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ObjectiveTo analyze the distribution and pulsedfield gel electrophoresis (PFGE) of pathogenic bacteria causing infectious diarrhea in a district of Beijing from 2011 to 2013,  and  provide basis for tracing infection sources.MethodsA total of 1 179 stool specimens of  infectious diarrhea from patients in a diarrhea outpatient department from January 2011 to December 2013 were collected, all isolated pathogens were identified by serotyping and PFGE analysis.Results330 enteric pathogens were isolated from 1 179 specimens, the top 4 bacteria were Shigella spp.（28.18%,n=93）,Salmonella spp.（20.91%, n=69）,Vibrio parahaemolyticus（13.33%, n=44）,and diarrheagenic Escherichia coli(3.33%, n=11). 18 Shigella sonnei isolates were identified as 8 PFGE patterns, clustering similarity was close to 88%;  69 Salmonella spp. strains belonged to 18 serotypes and 41 PFGE patterns,  Salmonella senftenberg and Salmonella enteritidis had dominant patterns; no dominant PFGE patterns were obviously identified among 23 strains of Vibrio  parahaemolyticus.ConclusionThe serotypes and PFGE patterns of pathogenic bacteria in infectious diarrhea in past three years showed a wide distribution characteristics, the dominant PFGE patterns of Salmonella spp.and Shigella spp. need to be paid more attention, and outbreak of  infectious diarrhea caused by Salmonella spp.and Shigella spp. should be alerted.

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ObjectiveTo investigate the contamination of carbapenemresistant Acinetobacter baumannii (CRAB) from object surface of key departments in a hospital, and identify whether these CRAB were homologous.MethodsEnvironmental hygienic monitoring in intensive care unit (ICU), emergency intensive care unit(EICU), hemodialysis room and operating room was conducted. Acinetobacter baumannii (A. baumannii) isolated from ICU and EICU environmental specimens were amplified  and typed by enterobacterial repetitive intergenic consensuspolymerase chain reaction (ERICPCR).ResultsExcept hand hygiene of health care workers in EICU was qualified, bacterial count of object surface of ICU and EICU were all unqualified; detection results of specimens from hemodialysis room and operating room were all qualified. A total of 53 specimens were taken from object surface of ICU and EICU, 7 (13.21%) A. baumannii isolates were isolated, and all were CRAB isolates, 6 of which were of the same genotype and were identical with  A.baumannii from  patients’ sputum.ConclusionCRAB isolated from object surface in key departments is homologous, cleaning and disinfection of environmental object surface should be intensified to reduce the occurrence of healthcareassociated infection.

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ObjectiveTo survey and control an extensively drugresistant Acinetobacter baumannii(A. baumannii) (XDRAB) lower respiratory tract infection（LRTI） outbreak in intensive care unit (ICU) of a hospital. MethodsFrom October 27, 2013  to December 27, 2013， 5 cases of XDRAB LRTI occurred in ICU，epidemiological investigation was conducted， sources and transmission routes of infection were searched,  intervention measures were performed. ResultsXDRAB were isolated from patients’ sputum and environmental object surface, drugresistant spectrums of isolated XDRAB were almost the same， suggesting the outbreak was due to the contamination of environment by the same pathogen. 54 specimens were taken before disinfection,  26 were positive, XDRAB were isolated from door handles, sheets and telephones.  Investigation concluded that the outbreak of XDRAB infection was due to contamination of indoor environment and equipment， incomplete disinfection， and inadequate hand hygiene compliance of health care workers. After the implementation of a series of control measures, XDRAB was not found, and there was no new XDRAB infection cases. ConclusionEnvironment contamination is the main cause of this XDRAB healthcareassociated infection（HAI） outbreak, strict implementation of isolation,prevention and control measures of MDROs can effectively control HAI outbreak caused by A. baumannii.

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ObjectiveTo analyze risk factors and antimicrobial use for hospitalacquired pneumonia (HAP) due to multidrugresistant organisms (MDROs) in an intensive care unit(ICU),  so as to perform risk assessment and  guide antimicrobial use.MethodsFrom January 2012 to December 2013, HAP patients were conducted retrospective cohort study, risk factors for MDROHAP and rationality of antimicrobial use were analyzed. ResultsA total of 110 cases of HAP occurred in ICU, 63 cases (57.27%) were MDRHAP. Logistic regression analysis revealed that recent hospital stay ≥5 days (OR=19.94)， transference from other hospitals (OR=19.33), infection type of lateonset HAP (OR=7.98)， and antimicrobial use in recent 90 days (OR=3.42) were independent risk factors for MDRHAP. Initial empirical antiinfective treatment revealed that there were no significant difference in timing of antimicrobial administration within 24 hours  after clinical diagnosis was confirmed, and rationality of antimicrobial selection between MDRHAP group and nonMDRHAP group (both P>0.05); The  isolation rate of pathogens in MDRHAP group was lower than nonMDRHAP group (73.02% vs 91.49% P<0.05).Targeted antimicrobial therapy revealed that there were no significant difference in selection， dosage, and frequency of antimicrobial use between two groups(all P>0.05); the rationality rate of therapy course in MDRHAP group was higher than noMDRHAP group, but rationality rate of combination use of antimicrobial agents was slightly lower than the latter(both P<0.05).ConclusionPatients in ICU should be conducted risk factor assessment, and according prevention and control measures should be formulated, so as to reduce the occurrence of MDRHAP，health care workers should standardized the initial empirical antiinfective treatment.

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ObjectiveTo evaluate pathogens and antimicrobial resistance of pathogens causing refractory pneumonia in children. MethodsChildren with refractory pneumonia who admitted to a hospital between May 2008 and December 2014 were performed  bronchoscopy, and bronchoalveolar lavage fluid (BALF) were performed bacterial culture and antimicrobial resistance testing.Results1 693 patients were recruited in the study,  273 bacterial isolates were isolated from BALF specimens of 226 children, grampositive bacteria accounted for 38.10%(104/273), the  main grampositive bacteria were Streptococcus pneumoniae(n=71) and Staphylococcus aureus(n=23); gramnegative bacteria accounted for 58.24%(159/273),including 44 isolates of Haemophilus parainfluenzae，28 Klebsiella pneumoniae，19 Escherichia coli, and 17 Pseudomonas aeruginosa; 10 isolates of fungi were also detected,8 of which were  Candida albicans.The sensitivity  of Streptococcus pneumoniae to quinolones,ceftriaxone and cefotaxime were high.  Methicillinresistant Staphylococcus aureus (MRSA) positive rate was 26.32%. ESBLsproducing rate of Haemophilus parainfluenzae and Klebsiella pneumoniae was 32.72% and 62.96%respectively.ConclusionThe major pathogens causing refractory pneumonia were Streptococcus pneumoniae and Haemophilus parainfluenzae, empirical treatment should be conducted accordingly, antimicrobial resistance should be considered if therapeutic effect is poor, and targeted therapy should be performed according to cultured results and antimicrobial susceptibility testing result.

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ObjectiveTo evaluate the occurrence of multidrugresistant organism (MDRO) infection in a general hospital, and take effective comprehensive intervention measures, so as to reduce MDRO infection.MethodsTargeted monitoring on MDROs was performed from October 2012 to December 2013, comprehensive intervention measures were conducted, the occurrence of MDRO infection before and after intervention was compared.ResultsA total of 62 384 patients were investigated, 17.91%（n=11 176）were sent specimens for pathogen culture, 606 times of culture for patients’ specimens  were detected MDROs,  292(0.47%) cases were MDRO healthcareassociated infection(HAI)，314 were communityacquired infection or colonization. MDRO infection case rate decreased from 0.65%（75/11 603） before intervention to 0.26%（36/13 875）after intervention (χ2=21.08，P＜0.05）.ConclusionComprehensive intervention measures can effectively reduce the occurrence of MDRO HAI.

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ObjectiveTo explore drug resistance and distribution of multidrugresistant（MDR） Mycobacterium tuberculosis (M. tuberculosis) in a countylevel hospital, so as to strengthen the prevention and control of healthcareassociated infection with M. tuberculosis. MethodsSpecimens with positive sputum smear were performed M. tuberculosis culture and drug resistance testing, and distribution of MDR tuberculosis patients in the departments before isolation were investigated retrospectively. ResultsOf 488 patients with tuberculosis, 254 were positive for sputum smear, 122 M. tuberculosis strains were isolated from positive sputum smear patients，120 isolates were performed drug susceptibility testing, results revealed that 86 isolates were drugresistant strains, 46 of which were monodrugresistant, 40 were MDR. Of MDR strains, 16 were all resistant to  isoniazide,  rifampicin,  streptomycin, and  ethambutol. The percentage of monodrugresistance, MDR, pandrug resistance was 9.43%, 8.20%, and 3.28% respectively.  Medical imaging department, ultrasound department, and respiratory disease department were the main units of M.tuberculosis exposure. ConclusionThe percentage of MDR M. tuberculosis is high among M. tuberculosis, surveillance should be intensified, so as to prevent the transmission in hospital.

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ObjectiveTo investigate the  effect of antimicrobialimpregnated incise drape on preventing surgical site infection(SSI)  following  neurosurgical operation.MethodsPatients undergoing neurosurgical operation from January to December 2012 were divided into two groups: antimicrobialimpregnated incise drape group(group A) and  general incise drape group(group B). The occurrence of SSI and risk factors for SSI were analyzed.ResultsPercentage of drape lifting at the wound edge in group A was lower than group B(38.3%［98/256］ vs 96.88% ［248/256］, χ2=200.57，P＜0.01）. Among 512 patients, SSI rate was 3.32%(n=17), SSI rate  in group A was lower  than group B(1.56%［4/256］ vs 5.08%［13/256］, χ2= 7.93，P＜0.05 ). Multivariate analysis revealed that body mass index ≥24, perioperative hypothermia, smoking, perioperative length of hospital stay ≥5 days, and lack of drape use were independent risk factors for SSI  following  neurosurgical operation.ConclusionWhether antimicrobialimpregnated incise drape is used in neurosurgical operation is one of the independent risk factors for SSI  following  neurosurgical operation, it can effectively reduce the drape lifting rate and incidence of SSI, and  is recommended to be used in neurosurgical operation.

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ObjectiveTo construct a questionnaire for patients to participate  in hand hygiene promotion in medical institutions, and provide a measuring tool for patients to participate in hand hygiene promotion.MethodsA questionnaire was constructed by methods of literature research, expert panel discussion, preinvestigation, and Delphi.ResultsThis questionnaire was designed respectively for patients and health care workers, each contained 20 questions, involving hand hygiene perception, willingness to participate in promoting hand hygiene, and participation method, et al.ConclusionA  questionnaire for patients to participate hand hygiene promotion in medical institutions is preliminary constructed, which can be used for evaluating patients’ and HCWs’ willingness and relevant influencing factors of patients’ participation in hand hygiene promotion in medical institutions.

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ObjectiveTo explore the distribution and antimicrobial resistance of pathogens causing urinary tract infection(UTI)  in patients with prostatic hyperplasia， and provide reference for clinical diagnosis and  rational antimicrobial therapy.MethodsUrine culture results of 171 patients with prostatic hyperplasia complicated with UTI from February 8, 2012 to October 12, 2013 were analyzed retrospectively.ResultsA total of 192 bacterial isolates were isolated from 171 patients, gramnegative bacteria accounted for 79.17%, 37.50% of which were Escherichia coli (E. coli) strains, and 18.75% were Klebsiella pneumoniae (K. pneumoniae); grampositive bacteria and Candida accounted for 18.23% and 2.60% respectively. Of E. coli and K. pneumoniae, the proportion of  extendedspectrum βlactamase (ESBLs) strains were relatively higher, which was 72.77% and 63.89% respectively, resistant rates of ESBLsproducing E. coli to piperacillin. cefuroixme， ceftazidime, ceftriaxone, aztreonam, and levofloxacin were all  significantly higher than nonESBLs strains, resistant rates of ESBLsproducing K. pneumoniae to piperacillin, cefoxitin, aztreonam, levofloxacin，and compound sulfamethoxazole were all  significantly higher than nonESBLs strains. Resistant rates of Pseudomonas aeruginosa to imipenem and meropenem were both 50.00%, susceptibility rates of Enterococcus to penicillins and aminoglycosides were both low, linezolid and vancomycinresistant strain was not found.ConclusionOrganisms isolated from patients with UTI associated with prostatic hyperplasia have high antimicrobial resistance, clinical therapy should be based on characteristics of bacterial distribution and antimicrobial resistance

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ObjectiveTo explore the occurrence of surgical site infection(SSI)  in patients in different levels of hospitals.MethodsSSI among patients in 47 hospitals at 0:00-24:00 of May 16,2012 were investigated by medical record reviewing, doctor inquiry, and bedside visiting.ResultsA total of 5 977  surgical patients were investigated, SSI prevalence rate was  1.76%.  SSI prevalence rate  in secondary hospitals was higher than tertiary hospitals(χ2=9.337, P=0.002);SSI prevalence rates in cleancontaminated  and contaminated incision in secondary hospitals were both  higher than tertiary hospitals (χ2=4.315, 8.129,  both  P<0.05);departments with high SSI prevalence rates were general surgery,  orthopedic, and neurosurgery;the major isolated pathogens were Escherichia coli, Staphylococcus aureus, and coagulase negative Staphylococcus.ConclusionSSI rates of different types of incision and different departments are varied, corresponding prevention and control measures should be taken.

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ObjectiveTo investigate perioperative antimicrobial prophylaxis in thyroid operation at all levels of hospitals in a province.MethodsFrom January 1,2011 to December 31,2013, all kinds of thyroid operation in a province were conducted targeted monitor,  investigated results were analyzed.ResultsA total of 1 304 cases of thyroid operation were investigated, 1 294 (99.23%) were elective operation; duration of operation of  1 051 cases (80.60%) were ≤2 hours; antimicrobial use rate was 96.70%; 196 patients (15.45%) were administered 30 minutes before operation, 887 patients (70.34%) used antimicrobial agents for >48 hours; 19.53% of patients used the first generation cephalosporins and clindamycin.ConclusionThere are some problems in antimicrobial use in thyroid operation in this province, such as inappropriate choice of antimicrobial agents, improper administration time， long time use of antimicrobial agents， and use antimicrobial agents without indications. Management of antimicrobial agents should be strengthened, so as to promote the rational use of antimicrobial agents.

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ObjectiveTo evaluate the risk factors for healthcareassociated infection (HAI) in patients in department of cardiology.MethodsClinical data of inpatients were performed retrospective casecontrol analysis, patients with HAI  were as case group, while without HAI were as control group, factors for HAI between two groups were compared.Results117 cases of HAI occurred among  2 308 patients, infection rate was 5.07%. The main infection site was respiratory tract (n=71,60.68%); a total of 90 pathogenic isolates were isolated, gramnegative bacteria, grampositive bacteria,  and fungi accounted for  72.22%(n=65), 22.22%(n=20), and 5.56%(n=5) respectively. Univariate analysis revealed that 7 variables were risk factors for HAI,  multivariate nonconditional logistic regression analysis revealed that independent risk factors for HAI were age, cardiac function classification, serum albumin level,and invasive operation.ConclusionHAI rate is higher among cardiology inpatients, which is related to many factors. Attention should be paid to the elderly, long term hospitalization, heart failure correcting, treatment for complications,reducing of invasive procedure, and strict sterile manipulation.

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ObjectiveTo improve hand hygiene compliance among healthcare workers (HCWs) in a stomatological hospital， and effectively reduce healthcareassociated  infection(HAI) rate.MethodsAccording to WHO hand hygiene guideline and implementation scheme of hand hygiene, a systemic and step by step hand hygiene promotion plan was formulated, the plan was divided into five steps: full alert, baseline investigation, improvement, tracking, and retrospective analysis. Hand hygiene compliance among HCWs before and after the promotion of activities was analyzed and compared.ResultsThrough hand hygiene promotion activities, the questionnaires showed that average score of knowledge about hand hygiene among HCWs enhanced from 58.33  to 77.40 (increased by 32.69%); the average hand hygiene compliance rate increased from 24.28%（59/243）to 49.81%（133/267），the difference was significant（χ2=35.331，P =0.000）；hand hygiene status at five moments for hand hygiene improved markedly.ConclusionHand hygiene promotion has a significant influence in hand hygiene among HCWs in this stomatological hospital.

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ObjectiveTo train health care workers (HCWs) by method of conventional training plus survey of hand contamination status, the influence of two kinds of methods in hand hygiene compliance of HCWs was evaluated. MethodsFrom November 2013 to April 2014, all HCWs in a cardiovascular internal medicine department were as trained subjects, they were divided into two groups (trial group and control group).Hand hygiene compliance status was investigated 1 month before training. In the  first month after training, conventional training method was adopted by both groups， from the second to fifth month, conventional training plus hand contamination survey was adopted by trial group, hand hygiene compliance between two groups were compared.ResultsHand hygiene compliance rates of trial group and  control group was 42.63% (107/251) and 41.80% (102/244) respectively before training, there was no significant difference（P＞0.05）.In the first and second month after training， hand hygiene compliance rate of  trial group was 55.70% (132/237) and 63.11% (154/244) respectively,control group was 56.52% (130/230) and 62.61% (149/238) respectively， compared with pretraining， the differences were significant (both P＜0.05), but the difference was not significant between two groups(P＞0.05); From the third to fifth month, hand hygiene compliance rates of trial group was 60.73%（150/247）,61.44%（145/236）,and 61.22%（150/245）respectively, control group was 51.68%（123/238）,51.02%（125/245）,and 52.32%（124/237）respectively, there was significant difference between two groups(P＜0.05).ConclusionConventional training combined with survey of hand contamination status can promote hand hygiene compliance of HCWs.

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目的调查某三级综合医院医务人员职业暴露发生情况，探讨职业暴露相关危险因素及预防对策。方法对该院2009年1月—2014年6月上报的106例次职业暴露人员的暴露途径、程度、暴露后处理及随访等相关情况进行调查分析。结果106例次职业暴露中科室分布以普通外科居多，18例次（16.98%）；职业分布以护士居多，50例次（47.17%）；工作年限以≤2年居多，55例次（51.89%）。发生职业暴露的锐器初始用途中以静脉注射居多，16例次（15.09%）；引起损伤的锐器以针头居多，76例次（71.70%）；发生时机中以使用后处理前居多，44例次（41.51%）；锐器伤后以表面少量出血或无出血居多，57例次（53.77%）。 暴露源明确且完成检测者85例次，占80.19%；按照流程进行紧急处理者96例次（90.57%），经评估无需进行血液监测和预防用药处理者27例次（25.47%），监测追踪未发现职业暴露后相关感染者。结论加强职业安全防护教育，实施标准预防，暴露后正确处理局部伤口，及时上报并采取相应干预措施，有助于降低职业暴露感染风险。

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目的分析重症监护室（ICU）导尿管相关泌尿道感染（CAUTI）病原菌分布及其对常用抗菌药物的耐药性。方法 回顾性分析2011年1月—2014年6月ICU住院患者中发生CAUTI患者的感染病原菌，对细菌进行鉴定及药敏分析。结果共检出283株病原菌，其中革兰阴性菌192株（占67.84%），位于前3位的由高至低依次为：大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌；革兰阳性菌65株（占22.97%），分别是屎肠球菌和粪肠球菌；真菌26株（占9.19%），主要是白假丝酵母菌。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌对哌拉西林、氨苄西林的耐药率均＞70%，鲍曼不动杆菌对头孢哌酮/舒巴坦100.00%敏感；屎肠球菌对氨苄西林和环丙沙星的耐药率分别为85.11%、80.85%。结论CAUTI病原菌以革兰阴性杆菌为主，细菌耐药现象较为普遍，应根据药敏结果合理使用抗菌药物，减少多重耐药菌产生。

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毛细血管渗漏综合征（capillary leak syndrome，CLS）是一种突发的、可逆性毛细血管高渗透性，血浆迅速从血管渗透到组织间隙，引起迅速出现的进行性全身性水肿、低蛋白血症、血压及中心静脉压降低、体重增加、血液浓缩，严重时可发生多器官衰竭。CLS的出现，给临床治疗带来困难，同时也是影响抢救成功的因素之一。近期，本院收治１例重症肺炎合并CLS的患者，现将其诊治情况报告如下。

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乙型肝炎病毒（hepatitis B virus infection, HBV）感染仍然是一个严重的公共卫生问题，全球约三分之一的人存在曾存在过HBV感染的血清学证据，约3.5亿人发生过感染，其流行特征存在地域差异［1］。中国处于HBV感染分布的高、中流行区，平均感染率约8%［2］。HBV感染临床分型包括：无症状携带者、急性乙型肝炎、重型乙型肝炎（乙肝相关肝衰竭）、慢性乙型肝炎、乙肝相关肝硬化、肝癌等。临床上发现部分HBV感染者乙型肝炎病毒表面抗原（HBsAg）血清学检测阴性，但分子生物学检测HBV DNA阳性，这类特殊感染模式引起研究者和临床医生的广泛关注，也由此发展出隐匿性乙型肝炎病毒感染（occult hepatitis B virus infection，OBI）的概念。近几年来，随着研究的不断深入，对其认知已经达到较高水平［3］。