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ObjectiveTo study gene transcriptions of pathogenicity locus (PaLoc) and toxin B expressions of A-B+ Clostridium difficile （C. difficile）strain BJ08 isolated in China and strain US1 isolated in C. difficile infection outbreak regions in the United States, and provide theoretical support for prevention and control of possible outbreak of C. difficile infection in China.MethodsCells and supernatants of C. difficile were collected every 3 hours, gene expressions of PaLoc domain, including tcdA, tcdB, tcdC, tcdR and tcdE genes, were detected by realtime polymerase chain reaction (PCR), the expressions of toxin B in cells and supernatants were detected by enzymelinked immunosorbent assay (ELISA).ResultsThe growth rate of strain US1 was slightly faster than that of BJ08, and the degradation rate of US1 was significantly faster than that of BJ08（P＜0.05）; No toxin A was detected but mRNA of tcdA were detected in both BJ08 and US1, and there was no significant difference in tcdA expression between BJ08 and US1. The transcriptions of tcdB,tcdC and tcdE of BJ08 were 3 hours earlier than those of US1. There was no significant difference in the production of toxin B in supernatants and cells between strain BJ08 and US1.ConclusionCompared with US1, there is similar virulence or stronger gene regulation of BJ08, possible outbreak of C.difficile infection in China should be alerted.

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ObjectiveTo evaluate characteristics of prevention and control of healthcareassociated infection (HAI) during treatment for earthquake victims after Wenchuan earthquake and Yaan earthquake.MethodsField investigation and literature review were conducted to compare the characteristics of HAI prevention and control between two earthquakes.ResultsCompared with medical rescue after Wenchuan earthquake in 2008, the challenge after Yaan earthquake in 2013 was less, infection control emergency preparedness and response of hospitals, including preview and triage, prevention and control of emphysematous gangrene, targeted surveillance and intervention in high risk factors, improved obviously. Infection control in preliminary tent hospitals was on the right track. ConclusionThe main characteristics of effective HAI prevention and control measures during treatment for earthquake victims are four early （early involvement, early screen, early isolation, and early intervention）and six demands (government attention， multidisciplinary cooperation， personalized prevention and control scheme， combination of infection theory with measures during the whole treatment process, scientific and standard infection control measures, professionals in infection control），so as to ensure the medical safety of the treatment for disaster victims.

Abstract:

ObjectiveTo investigate the status and development trend of healthcareassociated infection(HAI) in a tertiary hospital, and provide a basis for formulating prevention and control measures. MethodsHAI data of clinical departments in a hospital from 2010 to 2012 were analyzed with trajectory model.ResultsAll clinical departments were divided into three groups according to development trend of HAI rate. The first group accounted for 80.7% of total departments, HAI rate of this group was low, and showed a decreased trend(slope=-0.45), the difference was significant (P=0.04); the second group accounted for 16.0%,HAI rate was higher than the first group and also showed declined trend(slope=-0.17),the difference was not significant (P=0.17); the third group only contained intensive care unit, HAI rate was far higher than other departments, and the development trend of HAI rate increased first and then declined.ConclusionTrajectory analysis model can be used to divide clinical departments into different groups, is convenient to understand the development trend of HAI of every hospital department, and take measures to control HAI according to the characteristics of HAI of different clinical departments.

Abstract:

ObjectiveTo explore the risk factors for healthcareassociated infection (HAI) in hospitalized patients at an orthopaedics department of a hospital, and provide reference for the prevention of HAI. MethodsClinical data of 3 776 hospitalized patients between January 2011 and December 2012 were reviewed retrospectively.ResultsA total of 79 cases (2.09%) of HAI occurred, the most common infection site was lower respiratory tract（30.38%）,followed by surgical site（26.58%）; 79 pathogenic strains were isolated, 58 （73.42%）of which were gramnegative bacilli, 21（26.58%） were grampositive cocci. The risk factors for HAI in patients with orthopaedics diseases were age, length of hospital stay, surgery(types and modes), and associated diabetes mellitus.ConclusionOrthopaedics patients are vulnerable to respiratory tract and surgical site infection, corresponding measures should be taken to reduce the incidence effectively.

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ObjectiveTo investigate the pathogens causing healthcareassociated infection (HAI) in a hospital, and guide the prevention and control of HAI.MethodsDistribution and antimicrobial resistance of pathogens isolated from patients with HAI in 2012 were analyzed statistically.ResultsA total of 793 isolates of 71 pathogen species were isolated, including 504 isolates (63.56%) of gramnegative bacteria，204 (25.72%）of grampositive bacteria, and 85 (10.72%） of fungi; the top five pathogens were Escherichia coli（n=129，16.27%）, Klebsiella pneumoniae（n=121，15.26%）, Acinetobacter baumannii（n=100，12.61%）, Staphylococcus aureus（n=79，9.96%）, and Pseudomonas aeruginosa（n=70，8.83%）， the top three sites of pathogen islation were lower respiratory tract (323,40.73%), blood stream (116.14.63%)， and urinary system (116,14.63%).274(34.55%) pathogens were multidrugresistant organisms.ConclusionThe major pathogens in HAI are gramnegative bacteria, most are multidrugresistant strains, monitor should be intensified.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from blood culture, and to guide the rational use of antimicrobial agents.MethodsData of pathogens from blood specimens of inpatients and outpatients in a hospital between January 2008 and December 2011were analyzed statistically.ResultsOf 670 pathogenic isolates from blood culture, gramnegative bacilli, grampositive cocci and fungi accounted for 45.67%(n=306),49.11% (n=329) and 5.22%(n=35) respectively; the top 3 were Coagulase negative staphylococcus(23.88%), Escherichia coli(19.40%) and Staphylococcus aureus(12.98%).Susceptibility of multidrugresistant Staphylococcus to compound sulfamethoxazole, linezolid and vancomycin were relatively high (resistant rate were 0-20.34%).The resistant rates of gramnegative bacilli (except Acinetobacter spp.) to cefoperazone/sulbactam,piperacillin/ tazobactam and amikacin were 0-27.27%. Acinetobacter spp. had the highest resistant rate. The most common fungus in blood culture were Candida parapsilosis (2.38%) and Candida albicans(1.79%).ConclusionEarly blood culture and monitor on multidrugresistant pathogenic isolates can provide reliable evidence for clinical diagnosis and treatment.

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ObjectiveTo investigate clinical distribution and antimicrobial resistance of multidrugresistant organisms(MDROs)in a hospital in 2012, and provide reference for the prevention of MDROs infection.MethodsDistribution and antimicrobial susceptibility testing results of MDROs isolated from patients in a hospital between January and December 2012 were analyzed by targeted monitoring method. ResultsA total of 370 MDROs strains were isolated, isolation rate of gramnegative bacilli and grampositive cocci was 92.16%(n=341) and 7.84%(n=29,all were methicillinresistant Staphylococcus aureus［MRSA］)respectively; the top five departments with high MDROs isolation rates were intensive care unit(n=79 isolates), department of neurosurgery (n=65), neurology (n=40) general surgery(n=39), and geriatrics(n=32). Resistant rates of 29 MRSA strains to compound sulfamethoxazole,tigecycline,and rifampicin were all>60%, no vancomycinresistant strain was detected; resistant rates of extendedspectrum betalactamase (ESBLs)producing Escherichia coli and Klebsiella pneumoniae to imipenem were >75%,resistant rates to cefoperazone / sulbactam and amikacin were about 50%; multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii were generally not sensitive to antimicrobial agents, multidrugresistant Acinetobacter baumannii were almost pandrugresistant strains.ConclusionThe major MDROs isolated from this hospital are gramnegative bacteria, strains are mainly from patients with severe diseases and elderly age. Monitor and control measures on healthcareassociated infection should be intensified to prevent the spread of MDROs.

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ObjectiveTo realize the distribution and antimicrobial resistance of common pathogens in children with lower respiratory tract infection (LRTI), and provide basis for rational use of antimicrobial agents.MethodsPathogens were isolated from sputum of hospitalized children with LRTI in 2012, identification and antimicrobial susceptibility testing of major pathogens were performed with VITEK2compact system.ResultsOf 1 080 sputum specimens, 314(29.07%) isolates of pathogens were detected, 224(71.34%) of which were gramnegative bacilli, the major were Escherichia coli (n=56),Klebsiella pneumoniae (n=49), Enterobacter cloacae（n=46）,Serratia marcescens（n=39）; grampositive bacteria were 85 isolates (27.07%), the major were Staphylococcus aureus (n=30,8 were methicillinresistant strains), Staphylococcus haemolyticus (n=26), and Staphylococcus epidermidis (n=16, 6 were methicillinresistant strains); fungi were 5 isolates(1.59%), all were Candida albicans. Gramnegative bacilli were sensitive to imipenem and meropenem,sensitive rate was 100.00%, but had broadspectrum cephalosporin resistance; grampositive bacteria had 100.00% sensitive rate to vancomycin and was highly sensitive to linezolid. ConclusionMultidrugresistant organisms exists in LRTI in children, clinicians should pay attention to the resistance mechanisms of pathogens,use antimicrobial agents according to antimicrobial susceptibility testing results.

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ObjectiveTo evaluate antimicrobial resistance and resistance mechanisms of mucoid Pseudomonas aeruginosa (P. aeruginosa), and provide reference for the clinical use of antimicrobial agents.MethodsAll P. aeruginosa strains isolated from patients were identified by API strip, antimicrobial susceptibility testing was performed by KirbyBauer disk diffusion method, data were analyzed by WHONET5.4 software.ResultsOf 12 kinds of antimicrobial agents, resistance of nonmucoid P. aeruginosa to gentamicin, cefotaxime, aztreonam, cefepime, ciprofloxacin and levofloxacin were significantly higher than mucoid P. aeruginosa (P<0.05), but the resistance to imipenem, meropenem, piperacillin/sulbactam, amikacin, ceftazidime and cefoperazone were not significantly different（P>0.05）. Before and after the combination antimicrobial therapy for mucoid P. aeruginosa infection, resistance of mucoid P. aeruginosa to 12 kinds of antimicrobial agents were as follows : resistance to imipenem and meropenem was the same; to amikacin and cefotaxime after therapy was higher than before therapy （P<0.05）; resistance to the other antimicrobial agents showed different degrees of change.Conclusion In vitro antimicrobial resistance of mucoid P. aeruginosa is low, but in vivo effectiveness of antimicrobial agents is not ideal, therapeutic effect can be achieved by combination use of in vitro susceptible antimicrobial agents and drugs which can inhibit bacterial biofilm.

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ObjectiveTo investigate the application of antimicrobial agents before and after the enforcement of special rectification activities in an occupational diseases prevention and treatment hospital. MethodsAntimicrobial application in inpatients and outpatients from January 2010 to September 2012 were analyzed statistically; From May 2011, the special rectification activities on antimicrobial application were carried out, the data before and after intervention was compared.ResultsCompared with preintervention (between January 2010 and April 2011), data of antimicrobial application after intervention(between May 2011 and September 2012) were as follows: antimicrobial usage rate and antimicrobial use density in inpatients decreased significantly(29.98% vs 39.45%; 34.60 vs 49.56, respectively), singleagent application rate and specimen detection rate in patients receiving antimicrobial agents increased significantly(73.02% vs 55.58%;74.29% vs 49.87%,respectively）, the usage rate of antimicrobial agents in outpatients decreased significantly (19.87% vs 43.09%)(P＜0.005 or P＜0.05）.ConclusionThe special rectification activities in 2011 greatly improved the rationality of clinical application of antimicrobial agents.

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ObjectiveTo evaluate the necessity for testing patients’ serum indicators of infection before dental scaling.Methods1 929 outpatients in a stomatological clinic at a hospital between April and September 2012 were performed serological testing of HBsAg, antiHCV, antiHIV and syphilis (toluidine red unheated serum test,TRUST) before receiving dental scaling．ResultsBefore dental scaling, HBsAg positive rate was 2.50% in patients of 10-20 years age; positive rate of HBsAg, antiHCV, antiHIV, and TRUST was 7.14%,0.79%,0.26%, and 0.53% respectively in patients of 2140 years age, and was 4.06%,1.41%,0.09%,and 0.26% respectively in patients ≥41 years old.ConclusionTesting of serum indicators of infection before scaling is helpful for realizing status of bloodborne pathogen infection in patients, and promote control of healthcareassociated infection．

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ObjectiveTo investigate the epidemiological features of occupational exposure to blood among health care workers (HCWs) in a hospital.MethodsRetrospective questionnaires survey of 374 HCWs were performed by random accidental sampling method.ResultsThe correct rate of treatment contents and procedure was 54.81%（205/374） and 89.84%（336/374） respectively.174 HCWs suffered 533 times of exposures, exposure rate was 46.52%(174/374);exposure rate was significantly different among HCWs of different departments and different work locations (P＜0.05), exposure rate of HCWs in department of surgery,pediatrics,and internal medicine was 64.46%（78/121）,60.00%（18/30）,and 40.00%（50/125）respectively; the exposure rate in nurses and doctors was 51.52%(102/198) and 47.27%（52/110） respectively. The main exposure time were in the morning and evening, the main manipulation were puncture, blood withdrawal, and disposal of articles, the main locations were wards,operating rooms, and dressing rooms.ConclusionOccupational exposures in this hospital is high, the enforcement of preventive measures for occupational exposures should be enhanced.

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Objective To investigate occupational exposure among staff in a women and children hospital, and evaluate occupational exposurerelated risk factors and preventive measures.MethodsData of occupational exposure among 55 staff in JanuaryDecember 2012 was analyzed. ResultsA total of 55 staff suffered 57 times of exposure. Exposure sources of 31 times (54.39%) were unidentified, 26 (45.61%) were identified.Of 57 times of exposure, 82.46% (47 times) occurred in cleaners and nurses, incidence of occupational exposure was 9.76% and 5.32% respectively; the top three departments of occupational exposure were departments of outpatient and emergency (29.51%), obstetrics (9.80%), and cleaning company(9.76%); the incidence of occupational exposure was 87.72% (50 times) in staff with length of service ≤3 year. Sharp injury was the major types of exposure, which accounting for 94.74%(54 times); the main medical devices that caused injuries were scalp needles (42.11%) and syringe needles (19.30%). The major procedures involved in injury were syringe needle removal (29.83%) and medical waste disposal (28.07%).ConclusionCleaners, nurses and junior staff are high risk population for occupational exposure, in order to reduce the incidence of occupational exposure, corresponding measures should be taken, education about occupational precaution should be performed, management on key departments should be intensified.

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ObjectiveTo investigate the consumption of water running through five different kinds of faucets(foottouching, foot pedal, elbowtouching, induction, and handtouching faucet) in clinical departments, and provide basis for rational use of faucets.MethodsOne hundred health care workers(HCWs) were selected randomly and divided into 5 groups (20 /group), different types of faucets were used for sixstep handwashing, water consumption and purchase price of each type of faucet were calculated, hand hygiene compliance rate among HCWs’ was investigated and the pros and cons of all types of faucets were compared.ResultsOf 5 types of faucets, average consumption of water through foottouching faucet was the least (［932.50±319.24］mL), compared with the other four types of faucets, the difference was statistically significant（P＜0.05）. Purchase price of handtouching faucet was the lowest, but water consumption was the most(［2 258.50±363.93］mL), and can easily cause secondary pollution; purchase price of induction and foot pedal faucet was more expensive(606.70, 289.30 CNY per faucet, respectively); elbowtouching faucet was not convenient to use. After handtouching faucets were replaced by foottouching faucets, hand hygiene compliance rate of HCWs increased from 33.33% to 60.00%(P<0.05).ConclusionFoottouching faucet saves costs and water, and is convenient to use, it is better than the other four types of faucets, and is worth to be popularized in clinical application.

Abstract:

目的探讨医院获得性下呼吸道感染老年患者分离的金黄色葡萄球菌（SA）耐药情况及其变迁，为临床合理用药提供依据。方法收集2006年1月—2012年10月某三级甲等医院发生医院下呼吸道感染的65岁以上老年患者送检标本分离的SA进行菌株鉴定及药敏试验。结果共分离SA 126株，其中耐甲氧西林SA(MRSA) 113株（89.68%）。SA对糖肽类（替考拉宁、万古霉素）、呋喃类（呋喃妥因）、新型抗菌药物口恶唑烷酮类（利奈唑胺）、链阳菌素类（奎奴普丁/达福普汀）抗菌药物耐药率较低；对青霉素类（青霉素、氨苄西林/舒巴坦）、头孢类（头孢唑林、头孢噻肟）抗菌药物耐药率高。不同时段分离的SA对各类抗菌药物的耐药率差异无统计学意义（P＞ 0.05）。结论医院获得性下呼吸道感染老年患者分离的SA以MRSA为主，耐药性高；2006年以来，SA对常用抗菌药物的耐药性变迁不明显。

Abstract:

目的了解某院2010—2012年医院感染现患情况，为有效预防和控制医院感染提供科学依据。方法采用横断面调查方法，对该院2010年8月11日、2011年9月7日及2012年9月18日0∶00—24∶00所有住院患者进行调查。结果2010—2012年医院感染现患率分别为3.46%（16/462）、3.28%（18/548）、3.70%（26/702）。医院感染现患率最高的科室为综合重症监护室（ICU，25.00%～33.33%）；医院感染部位以下呼吸道为主（38.46%～43.75%）； 2010—2012年抗菌药物使用率分别为69.05%（319例）、67.70%（371例）和66.52%（467例）。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，规范抗菌药物合理使用，可有效减少医院感染的发生。

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目的了解某院医院感染发生的横断面情况，为制定防控措施提供依据。方法采用床旁和病历调查相结合的方法调查该院的医院感染现患率。结果共调查住院患者588例，医院感染现患率为4.42%，例次现患率为4.59%。医院感染现患率居前3位的科室分别是重症监护室（25.00%）、神经内科（6.95%）和肿瘤科（6.45%）。感染部位以下呼吸道居首位（占55.56%）。治疗使用抗菌药物者病原学送检率为43.71%，医院感染病原学送检率为38.46%。住院患者抗菌药物日使用率为60.37%。结论应加强重点科室的医院感染管理，降低呼吸道感染的发生率，提高病原学送检率，规范抗菌药物的使用，有效降低医院感染发病率。

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目的探讨手术室布类单在洗衣房包装后再送至消毒供应室灭菌的效果。方法由消毒供应室护士在洗衣房对手术室可重复使用的布类单进行配包，再送至消毒供应室灭菌，对灭菌效果进行监测。结果布类改革到洗衣房打包8个月，每月选送灭菌布类包到检验科进行检测，结果均无细菌生长。14 816个布类包“内卡外带”化学指示变色全部合格。各项灭菌监测完全达标，能够安全使用。结论手术室布类单改革为先在洗衣房包装，再送至消毒供应室灭菌的方法，优化了清洗灭菌流程，提高了工作效率，节省了人力和时间，提高了洁净手术室的空气洁净度。

Abstract:

明串珠菌属也称无色藻菌属，目前有25个种和亚种，代表菌种为肠膜明串珠菌，常见于生产乳（奶）制品、发酵、酿酒业和制糖工业中。对人类而言，明串珠菌属感染致病较为少见，但近年来引发人类感染不断增多，尤其是血液中分离率高，可引起人类脑膜炎、脓肿、肺炎、心内膜炎、心包炎、骨髓炎、腹膜炎、尿路感染等病症。大多发生在万古霉素治疗过程中，发病原因尚不明确。现将1例肠膜明串珠菌肠膜亚种致血流感染病例的临床资料以及相关文献研究报告如下。

Abstract:

锐器伤指在工作中被针头、手术器械、玻璃制品、医疗仪器设备、医疗废弃物及其他锐利物品刺伤和割伤皮肤而导致有被病原微生物感染风险的意外事件［1］。医院消毒供应中心承担着医院各种医疗器械的回收、清洗、消毒工作，是各种医疗污染物集中的地方，也是医院锐器伤高危科室之一。2009年，卫生部《医院消毒供应中心管理规范》［2］卫生行业标准实施后，医院消毒供应中心工作模式也由分散式管理改变为集中管理，医院内所有需要重复使用的器械、物品均由消毒供应中心统一处置，消毒供应中心诊疗器械、器具和物品处理的操作流程由回收、分类、清洗、消毒、干燥、器械检查与保养、包装、灭菌、储存、发放10个工作环节组成。而在这10个工作环节中，因前5个工作环节接触锐器较多，加之消毒供应中心工作任务成倍增加，工作人员数量却没有相应增加，以至于工作人员不得不加快速度完成日常工作，从而大大增加了工作人员锐器伤的职业风险，由针刺伤和刀割伤造成的职业暴露引发经血源感染的危险日趋严重。