Abstract:

ObjectiveTo investigate the causes of an outbreak of healthcareassociated infection with methicillinresistant Staphylococcus aureus(MRSA)  in a neurosurgical intensive care unit(NSICU).  MethodsEpidemiological investigation on 8 patients with lower respiratory tract infection (LRTI) in a NSICU between June 15 and June 28,2104 were performed by combination methods of prospective and retrospective survey.ResultsThe attack rate of MRSA LRTI in NSICU patients was 22.86%, a total of 16 MRSA isolates were detected from patients’ clinical specimens, nasal vestibule, as well as hospital surroundings during the period, pulsedfield gel electrophoresis (PFGE) result revealed that infection outbreak was caused by two subtypes of MRSA; risk factors analysis showed that long length of stay in ICU and aspiration of sputum through bronchoscopy were risk factors for MRSA LRTI.  ConclusionContamination of bronchoscope was the key factor for this  epidemic spread of healthcareassociated MRSA infection.

Abstract:

ObjectiveTo study the effect of new type antiseptic gallium nitrate on the clearance of Staphylococcus aureus (S. aureus) biofilm, and  explore new methods for suppressing bacterial biofilm formation. MethodsBiofilm positive strains were screened among 14 clinically isolated S. aureus strains by crystal violet staining method, minimal inhibitory concentration (MIC) of gallium nitrate for biofilm positive strains and effect of gallium nitrate on the clearance of biofilm were measured. ResultsOf 14 S.aureus isolates, 9 were biofilm positive strains; gallium nitrate MICs for S. aureus ATCC 25923, biofilmnegative strain, and 9 biofilm positive strains were all 16 μg/mL; the clearance rate of gallium nitrate for early biofilm of S.aureus was significantly higher than mature biofilm (［86.53±0.96］% vs ［62.54±1.53］ %, t=35.699,P<0.001). ConclusionGallium nitrate can inhibit growth of S. aureus strains and clear biofilm, it can be applied in the prevention and control of  S. aureus infection.

Abstract:

ObjectiveTo study the risk factors for pulmonary fungal infection associated with  chronic obstructive pulmonary disease (COPD), and evaluate the efficacy and safety of itraconazole for treatment of pulmonary fungal infection associated COPD. MethodsA retrospective analysis were conducted on clinical data of 42 COPD patients who were confirmed pulmonary fungal infection in a respiratory disease department from September 1, 2007 to May 31, 2012, and 53 COPD patients who  had no pulmonary fungal infection were as control. ResultsOf 42 patients with COPD and pulmonary fungal infection， 8 were confirmed by histopathological examination, 34 were confirmed by clinical diagnosis; 6 were acute cases,  36 were chronic cases；28 were positive for fungal detection, 6 of whom were detected Candida albicans, 13 were detected Aspergillus, 7 were detected unclassified fungi，and 2 had mixed fungal infection.Univariate analysis showed that underlying diseases, longterm use of broadspectrum antimicrobials, longterm use of glucocorticoid, hypoproteinemia, invasive procedure, invasive mechanical ventilation, diabetes mellitus, history of invasive fungal infection  were major risk factors for  pulmonary fungal infection associated with  COPD. After patients were treated by itraconazole, the improvement rate of clinical symptoms was 66.67%,  fungal eradication rate was 60.71%, total effective rate was 64.29%. Of 28 cases with positive fungal detection, the improvement rate of clinical symptoms, fungal eradication rate, and total effective rate was 71.43%（n=20）,60.71%（n=17）, and 67.86%（n=19）respectively. Itraconazole had good therapeutic efficacy on acute and chronic pulmonary fungal infection associated with COPD. Adverse drug reaction rate was 23.81%, most were mild and reversible, and had no obvious impact on the treatment. ConclusionItraconazole has positive clinical efficacy on treating pulmonary fungal infection associated with COPD,it is highly safe.

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ObjectiveTo analyze the characteristics of epidemic situation of HIV/AIDS in Yongzhou from 1993 to 2014, and provide evidence for HIV/AIDS prevention and control strategy.MethodsDescriptive epidemiological analysis was conducted on HIV/AIDS epidemic situation in Yongzhou from 1993 to 2014.ResultsA total of 2 917 HIV /AIDS cases were reported, the reported cases increased year by year; the ratio of male to female cases was 2.30∶1; 52.04% were aged 20-49 years old, 46.76% were aged ≥50 years old, the percentage of population ≥50 years old increased obviously in recent years; the major transmission route was sexual contact (88.48% ), gay transmission accounted for 2.64%.ConclusionThe knowledge about AIDS in Yongzhou should be strengthened, intervention in high risk population should be implemented, scope of detection should be expanded, so as to prevent the transmission of AIDS effectively.

Abstract:

ObjectiveTo realize the distribution and change in antimicrobial resistance of common pathogens causing acute lower respiratory tract infection (LRTI) in children, and provide evidence for rational use of antimicrobial agents.MethodsData about pathogens from children with LRTI in a hospital between January 2011 and December 2013 were analyzed statistically. ResultsOf 934 isoalted pathogenic strains, 728 (77.94%) were gram  negative bacteria, the major were Klebsiella pneumoniae (n=278), Escherichia coli (n=216), Enterobacter cloacae(n=85), and Pseudomonas aeruginosa(n=63). The isolation rate of gram  positive bacteria was 20.87%(n=195),  the major were Staphylococcus  aureus(n=132) and Streptococcus pneumoniae(n=49). Antimicrobial susceptibility testing results revealed that sensitive rate of gramnegative bacteria to imipenem, meropenem,and amikacin were all 100.00%, to ceftazidime/clavulanic acid and piperacillin/tazobactam were relatively low, to cephalosporins increased year by year. Sensitive rates of the main gram  positive bacteria to vancomycin were both  100.00%, to erythromycin  and clindamycin were relatively low. ConclusionThe major pathogenic bacteria causing LRTI in pediatric department are gram  negative bacteria, antimicrobial resistance rates increased year by year, management of antimicrobial use in children should be strengthened to prevent the occurrence of multidrugresistant organism infection.

Abstract:

ObjectiveTo investigate the clinical distribution and change in antimicrobial  resistance of  Acinetobacter baumannii （A.baumannii）from a hospital between 2011 and 2013,  so as to provide guidance for clinical treatment. MethodsSources and antimicrobial susceptibility testing results of A.baumannii from a hospital were analyzed statistically. ResultsA total of 14 705 bacterial isolates were isolated in 2011—2013，13.59%（n=1 999）of which were A.baumannii isolates, the percentage of A.baumannii  in isolated pathogens in 3 years was 12.74%,13.05%, and 14.85% respectively，which showed a rising trend  （χ2=9.458，P=0.002）. The main specimen was sputum (n=1 541, 77.09%), bacteria were mainly isolated from  patients in respiratory disease department（21.71%）, surgical intensive care unit (16.26%), and emergency intensive care unit (8.26%). Antimicrobial resistance rates of  A.baumannii  increased year by year(all P<0.05); multidrugresistant and extensively drugresistant A.baumannii also increased year by year (all P<0.001).  ConclusionIsolation rate and antimicrobial resistance rate of A.baumannii strains increase year by year, multidrugresistant and extensively drugresistant A.baumannii strains are obvious, which should be paid more attention in clinical department.

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ObjectiveTo investigate the distribution and antimicrobial resistance of clinically isolated pathogens from geriatrics department of a hospital in 2013, so as to provide reference for clinical antimicrobial use．MethodsDistribution and antimicrobial resistance of pathogens isolated from patients in a geriatrics department between January and December 2013 were analyzed statistically. ResultsOf 1 896 pathogenic strains, 1 289(67.99%) were gramnegative bacteria, 439 (26.00%）were grampositive bacteria, and 114(6.01%) were fungi; the top 4 isolated pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli. Extendedspectrum βlactamase (ESBL)producing Escherichia coli and Klebsiella pneumoniae accounted for  53.26% and 31.10% of Escherichia coli and Klebsiella pneumoniae respectively; Of Staphylococcus aureus and Staphylococcus epidermidis strains,  methicillinresistant isolates (MRSA and MRSE) accounted for 22.47% and  80.00%, respectively, of Enterococcus strains, vancomycinresistant isolates (VRE) was 3.10%,  Klebsiella pneumoniae  and Enterobacteriaceae were highly sensitive to imipenem, meropenem and ertapenem. Resistant rate of Acinetobacter baumannii to imipenem and meropenem was 79.48% and 80.35% respectively，Pseudomonas aeruginosa had the lowest resistant rate to amikacin (10.70%).Grampositive bacteria were highly sensitive to vancomycin and linezolid. ConclusionThe major pathogens isolated from the elderly patients are gramnegative bacteria, and antimicrobial resistance is serious, surveillance of antimicrobial resistance is important for rational use of antimicrobial agents and control of pathogen resistance.

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ObjectiveTo investigate the hospitalization cost, length of stay in hospital, and mortality in patients with pulmonary infection in a hospital, and evaluate the influencing factors, so as to  provide scientific basis for making targeted infection control measures. MethodsMedical records of patients with pulmonary infection  between January 2011 and December 2012 were collected, the difference and influencing factors of hospitalization cost, average length of stay, and prognosis among patients with different types of pulmonary infection were compared and analyzed by univariate analysis, multiple linear regression analysis, and logistic regression analysis.  ResultsOf  10 431 patients with  pulmonary infection, the average hospitalization cost was （29 081.95±38 682.92）yuan(RMB), the median cost was 16 085.25 yuan(RMB), and the average length of stay was （15.93±20.54）d, the median was 13.00 d, a  total of 828 patients died due to invalid treatment,mortality was 7.94%. There were significant differences in hospitalization cost, average length of stay  among patients with different genders, ages, modes of payment, admission status of illness, types of pulmonary infection, and operation or not (all P<0.05), and the differences in mortality were also  significant among patients of above characteristics except gender(all P<0.05). Influencing factors for hospitalization cost were as follows: length of stay, whether or not operated, modes of payment, types of pulmonary infection(healthcareassociated pneumonia, HAP), age,  gender, and so on, influencing factors for  length of stay were whether or not operated and types of pulmonary infection, factors leading to death were admission condition, types of pulmonary infection(HAP),and whether or not operated, and so on. ConclusionControl of healthcareassociated pulmonary infection is important for controlling hospitalization cost, shortening average length of stay, and improving survival rate of patients.

Abstract:

ObjectiveTo compare whether there is a difference in medical cost of intensive care unit(ICU) patients with catheterassociated infection (CAI) between before and after targeted intervention. MethodsCAI in ICU patients in 2010(preintervention group) and 2013 (postintervention group) were investigated by retrospective survey, hospitalization cost of two groups of patients before and after intervention was compared.  ResultsThe morbidity and mortality in patients with CAI  both decreased significantly after intervention, morbidity of healthcareassociated infection(HAI) decreased from 13.47% in 2010 to 4.41% in 2013, mortality decreased from 10.36% in 2010 to 2.2% in 2103. Total hospitalization cost, blood transfusion cost, and cost of special material before and after the implementation of targeted intervention all significantly different (all P<0.05), the difference of procalcitonin and antimicrobial agents cost were also significant(all P<0.05). ConclusionMedical cost in ICU patients with CAI decreased after intervention.

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ObjectiveTo explore the effect of Pareto analysis in  management on hospital cleaners in infectious disease specialty hospital.MethodsThe implementation of healthcareassociated infection(HAI) prevention and control measures among 32 cleaners were supervised, defects items were analyzed by Pareto analysis,  top priority problems which needed to be dealt with were found out,  the quality was improved by strengthening the training, formulating and perfecting standard operation procedures, providing clear signs,  and establishing competencebased strategic management.  ResultsBefore rectification, there were 121 cases of incorrect implementation, the main defects items were “implementation of standard precautions”， “disinfection and isolation procedures in each location”, “preparation of  disinfectant”, and “hand hygiene ”,  cumulative percentage  of  these four items was 76.03%（92 cases）. Pareto analysis and expert brainstorm method showed that the main causes of incomplete implementation of HAI prevention and control measures among cleaners were lack of HAI knowledge，incomplete operating process and all kinds of signs，varied attention on HAI management among administrators，and less stringent supervision. After rectification，incorrect implementation dropped to 48 cases，cumulative percentage of above four measures was 72.92%（35 cases）.The implementation rate of HAI prevention and control measures among 32 cleaners were statistically different before and after rectification (P＜0.05）.ConclusionPareto analysis can quickly find out the key problems which need to be solved, improve the efficiency of HAI prevention and control management, and has important significance to reduce the occurrence of HAI.

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ObjectiveTo evaluate the effect of implementing quality control circle (QCC) activities on nurses’ knowledge about ventilatorassociated infection(VAP), as well as headofbed (HOB) elevation and incidence of VAP in patients.  Methods100 patients who used ventilators in an intensive care unit(ICU)  of a hospital were randomly selected, 50 patients were selected before the implementation of QCC(JanuaryJune, 2013), and 50 were selected after the implementation of QCC (JulyDecember, 2103). Condition of nurses and patients who used ventilators before and after implementation of QCC were investigated. ResultsAfter implementing QCC,the scores of nurses’ recognition on knowledge about causes and risks of VAP, significance and standard of  HOB elevation, and  HOB elevation≥ 30°  were all higher than before implementing QCC; the total score was higher than before implementing QCC (［18.32±3.14］ vs ［7.98±1.12］, P<0.05); patients’ compliance to HOB elevation was higher than before implementing QCC(［96.00%, n=48］ vs ［44.00%, n=22］,P<0.05）; incidence of VAP was lower than before implementing QCC (［4.00%,n=2］ vs ［36.00%,n=18］,P<0.05). ConclusionImplementation of QCC activities can effectively improve ICU nurses’ recognition on knowledge about VAP and enhance patients’ compliance to HOB elevation, as well as reduce the incidence of VAP,it is helpful for improving healthcareassociated infection management quality.

Abstract:

ObjectiveTo understand the characteristics of population distribution, risk factors and risk links of occupational exposure among health care workers(HCWs)  in a hospital. MethodsOccupational exposure among HCWs  between January 2011 and June 2014 were monitored, data about occupational categories of HCWs, exposure locations, exposure links and exposure  modes were analyzed statistically. ResultsAmong 286 occupational exposure cases, the female and  male HCWs accounted for 22.03% (n=63) and 77.97% (n=223) respectively;  the  incidence of occupational exposure in 2011,2012,2013 and JanuaryJune of 2014 was 38.81%(n=111), 26.22% (n=75), 23.43% (n=67) and 11.54% (n=33) respectively; occupational exposure of junior nurses, doctors, nursing attendants,technicians, senior nurses and cleaners was 31.97%,19.90%, 15.79%, 7.64%, 4.17%, and 2.84% respectively; exposure mainly occurred at the time of sorting waste, withdrawing or changing needles, discarding sharps into sharps containers, surgical suturing or instruments passing, and puncturing (including drawing blood), the constituent  ratio was 22.38%, 19.58%, 14.34%, 12.94% and 11.19%, respectively; the main locations where exposure occurred were wards, operating rooms and injection (treatment) rooms, the constituent  ratio was 51.40%, 19.58% and 11.54% respectively. ConclusionHospital should establish comprehensive occupational exposure monitoring and risk management system, strengthen standard prevention, enhance the training about occupational exposure among highrisk population, and monitor and intervene on risk factors and links, so as to reduce the incidence of  HCWs’ occupational exposure.

Abstract:

ObjectiveTo evaluate the effect of intraoperative use of soluble hemostasis gauze on postoperative pelvic infection in parturients undergoing cesarean section.MethodsData about cesarean section parturients in obstetric group（n=322）and gynaecology group (n=92) were surveyed by clinical followup and retrospective analysis method, obstetric group adopted bulk packing of gauze，gynaecology group adopted flat lay packing  , incidence of postoperative pelvic infection between  parturients who used soluble hemostasis gauze with different packing methods, as well as  with different pieces were compared and analyzed. ResultsPelvic infection rate in  obstetric group and gynaecology group was 4.04%（13/322） and 0.00%（0/92） respectively，there was no significant difference between  two groups（P=0.082 ).  In obstetric group, pelvic infection rate in parturients who used ≤3 pieces of soluble hemostasis gauze was 0, used >3 pieces was 11.82%,  there was significant difference between the two (P<0.001).ConclusionRational use of soluble hemostasis gauze in caesarean operation can effectively avoid postoperative pelvic infection.

Abstract:

目的了解产超广谱β内酰胺酶（ESBLs）细菌医院感染的现状及原因，以便制定相应措施。方法对201例产ESBLs细菌感染患者的临床资料进行回顾性分析。结果201株产ESBLs的细菌构成中以大肠埃希菌为主，占69.15%；标本来源以痰/咽拭子（51.74%）及尿（33.33%）为主；接受各种侵入性操作的患者共160例，占79.60%；患者全部使用抗菌药物。结论医院应尽量减少患者侵入性操作，正确合理实施抗菌药物给药方案，并采取相应的预防控制措施，以减少患者产ESBLs菌感染及传播。

Abstract:

目的探讨某基层综合医院多重耐药菌的临床分布和标本来源情况，为控制多重耐药菌感染和暴发提供依据。方法回顾性分析该院2013年7月—2014年5月微生物实验室检出的326株多重耐药菌监测资料。结果居前4位的多重耐药菌依次是大肠埃希菌（26.07%）、金黄色葡萄球菌［21.78%，其中耐甲氧西林金黄色葡萄球菌（MRSA，13.50%）］、鲍曼不动杆菌（17.18%）、肺炎克雷伯菌（10.43%）。多重耐药菌株主要来源于痰标本（68.71%），高发科室依次是综合重症监护室（ICU，26.38%）、儿科（17.79%）、普通内科（11.04%）和神经外科（10.12%）。鲍曼不动杆菌和MRSA主要分布在综合ICU,大肠埃希菌和肺炎克雷伯菌以儿科分布相对较多。结论加强医护人员多重耐药菌预防控制知识和手卫生培训，落实消毒隔离措施，有利于预防多重耐药菌的感染和暴发。

Abstract:

目的探讨感染性腹泻患儿家长手卫生依从性，并分析影响其依从性的原因，提出相应干预措施。方法采用隐蔽性现场观察与自制调查问卷相结合的方法，对92例患儿家长的手卫生依从性和影响其依从性的原因进行调查。结果患儿家长给患儿冲奶或喂奶、喂水前手卫生依从率为49.78％；给患儿擦净鼻涕、口水或更换尿布后手卫生依从率为73.12％。影响患儿家长手卫生依从性的原因排名居前2位的为患儿家长觉得没有必要 (70.65％)、无频繁进行手卫生的习惯 (57.61％)。结论医护人员应采取有效的干预措施，提高感染性腹泻患儿家长的手卫生依从性。

Abstract:

目的探讨对护士进行针刺伤综合干预的效果。方法采取规范操作流程、职业安全培训、操作演练和督查相结合的方法对护士进行针刺伤综合干预，比较干预前后护士针刺伤发生情况。结果2012年护士针刺伤发生率为2.38%，低于2011年的11.44%，差异有统计学意义（χ2=20.022，P＜0.001）。2012年护士临床工作中拔针环节、注射及采血环节针刺伤发生率较2011年明显降低（均P＜0.01），差异均有统计学意义（均P＜0.05）。结论对护士实施针刺伤综合干预，可以有效减少其针刺伤的发生，值得推广应用。

Abstract:

导管相关血流感染（catheterrelated bloodstream infection，CRBSI）是新生儿重症监护室（NICU）较常见的重症感染，常导致患儿出现严重疾病状态甚至死亡。CRBSI  的主要致病菌是凝固酶阴性葡萄球菌（CNS）［1-2］，路邓葡萄球菌是CNS中毒性较强的一种细菌，目前报道该细菌的耐药率不高，笔者现将 1 例耐甲氧西林路邓葡萄球菌导致的CRBSI病例报告如下。

Abstract:

西非地区暴发的埃博拉病毒病（Ebola virus disease，EVD）是一次全球性的公共卫生灾难，截至2015年3月8日，仅西非3国已报道感染24 247人，其中840名医护人员感染，死亡491名,医务人员的病死率达58.45% ［1］。面对威胁，我们应全面地分析如何降低医护人员感染的风险，特别是针对外科高危操作环节。一方面，一定数量的EVD确诊患者，以及更多的可能、疑似患者，需要接受急诊外科手术治疗，如急腹症、妊娠、宫外孕、创伤、骨折等；另一方面，由于埃博拉病毒（Ebola virus, EBOV)的高传染性，穿刺、留置导管、气管插管、手术过程等操作给医务人员带来巨大风险［2-3］。目前，临床上尚缺乏相关的指南与实践，因此，建立正确处理EVD患者的围手术期流程，对减少医务人员感染风险极其重要。笔者结合本人在中国援助利比里亚埃博拉治疗中心(Ebola Treatment Center, ETC)的工作实践与经验，以及世界卫生组织（WHO）、美国疾病控制与预防中心(CDC)等发布的相关防控指南，探讨了医务人员在处理确诊或疑似EVD患者围手术期的相关操作流程、安全防护等方面的问题，为提高医务人员的预防控制水平提供参考。

Abstract:

艰难梭菌(Clostridium difficile)是专性厌氧革兰阳性芽孢杆菌，主要通过粪口途径进行传播，并可导致艰难梭菌感染（Clostridium difficile infection CDI）［1］。该菌于1935年首次报道，直至1978年被认为是引起假膜性肠炎的病原菌之一［23］。其致病机制主要是产生A、B两种毒素(TcdA,TcdB)，临床表现可从轻度的自限性腹泻到严重的假膜性肠炎的腹泻［4］。近年，由于艰难梭菌高产毒株(027/NAP1/BI型)在世界几个地区的暴发流行，且在中国香港和广东省已有027型散发的个案报道，艰难梭菌已成为医院获得性感染的主要病原菌之一［59］。我们曾对石家庄地区医院住院患者分离的33株艰难梭菌进行多位点序列分型，发现以ST37和ST54为主，与我国北京的报道［10］一致。近年，儿童及成人社区获得性CDI呈上升趋势［1114］，在美国、加拿大和欧洲地区社区获得性CDI占总CDI发病人数的20%~50%［15］，其越来越受到人们的关注［16］。但是，社区艰难梭菌传播途径，尤其是无症状携带艰难梭菌的健康人群在CDI的流行中所发挥的作用还未知。因此，本文对健康人群艰难梭菌的定植、传播及感染防控做一详细综述