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ObjectiveTo investigate the expression and resistant gene of integron in  multidrugresistant  Acinetobacter baumannii (MDRAb).Methods51 strains of MDRAb isolated from a hospital in AugustOctober  2012   were collected, antimicrobial susceptibility testing was performed. Class I(Int I)， II (Int II) and III (Int III) of integrase genes and integron variable region gene cassettes were detected by polymerase chain reaction (PCR)， and the homology of integron variable region was analyzed by detection results of  restriction fragment length polymorphism (RFLP)  and  DNA sequencing.ResultsPositive rate of integrase gene in MDRAb was 78.43%（40/51）. All genes belonged to Int I, while Int Ⅱ and Int Ⅲ were not found. Variable region cassettes were detected in 97.50% (n=39) of Int I， there were 5 types of integron gene cassettes: aacA4 in 14 strains， aacA4+catB8 in 22 strains，arr3+aacA4 in 1 strain， dfrA15 in 1 strain and  arr3 in 1 strain.ConclusionMDRAb isolated from this hospital may be related with Int I expression. Int I carried gene cassettes as follows: aacA4， aacA4+catB8， arr3+aacA4， dfrA15 and arr3.

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ObjectiveTo analyze strains of Proteus mirabilis (P.mirabilis) and Proteus vulgaris (P. vulgaris) isolated in a hospital, detect resistance to commonly used antimicrobial agents,and provide reference for rational application of antimicrobial agents in clinic. Methods172 P.mirabilis isolates and 68 P. vulgaris isolates isolated between January 1, 2011 and June 30,2013 were analyzed,  antimicrobial  resistance susceptibility testing were performed by disk diffusion method,  data were analyzed with WHONET 5.4 software. ResultsP. mirabilis strains were mainly isolated from wound secretion（26.74%）,sputum（22.68%）and urine（18.61%）, P. vulgaris were mainly from wound secretion（48.53%）,urine（17.65%）and sputum（11.77%）. The resistance rates of P. mirabilis to ampicillin and trimethoprim/sulfamethoxazole were both>45.00%； the resistance rates of P. vulgaris to cefazolin and trimethoprim/sulfamethoxazole was 86.76% and 41.18% respectively；the resistance rates of P.mirabilis and  P. vulgaris to piperacillin/tazobactam, cefotaxime，ceftazidime, cefepime, carbapenems (ertapenem and meropenem) and amikacin were all <20.00%. ConclusionThe resistance rates of P.mirabilis and  P. vulgaris  to piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, ertapenem, meropenem and amikacin are all high, and can be used as the empirical medication for the treatment of related infection.

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ObjectiveTo investigate colonization of multidrugresistant organisms (MDROs) in neonatal intensive care unit (NICU) newborns on admission. MethodsFrom April to November 2013, 293 newborns who admitted to  NICU of a hospital were screened for methicillinresistant Staphylococcus aureus (MRSA) by nasal and throat swabs and for extendedspectrum βlactamases  (ESBLs) bacteria and vancomycinresistant Enterococcus (VRE) by anal swabs.ResultsOf 293 newborns, 61 were detected MDROs (20.82%).The positive rate of MDROs screening  in newborns aged ＜3 days(5.92%) was lower than those aged ＜3-6 days（37.74%） and  7-28 days (43.66%）,the difference was significant (P=0.000). The major colonized MDROs were ESBLsproducing bacteria（83.60%）, the major colonized site was anus(88.52%). ConclusionNeonatal anus and stool are important sources of MDROs in  NICU; more attention should be paid to colonization screening for MDROs by anal swabs in newborns aged ＞3 days, and appropriate isolation measures should be taken for positive screening patients to prevent the transmission of MDROs.

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ObjectiveTo investigate whether ultrasonic coupling agent (UCA) can produce shielding or antagonistic effect on iodine disinfectant for preoperative skin disinfection. MethodsShielding or antagonistic effect of UCA on iodine disinfectant were detected by laboratory carrier immersion killing test and onthespot skin disinfection test. ResultsAntagonistic effect: after the mixing of iodophor with UCA, the average killing rate of iodophor containing available iodine 2 500mg/L and 625 mg/L to Staphylococcus aureus decreased from 100.00% to 99.67%-99.78% and 96.85%-98.25%, respectively; the average killing rate to Escherichia coli decreased from 100.00% to 99.71%-99.82% and 95.93%-98.56%, respectively. Shielding effect: after smearing with UCA, the average killing rate of iodophor and iodine tincture +alcohol to Escherichia coli decreased from 100.00% to 30.76% and 100.00% to 94.48%, respectively; the average killing rate to Staphylococcus aureus decreased from 99.99% to 55.55% and 100.00% to 98.22%, respectively. Onthespot skin disinfection test: the killing rate of iodophor and iodine tincture +alcohol to natural bacteria on skin surface were both 99.99%, after skin  was smeared with UCA, the killing rate decreased to 92.62% and 93.57%, respectively. ConclusionUCA remained on the operative field has shielding and antagonistic effect on iodine disinfectant

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ObjectiveTo realize the contamination status of dental unit waterlines (DUWL) in general hospitals,  and provide scientific evidence for  making preventive measures. MethodsThree hospitals were selected for study, water source adopted by hospital A,B and C was running water, reservoir water, and filtered water through reverse osmosis filtration system respectively, specimens of dental handpiece spray water and flushing water of dental chair units were collected quarterly, total bacterial colony in water were detected.  ResultsThe qualified rate of source water, handpiece spray water, and flushing water  in hospital  A was 75.00%（3/4）, 0 (0/40)  and 0 (0/40) respectively,  colony count of handpiece spray water and flushing water was （1.20×103-5.53×104 ）CFU/mL（M=3.80×104 CFU/mL） and （2.11×104-1.66×105）CFU/mL（M=4.80×104 CFU/mL）respectively.The qualified rate of source water, handpiece spray water, and flushing water in hospital B  was 50.00%(2/4), 60.00%（24/40）and 72.50%(29/40) respectively, colony count of handpiece spray water and flushing water was  （0.00-3.71×106）CFU/mL（M=83.00 CFU/mL） and （0.00-2.39×106 ）CFU/mL（M=72.00 CFU/mL）respectively.The qualified rate of source water, handpiece spray water, and flushing water in hospital C  was 100.00%(4/4), 55.00%（22/40）and 65.00%（26/40）respectively, colony count of handpiece spray water and flushing water was （0.00-6.20×103） CFU/mL（M=96.00 CFU/mL） and（0.00-1.63×103 ）CFU/mL（M=87.50 CFU/mL）respectively. ConclusionWater of DUWL in general hospitals is seriously contaminated， disinfection and standardized management of source water and DUWL must be strengthened.

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ObjectiveTo compare  the cleaning efficacy  of  surgical  instruments  by solid  detergent  and Liguid multienzymatic  detergent,  and conduct costeffectiveness analysis, so as to provide new cleaning technique for central sterile supply department(CSSD). MethodsFour washerdisinfectors in CSSD were randomly divided into experimental and control group, experimental group adopted new solid detergent for cleaning surgical instruments, control group used liquid enzymatic detergent. Cleaning  efficacy of two groups were  evaluated by visual observation(naked syesight and 10×magnifier with light）, ATP bioluminescence assay and residual protein test.Cleaning cost and medical waste generated by different detergents during the same period were analyzed statistically. ResultsQualified rate of cleaning observed by naked syesight was 97.70% （4 678/4 788）in experimental group  and 92.01%（5 075/5 516） in control group; qualified rate of cleaning observed by 10×magnifier with light was 94.30%（2 546/2 700）  in experimental group and 88.72%（2 453/2 765） in control group ; qualified rate in experimental group  were both higher than in control group （P=0.000）.ATP bioluminescence assay showed that qualified rate of cleaning of experimental group  and control group was 84.41%（996/ 1 180）and 86.83%（1 042/1 200）respectively，there was no statistical difference between two groups（P=0.092）. Residual protein test positive of experimental group and control group was 3.71%（26/700）and 16.31%（106/650））respectively,  experimental group  was lower than  control group （P=0.000）. Cleaning cost of experimental group  was 2/3 of  control group; medical waste produced in experimental group (plastic film) and control group (empty barrel) was 0.40kg  and 12.30kg respectively. ConclusionSolid detergent cleaning can efficiently eliminate the protein soil on surgical instruments, reduce cleaning cost and production of medical waste, it is a novel technology applied to surgical instrument cleaning.

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ObjectiveTo evaluate the influence of the placement of instant hand disinfectant in compliance and qualified rate of hand hygiene of clinicians. MethodsHand hygiene compliance of clinicians in departments of gynecology, obstetrics, and general surgery were observed after the placement of instant hand disinfectant at the doorway of wards, hand specimens were taken to check hand hygiene effectiveness. ResultsBefore and after placement of instant hand disinfectant at the doorway of wards of above departments, hand hygiene behaviors of 300 persontimes were observed. Hand hygiene compliance rate among clinicians in department of gynecology, obstetrics, and general surgery increased from 32.33% to 74.33%, 33.67% to 85.67%, and  26.33% to 64.00%，respectively（all P＜0. 001）. Each department selected 98 hand hygiene specimens, the qualified rate was 98.98%,100.00% and 94.90% respectively.  ConclusionThe placement of instant hand disinfectant at the doorway of each ward can effectively improve clinicians’ hand hygiene compliance and hand hygiene effectiveness.

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ObjectiveTo realize the risk factors for postoperative healthcareassociated infection (HAI) in patients undergoing oral and maxillofacial malignant tumor surgery, so as to take effective intervention measures and reduce the occurrence of HAI. MethodsProspective and retrospective survey were adopted to analyze the occurrence of HAI and related risk factors for postoperative HAI in patients undergoing oral and maxillofacial malignant tumor surgery in 2013. ResultsOf 432 patients, 58 developed 63 times of HAI, HAI rate was 13.43%，case infection rate was 14.58%. The main infection sites were lower respiratory tract (57.14%) and surgical site (38.09%).56 pathogenic strains were isolated, the major were Pseudomonas aeruginosa (46.43%), followed by Acinetobacter baumannii and Klebsiella pneumonia. Univariate analysis revealed that tracheotomy, length of hospital stay, operative time, intraoperative antimicrobial use were risk factors for HAI in patients undergoing oral and maxillofacial malignant tumor surgery(all P<0.05).ConclusionThe important measures for reducing HAI in patients undergoing oral and maxillofacial malignant tumor surgery are shortening the duration of surgery and length of hospital stay, taking active intervention, implementing hand hygiene, and using antimicrobial agents rationally.

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ObjectiveTo evaluate diagnostic value and clinical significance of procalcitonin (PCT)  in infection in intensive care unit (ICU) patients. Methods96 ICU patients in a hospital between September 2011 and March 2012 were selected for study, levels of patients’ PCT, highsensitivity Creactive protein (HsCRP)  and white blood cell (WBC) count were detected, statistical analysis were conducted. ResultsCompared with nonbacteria infected patients, serum PCT and HsCRP levels in all bacteria infected patients increased, the difference were significant (Z=-6.102;-3.918，both P＜0.05 ); WBC count was not significantly different（Z=0.212.P＞0.05）.PCT sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing infection was 82.35%，67.86%，86.15%，and 61.29% respectively; receiver operating characteristic (ROC) curve of PCT, HsCRP, and WBC was 0.898, 0.755, and 0.581 respectively. ConclusionThere are higher sensitivity and specificity of PCT to predict infection, which is helpful for early detection of infection in critically ill patients.

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ObjectiveTo investigate antimicrobial resistance and change trends of Ureaplasma urealyticum (Uu) from reproductive system of female patients at a traditional Chinese medicine hospital in three consecutive years. MethodsAntimicrobial resistance of Uu isolated from gynaecology leucorrhea and cervical secretion specimens of patients of dermatology &  sexually transmitted diseases department and gynaecology department from January 2011 to December 2013 were analyzed retrospectively. ResultsA total of 327 Uu strains were isolated, except resistance rates of Uu to doxycycline（5.23%-6.12%） and  josamycin（0-1.96%） remained at a relatively low level in three consecutive years,  resistance rate  to the other  antimicrobials showed an upward trend year by year,but the difference was not significant (P＞0.05）.The resistance of Uu to ofloxacin, clarithromycin and sparfloxacin were relatively high（42.11%-61.40%）, to josamycin, doxycycline and minocycline were lower（0-13.07%）, and multidrug resistance was serious. ConclusionAntimicrobial resistanc of Uu isolated from reproductive system of female patients in this hospital is high. It is necessary to realize the status and change trends of antimicrobial resistance of Uu for the treatment of disease and control of the emergence of multidrug resistance pathogens.

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ObjectiveTo analyze antimicrobial use in the different grades of hospitals within 3 years after the carrying out of rectification activities of antimicrobial use, and provide basis for making continuous improvement program of antimicrobial management. MethodsRetrospective analysis was performed, outpatient and emergency prescriptions and medical records of discharged patients (100 were type Ⅰ incision surgery) were selected from 5 tertiary hospitals and 5 secondary hospitals within 3 months, antimicrobial use and management were investigated. Results200 outpatient prescriptions, 100 emergency prescriptions, and 200 medical records of discharged patients were selected from each hospital. In tertiary and secondary hospitals, antimicrobial usage rate in outpatient prescriptions was 17.40% and 18.00% respectively,  emergency prescriptions was 31.60% and 40.10% respectively; among inpatients,antimicrobial usage density（AUD）was (28.13±8.04) and (49.67±11.63) respectively, and antimicrobial usage rate was 41.30% and 56.20% respectively; pathogenic detection rate of antimicrobial therapeutic cases was 45.70% and 22.70% respectively, therapeutic cases with limit level of antimicrobials was 61.50% and 27.40% respectively; antimicrobial usage rate in type I incision surgery was 20.00% and  40.40% respectively；The rational rate of antimicrobial types was 94.60% and  59.20% respectively, rational rate of opportunity of antimicrobial use was 95.20% and 48.20% respectively；combination rate was 8.80% and 36.60% respectively, and rational rate of treatment course was 84.00% and 52.80% respectively. ConclusionIn tertiary hospitals, antimicrobial use after 3 years rectification of antimicrobial use conform to the antimicrobial management requirement of Ministry of Health, the overall quality index is better than secondary hospitals, management of antimicrobial in secondary hospitals use should be improved.

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ObjectiveTo investigate the basic status of healthcareassociated infection(HAI) in a hospital, and  provide evidence for strengthening HAI management. MethodsA crosssectional study was conducted to investigate the prevalence rates of HAI in all hospitalized patients at 0∶00-24∶00 of May 7,2014. ResultsA total of 2 262 patients were supposed to be investigated, while 2 253 (99.60%) patients were actually investigated, 586 of whom (26.01%) came from pulmonary hospital(specialized in tuberculosis) affiliated to the general hospital.  53 patients developed 58 times of HAI, prevalence rate and case prevalence rate was 2.35%  and  2.57% respectively; 1 073 patients developed 1 265 times of communityacquired infection (CAI), prevalence rate and case prevalence rate was 47.63% and 56.15% respectively. Rates of HAI and CAI were high in intensive care unit（ICU, 21.28%） and pulmonary hospital（99.49%） respectively； the main infection site was lower respiratory tract, which accounting for 46.55%（n=27） and 69.72%（n=882）respectively. The major pathogens causing HAI were gramnegative bacteria(n=19), and the major pathogens causing CAI were Mycobacteria(n=141) and fungi (n=89). The  rate of antimicrobial usage and etiological examination was 34.80%(n=784 ) and 81.48%(n=550 ) respectively. ConclusionIn order to prevent cross infection of tuberculosis and reduce the incidence of HAI, lower respiratory tract and ICU should be one of the key infection sites and departments of HAI surveillance, treatment and management of patients with tuberculosis should be standardized,  professional  precaution of health care workers should be enhanced

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ObjectiveTo investigate the prevalence rates of healthcareassociated infection(HAI) and antimicrobial use in a maternal and child health hospital, so as to provide reference for preventing and controlling HAI.  MethodsA crosssectional survey on HAI prevalence of all hospitalized patients from 2010 to 2014 was conducted by combination of bedside examination and medical record review. ResultsThe prevalence rates of HAI in 2010—2014 was 3.29%, 5.20%, 3.97%, 3.93% and 3.73% respectively. HAI mainly occurred in patients at department of pediatrics (9.09%-12.96%), the major infection site was upper respiratory tract (50.00%-69.56%). Antimicrobial usage rate was 50.19%, 41.40%, 23.40%, 25.47% and 23.92% respectively, which decreased year by year (χ2=133.40,P<0.001); antimicrobial prophylactic usage rate was as high as 57.38%-75.47%; single usage rate were all>95%.ConclusionAntimicrobial agents used by hospitalized patients showed a overall downward trend from 2010 to 2014., but antimicrobial prophylactic usage rate is high, management of antimicrobial agents should be strengthened.

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ObjectiveTo realize hospital administrators’  recognition extent to healthcareassociated infection (HAI ) management staff ’s competency and qualification. MethodsThe unified questionnaires were filled in by respondents in 173 hospitals of Inner Mongolia autonomous Region, administrators’ recognition on the competency and qualification of HAI management staff were surveyed. ResultsOf 445 hospital administrators, 20.09%, 19.89%, and 18.05% considered that staff  members in HAI management departments should have the knowledge background of preventive medicine, clinical medicine, and nursing respectively. 58.20%, 89.44%, and 43.37% of hospital administrators considered that the directors of HAI management departments should have senior professional titles, undergraduate course or above, and with 2-5 working experience, respectively. 34.92% and 30.93% considered that the most important professional ability of directors of HAI management department were professional  and management ability, respectively.  ConclusionHospital administrators are apt to consider that the competency and qualification of HAI management staff are strong professional ability and certain management ability, and are interdisciplinary talents.

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ObjectiveTo evaluate the effectiveness of refined management on the prevention and control of multidrugresistant organisms (MDROs). MethodsRefined management concept and methods were adopted to standardize  all aspects of  management of MDROs, healthcareassociated infection (HAI) caused by MDROs in 2012 (before refined management) and 2013 (after refined management ) was compared.ResultsThe percentage of MDRO infection in 2013 was lower than 2012  (36.65%［70/191］ vs 48.44%［62/128］）; rate of HAI reporting , contact precautions implementation, and hand hygiene compliance in 2013 were all higher than  2012 ( 80.00% vs 32.25% ; 70.16% vs 28.13%; 75.86% vs 44.09%, all P＜0.05）. ConclusionImplementation of refined management can improve health care workers’ awareness of prevention and control of MDRO HAI , and promote continuous improvement of HAI management quality.

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ObjectiveTo realize the effect of WHO multimodal hand hygiene improvement strategy  (MHHIS) on improving hand hygiene compliance of health care workers(HCWs). MethodsFrom June to December 2012, HCWs in a hospital was intervened by adopting MHHIS, hand hygiene compliance rate before and after intervention was compared, and effectiveness of intervention was assessed. ResultsHand hygiene compliance of doctors and nurses improved from 14.06%（35/249） and 28.62%（81/283） before intervention  to 31.73%（79/249） and 57.60%（163/283）after intervention respectively（both P＜0.05）. Except outpatient and emergency department, hand hygiene compliance of the other departments significantly improved (all P<0.05); hand hygiene compliance of various hand hygiene indicators significantly improved except ‘after contact with patient surrounding’ (all P<0.05), the differences were statistically different (P＜0.05).ConclusionUsing WHO MHHIS can effectively improve hand hygiene compliance of HCWs.

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目的了解护生在临床实习过程中发生针刺伤后的焦虑程度、持续时间及认知情况，以制定有效的干预措施。方法采用焦虑自评量表对某院41名发生过针刺伤护生的心理状态进行评估。结果41名护生发生针刺伤后以轻度焦虑为主（68.29%）；焦虑状态持续时间多为3 d 以内（87.80%）；护生担心感染的疾病主要是经血液传播疾病，其中以担心感染人免疫缺陷病毒（HIV）者最多（80.49%）。结论医院应建立心理支持团队，减轻护生针刺伤造成的心理影响，并通过规范操作行为，加强职业安全防护知识培训，提高护生职业防护意识，减少针刺伤的发生。

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手术部位感染是剖宫产术后常见的并发症之一，轻则引起切口愈合不良，重则导致宫腔感染、败血症等，甚至危及产妇生命。大肠埃希菌、肠球菌属等是导致剖宫产术后手术部位感染的主要病原菌［1］，而感染咽峡炎链球菌者鲜见。目前，国内对咽峡炎链球菌感染后的临床表现、转归及治疗研究也少有报道。2014年6月，本院从1例剖宫产术后腹部切口感染合并子宫切口感染患者的脓液中分离出咽峡炎链球菌，现将其诊治情况报告如下。

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自噬可分为3种类型：微自噬(microautophagy)、分子伴侣介导的自噬(chaperone mediated autophagy,CMA)和巨自噬(macroautophagy)。巨自噬(简称自噬autophagy)是一种基因调控的、高度保守的细胞降解过程，也是一种重要的自我平衡的过程，发生于所有真核细胞中［1-3］。在针对应激的过程中，自噬常常扮演着细胞应答的角色［4］。而且，自噬无论在先天免疫还是适应性免疫机制中均有着不可忽视的重要作用［2］。自噬与各种疾病的病理及生理过程广泛相关（例如感染、肿瘤、神经退行性疾病、心血管及肺部疾病等），近期的研究［5-6］也表明，自噬在脓毒症中发挥一定的保护作用。本文从细胞病理学和分子生物学角度就细胞自噬在脓毒症发生发展中的作用作一综述，为寻找脓毒症治疗的新手段提供依据与线索。