数和死亡人数均较多,疗效欠佳。结核病感染耐药率高达46%,被世界卫生组织(WHO)列入特别引起警示的国家和地区之一[1]。急性粟粒型肺结核,病情重,来势凶猛,难以救治,病死率高。本文报道1例应用肾上腺皮质激素(以下简称激素)治疗肾病综合征患者合并感染急性粟粒型肺结核,经治疗无效死亡的病例,以期引起临床关注。

    • Study  progress  of  surgical  instruments  cleaning  methods

      2013, 12(1):78-80. DOI: 10.3969/j.issn.1671-9638.2013.

      Abstract (990) HTML (0) PDF 745.00 Byte (1619) Comment (0) Favorites

      Abstract:

      医疗器械使用后,应进行彻底地清洁处理,去除附着在上面的血液、黏液和体液等有机物,这是预防和控制医院感染,保证医疗安全的重要环节。器械清洁方法正确与否,清洗质量合格与否,清洗后的维护和保养及如何通过物理和化学方法将器械上的有机物、无机物和微生物清除到安全的水平,对保证灭菌效果和控制交叉感染具有重要的作用[1]。在所有环节中,器械清洗是基础和前提,如果清洁不彻底,医疗器械上残留的有机物会在微生物的表面形成一层保护层,妨碍消毒灭菌因子与微生物接触或延迟其作用,影响消毒灭菌效果。因此,器械清洗质量是否合格尤为重要。

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