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ObjectiveTo determine antimicrobial activity of 80% ethanol extracts of 20 kinds of heatclearing and toxicityremoving Chinese herbal medicines(CHM) against Staphylococcus aureus(SA) and methicillinresistant Staphylococcus aureus (MRSA),so as to screen medicines with strong bacterial inhibition.MethodsEthanol extracts of 20 kinds of CHM were prepared, in vitro antimicrobial activity against SA and MRSA (MRSA 82, MRSA 92, MRSA 111,MRSA 135,and MRSA 144) were determined by agardiffusion method, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined by doubledilution method.ResultsThe extraction rate of ethanol extracts of 20 kinds of CHM ranged 5.33%-15.89%, Flos Carthami had the highest extraction rate(15.89%),followed by Solanum nigrum (12.64%), Cuscuta chinensis Lam had the lowest extraction rate (5.33%), 16 kinds of ethanol extracts showed different inhibitory effect on SA and MRSA, 4 kinds of extracts had high antimicrobial activity (inhibition zone diameter ［IZD］≥16 mm, including Mahonia bealei［Fort.］,Prunella vulgaris,Herba moslae, and Geranium wilfordii Maxim), 9 extracts had moderate antimicrobal activity (IZD［>10 mm，<16 mm］, including Herba Verbenae,Potentilla discolor,Oxanlis corniculata L.,Solidago decurrens Lour,Viola philippica Car,Herba artemisiae Scopariae,Plantago asiaticaL&Plantago depressa Willd, Lysima chiachristinae Hance, and Leucas ciliata Benth), 3 extracts had low antimicrobial activity (IZD ≤10mm, including Pulsatilla chinensis ［Bunge］ Regel,Campsis grandiflora, and Allium tuberosum Rottler). IZD of most extracts for MRSA were larger than that of standard strain. MIC and MBC of 13 kinds of extracts with better antimicrobial activity against standard and drugresistant strains were 64-1 024 μg/mL and 128-2 048 μg/mL respectively.ConclusionEthanol extracts of Mahonia bealei(Fort.), Prunella vulgaris, Herba moslae, and Geranium wilfordii Maxim have strong antimicrobial activity against MRSA.

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ObjectiveTo evaluate the changes and significance of T lymphocyte subsets and cytokines in peripheral blood of patients with drugsensitive and multidrugresistant pulmonary tuberculosis（MDR pulmonary TB）.MethodsFrom July 2011 to July 2012, T lymphocyte subsets (CD3+,CD4+,and CD8+T)and cytokines(IFNγ and IL10) were detected in patients with drugsensitive pulmonary TB (DS group, 20 cases),MDR pulmonary TB (MDR group, 15 cases) and healthy physical examination persons (control group,26 cases) in a hospital, data of three groups were compared.ResultsNo significant differences were found in percentages of CD3+,CD4+,and CD8+T among three groups(P>0.05);there were significant differences in absolute counts of CD3+,CD4+,and CD8+T among three groups（P＜0.01）,and the difference between every two groups was also significant (P<0.05), which was highest in control group(CD3+［1 426±485］/μL;CD4+［825±306］/μL;CD8+T［516±213］/μL）and lowest in MDR group（CD3+ ［746±358］/μL；CD4+ ［461±204］/μL；CD8+T ［213±101］/μL）. There were significant differences in IFNγ value among three groups（P＜0.01）, and the difference between every two groups was also significant (P<0.05), which was highest in control group (［65.04±36.31］pg/mL) and lowest in MDR group(［23.32±14.04］pg/mL). No significant differences were found in IL10 among three groups（P＞0.05）.ConclusionThe absolute counts of T lymphocyte subsets CD3+,CD4+,and CD8+T as well as IFNγ declined in drugsensitive pulmonary TB patients and MDR pulmonary TB patients, which may accelerate the progress of TB and be one of the causes of MDR pulmonary TB.

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ObjectiveTo develop a novel oral delivery system for interleukin12 (IL12) using genetically engineered Bifidobacterium longum(B. longum) as the carrier and further evaluate the efficacy of IL12expressed B. longum on the coxsackievirus B3 (CVB3)induced myocarditis in mice.MethodsA mIL12 gene expression vector pBBADsIL12 for B. longum was constructed and transformed into Bifidobacterium, the expression of mIL12 in the engineered B. longum was identified in vitro by Western Blot and enzymelinked immunosorbent assay (ELISA) after Larabinose induction. BLAB/c mice were inoculated i.p. with infectious dose of CVB3 for fourteen days and were divided randomly into three groups. The IL12 group and green fluorescent protein group (GFP group) were orally administered with pBBADsIL12 and pBBADsGFP transformed B. longum for fourteen days respectively after the inoculation of the virus； saline group was administered i.p. with sterile PBS. All animals were killed in day 14 of treatment, and the murine hearts were dissected aseptically for hematoxylineosin (HE) staining, viral titer and RNA extraction for Th1 cell cytokines quantification.ResultsAfter 14 days of treatment, HE staining revealed that the severity of virusinduced myocarditis in IL12 group was reduced compared with that of GFP group and saline group; the percentage of cardiac pathological lesions and CVB3 titers in IL12 group was （18±5）% and (2.89±0.10)pfu/g respectively,which was significantly lower than that of GFP group (［31±6］%, ［4.83±0.14］pfu/g) and saline group (［32±9］%, ［4.80±0.15］pfu/g), respectively (all P<0.01); levels of interferonγ(IFNγ) and tumor necrosis factorα(TNFα) in cardiac tissue and supernatants of IL12 group was（2.27±0.15）pg/mL and （3.05±0.17）pg/mL, respectively, which was significantly higher than that of GFP group (［1.32±0.11］pg/mL,［2.37±0.16］pg/mL) and saline group (［1.38±0.11］pg/mL, ［2.37±0.12］pg/mL）, respectively (all P<0.01).ConclusionA novel oral delivery system of Bifidobacterium for murine IL12 has been successfully established. Oral administration of mIL12transformed B. longum may play a therapeutic role in the treatment of CVB3induced myocarditis in the mice.

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ObjectiveTo evaluate the relationship between consumption of imipenem and imipenem resistance in Klebsiella pneumoniae (K. pneumoniae)．MethodsImipenem resistance in K.pneumoniae isolated from all patients in a hospital from 2008 to 2012 were analyzed, the amount of imipenem consumption during the same period was also calculated, and the correlation was analyzed.ResultsThe clinical isolates of K.pneumoniae from 2008 to 2012 were 174,187,363,290, and 625 respectively, which accounting for 6.88%，7.86%，10.01%，8.07% and 11.05% of all pathogens（χ2=16.516，P＜0.001）. Resistant rate of K. pneumoniae to imipenem from 2008—2012 was 0.00%,0.00%,4.13%,10.34%, and 25.44% respectively, CochranArmitage trend test revealed a significant difference among them(Z=12.563，P＜0.001）,namely imipenem resistance in K.pneumoniae increased year by year; annual consumption of imipenem from 2008 -2012 were 1.24, 1.60, 2.14, 2.78, and 3.71 daily defined doses/1000 patient day, there was a increased tendency in imipenem resistance; imipenem consumption had positive correlation with imipenem resistance in K. pneumoniae（R=0.966，P=0.007）.ConclusionResistance rate of K. pneumoniae to imipenem increased year by year from 2008 to 2012,which is related to the consumption of imipenem, it is important to monitor the antimicrobial resistance in K. pneumoniae and use imipenem and other carbapenems rationally.

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ObjectiveTo investigate genotypes of extendedspectrum βlactamases（ESBLs） produced by Escherichia coli （E. coli） and Klebsiella pneumoniae (K. pneumoniae) isolated from a hospital.MethodsClinical isolates of ESBLsproducing E. coli (n=40) and K. pneumoniae (n=20) were collected according to ESBLs confirmatory test. Plasmid DNA was extracted by alkaline lysis method. PCR analysis was used to amplify TEM, SHV, and CTXM genes, sequence analysis was performed to identify βlactamase genotype.ResultsSixty confirmatory test positive E.coli and K.pneumoniae were positive for PCR amplification, including TEM,SHV, CTXM3 and CTXM9. The positive rate of above four genotypes among E.coli was 37.50%（15 isolates）,2.50%（1 isolate）,62.50%（25 isolates） and 50.00%（20 isolates）respectively; the positive rate of above four genotypes among K.pneumoniae was 40.00%（8 isolates）,90.00%（18 isolates）,65.00%（13 isolates） and 40.00%（8 isolates）respectively. 100.00% of E.coli and 80.00% of K.pneumoniae expressed blaCTXM, 12.50% (5/40) of E.coli and 25.00%(5/20)of K.pneumoniae carried two types of CTXM gene. Twentythree isolates with TEM gene were TEM1;nineteen isolates with SHV gene included 6 isolates of genotype SHV1, 6 of SHV11, 5 of SHV12 and 2 of SHV25，only SHV12 was ESBLs gene,all these types were from K.pneumoniae; 66 isolates were with CTXM gene, the detection rate of CTXM14 among E.coli and K. pneumoniae was 45.00% and 35.00% respectively, CTXM55 were both 35.00%，CTXM15 was 20.00% and 15.00% respectively，CTXM3, CTXM65, CTXM101 and CTXM123 genotypes accounted for fewer percentage of CTXM genotype.ConclusionThe majority of ESBL gene in E. coli and K.pneumoniae in this hospital is CTXM, the next is SHV12. The most prevalent ESBL genotype is CTXM14. CTXM101 and CTXM123 are initially detected in Shandong province.

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ObjectiveTo analyze vancomycin minimum inhibitory concentration (MIC) in methicillinresistant Staphylococcus aureus (MRSA) isolated from different clinical specimens.MethodsFrom 2010 to 2012, MRSA were identified and vancomycin MIC in MRSA was determined by VITEK 2 COMPACT; vancomycin MIC values were analyzed.ResultsA total of 1 434 isolates of Staphylococcus aureus were detected, including 857 sputum specimens, 239 blood specimens,and 338 other specimens; MRSA isolation rate of all specimens was 41.12% (169/411), 44.96% (214/476) and 48.08% (263/547) respectively. MRSA isolation rate of blood specimens was 29.03%,30.86% and 30.21% respectively, and sputum was 46.89%,51.03% and 57.10% respectively; MRSA isolation rate of sputum was higher than that of blood specimens (χ2= 6.41, 10.36, 21.43 respectively, all P<0.05). All strains were sensitive to vancomycin. The percentage of vancomycin MIC≥1.00 μg/mL in MRSA from blood specimens was 38.89%（7 isolates）,40.00%（10 isolates）and 37.93%（11 isolates）in 2010-2012 respectively(χ2=0.02，P=0.999）,and from sputum specimens was 36.28%（41 isolates）, 40.94%（61 isolates） and 49.73% （92 isolates）respectively（χ2=5.72，P=0.057）.ConclusionThe detection rate of MRSA clinical isolates has shown an increased trend from 2010 to 2012. Detection rate of MRSA from sputum was higher than that of blood specimens; detection rate and vancomycin MIC value of MRSA from sputum specimens increased a little; detection rate and vancomycin MIC value of blood specimens didn’t change obviously.

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ObjectiveTo evaluate the risk factors of healthcareassociated infection(HAI) in thoracic tumor surgery patients.MethodsClinical data of 796 thoracic tumor patients in a hospital from December 2008 to November 2012 were analyzed retrospectively.ResultsOf 796 patients, 156 developed 167 times of HAI,HAI rate was 19.60%, case infection rate was 20.98%;the most common infection site was lower respiratory tract（59.28%，99/167），followed by upper respiratory tract (15.57%，26/167）,surgical incision （10.18%，17/167）and urinary tract （5.39%，9/167）. Univariate analysis revealed that patients≥ 60 years of age, smoking, length of hospital stay ≥15 days, duration of surgery≥3 hours, tracheal catheter indwelling≥5 hours, complicated underlying diseases (diabetes,chronic bronchitis, pulmonary dysfunction,et al), preoperative radiotherapy and chemotherapy, central or peripheral venous catheterization, and use of immunosuppressive agents were risk factors for HAI in thoracic tumor surgery patients (all P<0.05). ConclusionIncidence of HAI in thoracic tumor surgery patients is high, effective preventive measures should be taken to control and reduce the occurrence of HAI.

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ObjectiveTo realize the current situation and risk factors of healthcareassociated infection(HAI) in a hospital, so as to provide a scientific basis for improving management of HAI.MethodsA crosssectional survey on HAI prevalence was conducted by combination of bedside examination and medical record review, all hospitalized patients from 00∶00 to 24∶00 on May 10, 2012 were included in the survey.ResultsA total of 2 700 patients should be surveyed, 2 684 of whom (99.41%) were actually surveyed. 67 patients developed 74 times of HAI, HAI prevalence rate and case rate was 2.50% and 2.76% respectively; 171 patients developed 182 times of communityacquired infection (CAI),CAI prevalence rate and case rate was 6.37% and 6.78% respectively. The stem cell transplantation ward had the highest HAI prevalence (25.00%, 2/8), followed by hematology department(7.77%,8/103) and the department of plastic surgery (6.82%,3/44); lower respiratory tract was the main site of HAI (41.90%), followed by urinary system (10.81%) and surgical incision (9.46%). Antimicrobial usage rate was 32.94%(884/2 684), 76.24% of which were for prophylactic use, 3.28% for both prophylactic and therapeutic use, and 20.48% for therapeutic use;the usage rate of single,combination of 2,3 or more antimicrobial agents accounted for 86.65%,12.78%, and 0.57% respectively. Multivariate regression analysis revealed that risk factors of HAI were tracheotomy, indwelling urinary catheterization, peripherally inserted central catheterization, drainage, and enteral nutrition.ConclusionPrevalence survey of HAI helps to know the occurrence of HAI; hospital should strengthen the management of key departments,avoid unnecessary invasive operation, standardize the use of antimicrobial agents, and reduce the incidence of HAI.

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ObjectiveTo evaluate the efficacy of plandocheckact (PDCA) cycle management in standardizing antimicrobial application in type Ⅰincision operation.MethodsPatients with type Ⅰincision operation between January and June 2011 were selected as prePDCA group; according to three cycles of PDCA, all patients with type Ⅰincision operation between July 2011 and December 2012 were divided into three groups. According to plan，do，check and act procedure of PDCA cycle， antimicrobial use in typeⅠincision were managed and controlled, case control study on the rationality of antimicrobial use before and after the implementation of PDCA were performed.ResultsAntimicrobial use in type Ⅰincision operation decreased from 100.00%(101/101) before implementing PDCA to 36.09%(61/169) after implementing  three cycles of PDCA, the difference was significant(χ2=135.66,P＜0.001）；antimicrobial rational usage increased from 62.38%（63/101） to 81.97%（50/61），the difference was significant (χ2=8.29,P=0.04).Before implementing PDCA, 51.49%(52/101) of patients used antimicrobial agents >3 days; after implementing three cycles of PDCA, 7.69% of patients used antimicrobial agents >3 days,postoperative antimicrobial use was more rational than before, there was no combination use of antimicrobial agents.ConclusionPDCA cycle is obviously effective in standardization the rational use of antimicrobial agents in type Ⅰincision operation.

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ObjectiveTo investigate the effect of dental dust collector on controlling air pollution in sandblasting room.MethodsBacterial sedimentation method and dust sampler monitoring method were adopted to monitor the air in a dental sandblasting room.The experimental group used dental dust collector to intervene during cleaning, control group was not taken intervention, the air colony forming unit and dust density before,during and after treatment were compared.ResultsBefore treatment, there were no significant differences in air bacterial count and dust density between two groups (［273.30±85.30］ CFU/m3 vs［265.30±90.30］CFU/m3,P＞0.05; ［0.47±0.03］ mg/m3 vs ［0.45±0.04］ mg/m3, P＞0.05)；during and after treatment, air bacterial count in experimental group were (512.60±99.30) CFU/m3 and （350.70±62.40）CFU/m3 respectively, dust density were (0.61±0.23) mg/m3 and (0.52±0.16) mg/m3 respectively, which were significantly lower than that of control group respectively(［918.90±135.20］CFU/m3,［488.50±85.20］CFU/m3,［3.26±0.35］mg/m3,［1.65±0.21］mg/m3)（P＜0.01 or P＜0.05）.ConclusionDental sandblasting cause air pollution seriously, dental dust collector can effectively remove pollutants， control the sources of pollution, and maintain the cleanliness of the air in dental clinic.

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ObjectiveTo evaluate the value of serum procalcitonin (PCT) in diagnosis of infectious diseases in children at an outpatient department.MethodsSerum PCT value of 166 children with fever (98 in bacterial infection group, 68 in nonbacterial infection group) and 60 healthy children (control group) were detected by semiquantitative solid phase immunoassay， and blood routine test and Creactive protein (CRP) were also detected simultaneously, results of three groups were compared.ResultsIn bacterial infection group, the positive rates of PCT,CRP,white blood cell (WBC)count, and percentage of neutrophils were 92.86%（98 cases）,88.78%（87 cases）,86.73%（85 cases）,and 81.63%（80 cases） respectively, which were significantly higher than those of nonbacterial infection group(10.29%［7 cases］,27.94%［19 cases］,25.00%［17 cases］, 26.47%［18 cases］)and control group(6.67%［4 cases］,5.00%［3 cases］,8.33%［5cases］, 11.67%［7cases］) respectively (P＜0.01). Sensitivity (92.86%), specificity (89.71%) and Youden’s index (82.56) of serum PCT detection of bacterial infection group were all higher than those of CRP（88.78%,72.06%,60.84 respectively）and WBC（86.73%,75.00% and 42.30 respectively） and percentage of neutrophil (81.63%,73.53% and 55.15 respectively）.ConclusionPCT can be used as an indicator of the rapid diagnosis of early bacterial infection in children, and is with better sensitivity and specificity than the other inflammatory markers.

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ObjectiveTo investigate the perioperative antimicrobial prophylaxis in patients with hip replacement before and after implementing clinical pathway (CP), so as to provide rational and effective clinical management path.MethodsPerioperative antimicrobial prophylaxis in 120 patients with hip replacement in a hospital between January 2008 and December 2011 was surveyed retrospectively. Sixty patients without implementing CP between January 2008 and December 2009 were as preintervention group, and 60 patients with CP between January 2010 and December 2011 were as postintervention group.ResultsThe rate of antimicrobial used 0.5-2 hours before operation and duration of postantimcrobial prophylaxis≤5 days in postintervention group was significantly higher than that of preintervention group respectively (78.33%［47/60］ vs 31.67%［19/60］,P＜0.05；91.67% ［55/60］ vs 5.00%［3/60］，P＜0.05）; The top three used antimicrobial agents in preintervention group were cefoperazone/sulbactam, cefpiramide, and ceftazidime, which were replaced by cefazolin, cefuroxime, and clindamycin in postintervention group; the average duration of antimicrobial use, average length of hospital stay and daily expense of antimicrobial agents decreased from (13.25±1.69) days, (17.55±1.60) days,and(193.22±34.70) yuan in preintervention group to (4.12±0.87) days, (7.83±1.36) days，and (54.03±9.98) yuan in postintervention group respectively, the difference between two groups was statistically significant（all P＜0.01). ConclusionThe implementation of CP can standardize preventive perioperative antimicrobial use in hip replacement patients, shorten the length of hospital stay,and reduce antimicrobial expense.

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ObjectiveTo investigate the prevalence rate of healthcareassociated infection (HAI) in a hospital, so as to provide reference for making HAI control measures.MethodsThe crosssectional survey on HAI was carried out among all hospitalized patients at 0∶00—24∶00 on June 1,2010, June 20,2011 and April 16, 2012, respectively, surveyed data were analyzed.ResultsThe prevalence rate in 2010—2012 was 3.41%, 2.32% and 1.73% respectively（χ2=4.65,P＞0.05）; Univariate analysis revealed that risk factors for HAI were gender, age, urinary tract intubation, arteriovenous intubation, tracheotomy, the use of ventilator, and surgery;the top infection site was lower respiratory tract (59.65%), followed by urinary tract (15.79%), surgical site infection(10.53%), and gastrointestinal tract (8.77%); Antimicrobial use rate in three surveys was 57.95%, 43.17% and 40.23% respectively（χ2=54.25，P＜0.01）. A total of 26 pathogenic strains were isolated, Pseudomonas aeruginosa,Acinetobacter baumannii,Stenotrophomonas maltophilia were 11(42.31%)， 6（23.08%），3（11.54%) isolates respectively,Escherichia coli, Staphylococcus aureus and fungi were 2（7.69%） each. ConclusionPrevalence rate of HAI showed decreasing trend, proper measures should be taken, intervention in susceptible sites and management on antimicrobial use should be strengthened.

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ObjectiveTo investigate the characteristics of distribution and drug resistance of Streptococcus pneumoniae(S. pneumoniae) in a large teaching hospital, and provide the basis for the rational use of antimicrobial agents in the clinic.Methods192 clinical isolates of S. pneumoniae from Xiangya Hospital between November 2010 and November 2012 were identified by Vitek2 system. Susceptibility of these isolates to 14 kinds of commonly used antimicrobial agents were determined by KirbyBauer method, the minimum inhibitory concentration (MIC) of S.pneumoniae to penicillin was determined by agar dilution method.ResultsS.pneumoniae were mainly from pediatric department(36.98%), sputum was main specimen (64.07%); patients’ age showed bimodal distribution, mainly <5 and >50 years old. The resistance rates of S. pneumoniae to erythromycin, chloramphenicol, tetracycline, and clindamycin were all >80%. MIC range of penicillin to all S.pneumoniae was 0.015- ≥ 32.0 μg/mL, MIC50 and MIC90 was 2.0 μg/mL and 16.0 μg/mL respectively. The resistance rates of noninvasive S. pneumoniae was higher than invasive one.ConclusionAntimicrobial resistance of S. pneumoniae in this hospital is serious, the emergence of penicillinresistant S. pneumoniae should be paid attention during clinical treatment.

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ObjectiveTo investigate the distribution and antimicrobial resistance of infection caused by clinically isolated Enterobacteriaceae from a hospital．MethodsData about Enterobacteriaceae isolated from January 2005 to June 2012 was analyzed statistically．Results A total of 5 538 isolates of Enterobacteriaceae were isolated, the top three specimen sources were urine（35.63%，1 973 isolates），respiratory tract（32.38%，1 793 isolates），wound secretion, drainage and pus（10.88%，603 isolates）； the top five isolated pathogens were Escherichia coli （49.41%，2 736 isolates）, Klebsiella pneumoniae （25.30%，1 401 isolates）, Enterobacter cloacae（6.37%，353 isolates）, Proteus mirabilis（4.24%，235 isolates） and Salmonella spp. （4.17%，231 isolates）. The resistant rates of most Enterobacteriaceae to imipenem and meropenem were ＜2%; amikacin and piperacillin/tazobactam were with high activity against Enterobacteriaceae, the resistant rate was ＜10%. Resistance rate of Escherichia coli from sputum specimens was significantly higher than those from blood and urine specimens（both P＜0.05）.ConclusionEnterobacteriaceae in this hospital are mainly isolated from urine and respiratory tract, and with varied degree of resistance to different antimicrobial agents, carbapenems remains high activity against Enterobacteriaceae，attention should be paid to the emergence of carbapenemresistanct strains．

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ObjectiveTo investigate the biotypes of Haemophilus parainfluenzae(H.parainfluenzae) isolated from adults with respiratory tract infection in a hospital and relationship of H.parainfluenzae with producing of βlactamase and antimicrobial resistance.Methods1 994 sputum specimens from adult patients with respiratory tract infection from October 2011 to July 2012 were taken for Haemophilus isolation and culture, the isolated H.parainfluenzae were identified, performed biotyping, βlactamase detection and antimicrobial susceptibility testing.ResultsA total of 102 isolates （5.12%） of Haemophilus were isolated, 68(66.67%) of which were H.parainfluenzae, 20（19.61%） were Haemophilus influenzae，and 14（13.72%）were other types of Haemophilus.Six biotypes(ⅠⅥ)were detected among H.parainfluenzae, type Ⅰ, Ⅱ, Ⅲ, Ⅳ，Ⅴ,Ⅵ were 42,4,2,2, 14, and 4 isolates,respectively. There were 54(79.41%) βlactamaseproducing isolates. H.parainfluenzae had higher resistance to ampicillin(83.82%), levofloxacin(60.29%), tetracycline(57.35%), and sulfamethoxazole /trimethoprim (70.59%). The resistant rates to cefotaxime，ampicillin/sulbactam, cefaclor,clarithromycin, and rifampicin was 8.82%,13.24%,5.89%,20.58% and 25.00%,respectively; There were no strains resistant to imipenem and chloramphenicol. There were some differences in antimicrobial resistance among various biotypes.ConclusionH.parainfluenzae is a common pathogen in adults with respiratory tract infection in this hospital,the major epidemic biotypes are type Ⅰand V,most isolates produce βlactamase, detection of biotypes and antimicrobial resistance of H.parainfluenzae should be paid attention.

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目的普及乡镇卫生院专（兼)职医院感染管理人员的医院感染管理基本知识。方法某市级医院感染管理质量控制中心对该市28所乡镇卫生院的医院感染管理现状进行调查，根据调查结果制订培训计划；各乡镇卫生院指定1名专（兼）职医院感染管理人员参加培训学习，采用考试形式对培训效果进行评价。结果该市28所乡镇卫生院医院感染管理现状调查结果显示， 21所（75.00%）无医院感染管理的基本组织架构和专（兼）职管理人员； 22所(78.57%)连续2年未进行过任何与医院感染相关的知识培训；21所（75.00%)未建立医院感染管理制度；12所(42.86%)无健全的消毒隔离、手卫生、职业防护等基本的医院感染管理制度。252所乡镇卫生院，应参加培训的医院感染管理专（兼）职人员252人，实际参加培训250人，参培率达99.21%。培训前回收测试试卷215份，培训后回收测试试卷226份；培训后，考试成绩由（39.38±20.91）分提高至（74.56±13.30）分（t=1.97，P＜0.05）；对比培训前后各项考试内容，差异均有统计学意义（均P＜0.05）。结论通过此次市级医院感染管理质量控制中心培训，达到了普及乡镇卫生院医院感染管理基本知识的目的。

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目的比较两种干手方法对手部细菌菌落数的影响，为临床医务人员选择正确的洗手后干手方法提供依据，避免手部的二次污染。方法某院104名临床医务人员按六步洗手法洗手后，采用两种不同的干手方法：同一人左手使用一次性干手纸巾(A组)、右手使用烘干机(B组)干手。由专人分别采样检测，比较两种干手方法的手部细菌菌落数。结果A、B两组各采样104份，其中A组菌落计数为（2.92±2.83）CFU/cm2，B组为（3.71±3.11）CFU/cm2，两组比较，差异无统计学意义（t=1.92，P＞0.05）；A、B两组合格率分别为96.15%（100/104）和92.31%（96/104），差异无统计学意义（χ2=1.41，P＞0.05）。结论使用一次性干手纸巾和烘干机两种方法干手效果均安全可靠，均可用于临床工作。

Abstract:

目的比较浓氯化钠溶液换药与庆大霉素溶液换药，治疗骨科手术切口感染的效果。方法将某院骨科2011年1月—2012年6月间46例手术切口感染患者随机分为观察组(用5%氯化钠溶液换药)和对照组［用庆大霉素(8万U/mL)溶液换药］，各23例,比较两组患者创面愈合情况。结果观察组的换药次数为（17.39±9.39）次，显著低于对照组的（34.13±20.13）次；切口愈合时间（11.04±4.04）d，显著短于对照组的（17.26±10.26）d，差异均有统计学意义（均P＜0.01）。观察组治愈8例，显效11例，好转4例，无效0例；对照组治愈3例，显效4例，好转11例，无效5例,采用Ridit分析，结果显示观察组疗效优于对照组。结论对于骨科手术切口感染患者，使用浓氯化钠溶液换药治疗，疗效较佳，优于庆大霉素溶液。

Abstract:

目的了解某院免费提供手卫生用品和增加手卫生投入，对医务人员手卫生依从性及环境和医务人员手卫生微生物学监测合格率的影响。方法将该院7个病区作为试点科室免费配置手卫生用品，血液科一病区为对照组（不予免费配置手卫生用品），比较试点科室和对照组科室的医生、护士、进修生和实习生的手卫生依从性，以及环境和医务人员手卫生微生物学监测合格率。结果实施手卫生活动后（7月份），试点科室手卫生依从率为93.21%（2 170/2 328），与活动前（4月份）的49.78%（569/1 143）比较，差异有统计学意义（χ2=868.952，P＜0.001）。7月份，各试点科室物体表面和医务人员手卫生微生物监测整体合格率分别为92.73%(153/165)、99.40%(167/168)，较4月份的70.81%(114/161)、72.19%(109/151)显著提高（χ2值分别为26.414、50.519,均P＜0.001）。作为对照组的血液科一病区，活动前后医务人员手卫生依从性、环境及医务人员手卫生微生物学检测合格率差异均无统计学意义（P＞0.05）。结论医院免费提供手卫生用品，增加手卫生投入，可提高医务人员手卫生依从性及手卫生合格率。

Abstract:

目的探讨保湿与否对使用后不同时段清洗手术器械清洗效果的影响。方法将使用后的2 000件手术器械立即回收，随机分为A、B、C、D 4组，每组500件。其中A组：未保湿，2 h内清洗；B组：将器械置于稀释的多酶清洗液中浸泡保湿，2 h内清洗；C组：未保湿，12 h后清洗；D组：将器械置于稀释的多酶清洗液中浸泡保湿，12 h后清洗。所有器械置于加有1∶200碱性含酶清洗剂中浸泡5 min后清洗，由同一台全自动清洗消毒机按照日常使用程序清洗，比较各组合格率。结果 A组（未保湿）与B组（保湿）清洗合格率比较，目测法（98.80% vs 99.20%）和试纸测试法（98.40% vs 99.00%）差异均无统计学意义（χ2值分别为0.404、0.701,均P＞0.05）；C组（未保湿）与D组（保湿）清洗合格率比较，目测法（87.20% vs 99.00%）和试纸测试法（84.40% vs 98.60%）差异均有统计学意义（χ2值分别为54.188、64.815，均P＜0.01）。结论 使用后2 h内清洗的手术器械，不保湿与保湿保存，均能达到清洁标准；而对于使用后超过12 h清洗的器械，需要先经保湿处理再按正常清洗程序清洗，才能达到清洁标准。

Abstract:

目的了解某中医医院医院感染基本情况，为采取有效防控措施提供依据。方法由医院感染管理专职人员采用查阅电子病历信息和床旁调查相结合的方法，对该院2012年10月17日0∶00—24∶00所有住院患者进行医院感染现患率调查，填写个案调查表。结果应查人数2 028例，实查2 028例，实查率100%。发现医院感染38例，医院感染现患率为1.87%。医院感染部位以呼吸道居首位，占65.79%，其中下呼吸道感染占60.53%。抗菌药物使用率为31.85%，病原学送检率为18.96%。结论通过医院感染现患率调查，及时发现医院感染管理中存在的问题，强化对医院感染高危科室的督查和指导，规范抗菌药物合理使用，提高病原学送检率，有效减少医院感染发生。

Abstract:

导尿管相关性泌尿道感染（catheterassociated urinary tract infection，CAUTI）是常见的医院感染类型，可导致高发病率和死亡率。每年有超过100万患者发生泌尿道感染，占所有医院和疗养院感染的40%，其中80%是医院感染［1-3］。其发病率高，治疗费用也很高。在美国，每年平均有4.24～4.51亿美元用于治疗此类感染［4］。导尿管相关性菌血症每例治疗费用大约2 900美元［1］。Kunin等［5］对1 540所疗养院的调查结果显示，留置导尿管的患者在住院期间发生泌尿道感染的危险性是未留置导尿管患者的3倍。留置导尿管时间＜1周的患者可避免感染，但对于留置导尿管数月甚至数年的老年人或伤残患者，感染是不可避免的。近年来，国内外学者在感染相关因素等方面进行了大量研究，现总结如下.