Abstract:

提高医疗质量是医院管理的永恒主题，加强医院感染质量管理对医院的建设与发展起着重要的作用［12］。根据国家卫生和计划生育委员会（卫计委）关于加强医疗质量管理的工作要求和进一步全面落实《国家预防与控制医院感染行动计划（2012—2015年）》的整体部署，借鉴与吸收国外医院先进管理理念与方法，为进一步提高医院感染质量管理与控制水平，医院感染防控工作将主要围绕以下几个方面展开。

Abstract:

ObjectiveTo investigate antimicrobial resistance, distribution, and carriage of carbapenemase genes of Acinetobacter baumannii(AB) from two hospitals in Qingdao.Methods145 AB isolates collected from two hospitals  (78 from hospital A，67 from hospital B) were performed antimicrobial susceptibility testing， carbapenemase genes were amplified by polymerase chain reaction (PCR); homology analysis were conducted with enterobacterial repetitive intergenic consensus (ERIC)PCR.ResultsAB from hospital A were generally resistant to 16 commonly used  antimicrobial agents， with the lowest resistant rate of 3.85% to cefoperazone/sulbactam， followed by resistance rate of 16.67%  to  minocycline， resistant rates to the other antimicrobial agents were all> 73%. AB from hospital B were generally resistant to 23 commonly used antimicrobial agents, but the resistance rates to minocycline and tigecycline were both 0,  resistance rates to amikacin and levofloxacin were 23.88% and 38.81% respectively, resistant rates to the other antimicrobial agents were all >64%. All strains carried OXA51 gene, the carriage rates of OXA23 gene in carbapenemresistant group were 86.76%(59/68) and 56.67%(34/60) in hospital A and B respectively, the difference was significant（χ2=14.53,P＜0.001）; OXA58 gene was detected  in 3 isolates in hospital A but not detected from hospital B. 145 AB strains were classified into 8 types， the major prevalence types were type A (n=71) and  E(n=37); the major prevalence types in hospital A were type A (46.15%) and  E（41.03%）,  hospital B were type A (52.24%) and C (17.91%).ConclusionAntimicrobial resistance of clinically isolated AB is serious and prevailed in two hospitals. OXA23 and  OXA51 genes play an important role in AB resistance to carbapenems.

Abstract:

ObjectiveTo investigate the carriage of phenol soluble modulinα (PSMα) in methicillinresistant Staphylococcus aureus（MRSA）and influence in human peripheral blood neutrophils， so as to provide theoretical basis for guiding clinical treatment and identifying pathogenesis of MRSA.MethodsNinety MRSA isolates which were isolated from clinical specimens and performed SCCmec genotyping were collected， PSMα gene was amplified by polymerase chain reaction（PCR), and the effects of PSMα gene on  hunman peripheral blood neutrophils was studied by cell morphology analysis.ResultsOf 86 hospitalacquired MRSA(HAMRSA) isolates，78 were positive for PSMα gene，the positive gene was 90.70%; Of 4 communityacquired MRSA(CAMRSA)， 2 were positive for PSMα gene，the positive rate was 50.00%; neutrophil death rate in PSMα positive group was significantly higher than normal saline group, PSMα negative group and ATCC 25923 group, but there was no significant difference between  PSMα negative group and ATCC 25923 group.ConclusionHAMRSA detected in this region carry PSMα gene, and PSMα secreted by PSMα positive MRSA has the activity of promoting the lysis of neutrophils.

Abstract:

ObjectiveTo realize drug resistance pattern and disinfectantresistant genes  (qacA/B)  of Staphylococcus aureus (S. aureus) from neonates at a neonatal ward.MethodsS. aureus from neonates between January and December 2013 were identified and performed antimicrobial susceptibility testing by VITEK 2 Compact system, qacA/B gene was detected by polymerase chain reaction (PCR). Results225 S. aureus strains were isolated,which were mainly from respiratory tract (72.44%) and umbilical  secretion (14.33%); isolation rate of methicillinresistant S.aureus (MRSA) was 8.89%(n=20); antimicrobial resistant rate of MRSA was generally higher than methicillinsensitive S.aureus (MSSA)；levofloxacin, moxifloxacin, tigecycline, vancomycin, linezolid， and nitrofurantoin were all had high antimicrobial activity against all S.aureus， susceptibility rates were all 100%. 21( 9.33%) S.aureus carried qacA/B, 3(15.00%) of which were MRSA, and 18(8.78%) were MSSA.ConclusionDrug resistance of MRSA isolated from neonates in neonatal ward is serious, MRSA strains carry qacA/B, which should be paid more attention.

Abstract:

ObjectiveTo evaluate disinfectant efficacy of air disinfector and  ultraviolet  lamp.MethodsDomestic literatures were searched by computer, RevMan 5.3 software provided by the Cochrane collaboration  was used for quantitative analysis,  efficacy of two kinds of air disinfection methods was compared. ResultsA total of 11 articles met the inclusion criteria. Because the heterogeneity of literatures, random effects model analysis was adopted,  colony forming unit (CFU) before disinfection（WMD=-26.28，95%CI：［-60.31，7.75］，P＞0.05 ）and immediatelyafter disinfection（WMD=22.45，95%CI:［-34.24，79.13］，P＞0.05） had no obvious difference between two methods respectively,  but CFU of air disinfector 2 hours after disinfection  was significantly less than ultraviolet lamp group（WMD=-345.11，95%CI:［-478.28，-211.94］，P＜0.05）.ConclusionAir disinfector has good continuous disinfection efficacy.

Abstract:

ObjectiveTo evaluate the feasible hand hygiene intervention methods to improve health care workers’ (HCWs) hand hygiene compliance, and reduce healthcareassociated infection(HAI) rate.MethodsThe surgical department in a hospital was selected as intervention department, intervention department was conducted baseline investigation in JanuaryFebruary 2013, multimodel intervention measures were conducted  between  March  2013 and April 2014, postintervention survey was performed by the same method as baseline survey in MayJune 2014, hand hygiene of HCWs as well as  occurrence of HAI between before  and after intervention was compared respectively. ResultsAfter intervention, HCWs’ hand hygiene compliance  before and after patient contact both enhanced significantly; HCWs’ hand hygiene compliance rate increased from 53.32% before intervention to 69.27% after intervention, the difference was significant(χ2=26.19, P<0.001). HCWs’ hand hygiene modes before patient contact: liquid soap plus running water before intervention(67.02%), alcoholbased hand rub after intervention (61.08%); HCWs’ hand hygiene modes after patient contact : both liquid soap plus running water before and after intervention (86.40% and 70.41% respectively). Before intervention， hand dry method of  HCWs before and after patient contact was by wiping with uniforms， after intervention was by wiping with paper towel. HAI in intervention department decreased from 3.08% before intervention to 2.00% after intervention, the difference was significant(χ2=7.76, P=0.005).ConclusionMultimodel intervention measures in intervention department can effectively improve HCWs’ hand hygiene compliance rate.

Abstract:

ObjectiveTo investigate the clinical characteristics，diagnosis and therapeutic prognosis of Pneumocystis pneumonia（PCP）in patients with acquired immunodeficiency syndrome (AIDS).MethodsAIDS  patients with PCP were searched through computer medical record information system， clinical data were analyzed retrospectively, patients were divided into respiratory failure group (n=11) and nonrespiratory failure group (n=12)，partial pressure of oxygen in arterial blood（PaO2）， degree of blood oxygen saturation(SaO2),CD4+T lymphocyte, and lactate dehydrogenase（LDH）between two groups were compared.Results23 patients generally had the symptoms of weight loss，oral leukoplakia，shortness of breath, dyspnea， fever， cough，and expectoration. PaO2 value in 23 patients was (78.65±30.85）mmHg， partial pressure of carbon dioxide（PaCO2）was (24.42±5.60) mmHg，pH value was（7.43±0.79），SaO2 was （91.16±9.55）%；SaO2 and PaO2 in  respiratory failure group was lower than  nonrespiratory failure group, the difference was significant (both P＜0.05).Lung computed tomography (CT) scans showed bilateral pulmonary groundglasslike change. 21 patients used compound sulfamethoxazole tablets, 1 patient used compound sulfamethoxazole tablets plus clindamycin，1 patient used only clindamycin，17 patients used glucocorticoid in addition to compound sulfamethoxazole；after treatment,20 patients improved，2 died，and 1 gave up treatment.ConclusionSubacute progressive dyspnea, fever, dry cough,and lung groundglasslike shadow are common symptoms of PCP in AIDS patients,  compound sulfamethoxazole or compound sulfamethoxazole with clindamycin can be used for treatment, glucocorticoid  can obviously alleviate the symptoms of patients.

Abstract:

ObjectiveTo evaluate the clinical, epidemiological, and viral molecular biology features of 26 patients infected with H7N9 avian influenza A virus.MethodsClinical and epidemiological data of 26 patients with confirmed avian influenza A (H7N9) infection in 2013 and 2014 were collected, virus isolated from human and poultry were identified and typed through sequencing.ResultsOf 26 patients, fever and cough were the most common symptoms, all patients had pneumonia; 20 patients（76.92%）developed acute respiratory distress syndrome(ARDS); 25 patients  (96.15%) had leucopenia or normal leukocytes at the initial diagnosis; treatment with antiviral drugs was initiated in 25 patients at a median of 10 days after the onset of illness；10 patients (38.46%)  died. Gene sequencing indicated Gln226Leu and Gly186Val substitutions in human virus H7 gene and the PB2 Asp701Asn mutation. ConclusionAcute respiratory system damage is the main clinical manifestation of avian influenza (H7N9) virus infection in humans， live poultry exposure is an important risk factor for  H7N9 infection in humans, adaptive mutation occurred at partial site of avian virus gene, which can be more easily be spread from birds to human and cause serious diseases, it is necessary to strengthen the pathogen monitoring.

Abstract:

ObjectiveTo investigate the distribution and antimicrobial resistance of major gramnegative bacilli isolated from patients in intensive care unit (ICU) and nonICU wards，and provide reference for rational clinical antimicrobial  application. MethodsSpecimen sources and antimicrobial resistance of gramnegative bacilli from hospitalized patients in ICU and nonICU wards between 2011 and 2013 were analyzed statistically and compared.ResultsA total of  3 875 gramnegative bacterial isolates were detected among 25 153 specimens, isolation rate was 15.41%; 1 121 specimens from ICU were isolated 527 isolates of gramnegative bacilli， isolation rate was  47.01%; 3 348 isolates of  gramnegative bacilli were isolated from 24 032 specimens of nonICU, isolation rate was 13.93%, there was significant difference between the two（χ2=899.32，P＜0.001）. Extendedspectrum βlactamases (ESBLs)producing rate of Escherichia coli and Klebsiella pneumoniae in ICU patients was 56.00%（28/50） and 70.65%（65/92） respectively, in nonICU patients was 52.81%（517/979） and 40.37%（241/597）respectively. The imipenemresistant rate of Pseudomonas aeruginosa， Acinetobacter baumannii,  Escherichia coli, and Klebsiella pneumoniae from ICU was 36.59%, 88.54%, 10.00%, and 10.87% respectively， while from nonICU was 20.21%, 61.15%, 1.74%, and 2.85% respectively，the resistant rates of strains from ICU were higher than nonICU.ConclusionAntimicrobial resistant rates of major gramnegative bacilli from ICU are higher than those from nonICU, and the main strains are multidrugresistant nonfermentative bacteria. Clinical treatment should be different to reduce the emergence of drugresistant bacteria.

Abstract:

ObjectiveTo analyze the surveillance result of antimicrobial resistance of nonfermentative gramnegative bacilli(NFGNB) from a hospital in  2011—2013, and guide rational antimicrobial use. MethodsNFGNB were identified by US BD Phoenix100 automated microbial identification system, and antimicrobial susceptibility analysis were tested by microdilution method.ResultsA total of 3 138 NFGNB were isolated in 20112013, the detection rate of Pseudomonas aeruginosa (P. aeruginosa), Acinetobacter baumannii(A. baumannii), Stenotrophomonas maltophilia (S. maltophilia), and Burkholderia cepacia was 55.64% (n=1 746），30.21% (n=948），12.68% (n=398），and 1.47% (n=46）respectively. Respiratory specimens was the main specimen source(56.53%), strains were mainly isolated from patients in department of critical care medicine（26.48%）; resistant rates of P. aeruginosa and A. baumannii to carbapenems, βlactamase inhibitors, and aminoglycosides changed every year， but did not increase year by year, and declined in 2013; resistant rate of P. aeruginosa to cefepime, aztreonam, and moxifloxacin were all high(resistant to moxifloxacin was ＞90%);  resistant rates of  A.baumannii to most antimicrobial agents were high; resistant rate of S. maltophilia to compound sulfamethoxazole was relatively low.ConclusionAntimicrobial resistant rates of NFGNB changed each year, A. baumannii has a higher resistant rates to most antimicrobial agents, clinicians should use antimicrobial agents according to antimicrobial susceptibility testing result

Abstract:

ObjectiveTo analyze antimicrobial resistance of hospitalassociated methicillinresistant Staphylococcus aureus(HAMRSA)  and communityassociated methicillinresistant Staphylococcus aureus (CAMRSA), and provide reference for clinical treatment and  rational antimicrobial use.MethodsFrom May 2013 to June 2014, Staphylococcus aureus in a hospital were collected and analyzed， strains were identified and performed antimicrobial susceptibility testing by using VITEK 2 Compact system， diagnosis of HAMRSA and CAMRSA were confirmed in  combined with clinical symptoms.ResultsA total of 84 MRSA isolates were isolated (61 were HAMRSA strains, 23 were CAMRSA).Resistant rates of HAMRSA and CAMRSA to penicillin G and oxacillin were both 100.00%; to  ampicillin/sulbactam  was 100.00% and 95.65% respectively; to compound sulfamethoxazole was 39.34% and 34.78% respectively.  Antimicrobial resistant rates of HAMRSA to gentamicin, tetracycline, erythromycin, clindamycin, levofloxacin，ciprofloxacin, moxifloxacin, nitrofurantoin, and  rifampicin were all higher than CAMRSA, the difference were significant(all P＜0.001).ConclusionAntimicrobial resistance of HAMRSA and CAMRSA are all serious, monitor should be intensified, antimicrobial use should be chosen according to antimicrobial susceptibility testing result.

Abstract:

ObjectiveTo evaluate the effectiveness of comprehensive intervention measures in reducing postoperative lower respiratory tract infection (LRTI)  in patients with oral cancer.MethodsPatients were divided into intervention group and control group, intervention group :146 patients who admitted to a hospital between September 2012 and March 2013 received comprehensive intervention measures during perioperative period for preventing postoperative LRTI; control group: 140 patients who admitted to the hospital between March and August 2012 received routine medical care, incidence of postoperative LRTI between two groups was compared.ResultsThe implementation rates of 5 intervention measures of intervention group (30° bed head elevation, oral rinse with compound chlorhexidine gargle, autoclave sterilization of head of laryngoscope used in general anaesthesia, hand hygiene before anaesthesia for endotracheal intubation, and  gentamycin inhalation) were all higher than control group (all P<0.01). Incidence of LRTI in intervention group was significantly lower than control  group (［0.68%,n=1］ vs ［5.71%,n=8］, χ2＝4.39，P＜0.05）.ConclusionThe implementation of comprehensive intervention measures can effectively reduce the incidence of postoperative LRTI in patients with oral cancer.

Abstract:

ObjectiveTo investigate the current status of healthcareassociated infection(HAI) and antimicrobial usage, so as to  provide a scientific basis for improving the management of HAI. MethodsA crosssectional survey was conducted by combination of  bedside visiting and medical records reviewing,  HAI were investigated among all  hospitalized patients  between 0：00 and 24：00 on August 21,2014.ResultsA total of 2 216 patients were investigated, the prevalence rate of HAI was 4.83％, the case infection rate was 5.14％; the main infection site was lower respiratory tract(63.16％), antimicrobial usage rate was 39.71％, the proportion of prophylactic  and therapeutic use of antimicrobial agents was 32.27% and 61.71% respectively.596 patients received therapeutic antimicrobial use, specimen detection rate was 56.21%（n=335）, the detection rate of pathogens was 15.52%（n=52）. The major detected bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Stenotrophomonas maltophilia.ConclusionHAI prevalence survey is helpful for realizing the occurrence of HAI, respiratory tract  is the main infection site, gramnegative bacteria is the major pathogen, management of prophylactic use of antimicrobial agents is the focus of HAI management.

Abstract:

ObjectiveTo study the application and effectiveness of large class problembased learning (PBL) in the prejob training on healthcareassociated infection knowledge for medical students.MethodsMedical students of  2010 session were as the subjects of study, and were randomly divided into control group (n=163) and trial group(n=163). Control group adopted conventional lecturebased learning (LBL),  trial group adopted PBL. After finishing the course, two groups of students conducted closedbook exam,  and a questionnaire survey was also conducted among students in trial group.ResultsThe score of theoretical exam of trial group was higher than that of  control group (［87.99±4.49］ vs ［81.98±5.73］，P=0.001). Large class PBL  method can improve students’ active learning enthusiasm, promote initiative research and solving problems, promote communication and cooperation among students, as well as connection between learning and practice.ConclusionLarge class PBL is much better than LBC, but exam system of students’ participation before class needs to be explored constantly during the implementation process.

Abstract:

ObjectiveTo investigate the incidence of healthcareassociated infection(HAI) in hospitalized patients ≥65 years at a hospital in Hunan  Province.MethodsData of patients with HAI in this hospital in 2011—2013 were classified and analyzed statistically.ResultsA total of 47 626 patients were investigated, 1 068 cases  of HAI occurred, all cases were single site infection， incidence and case rate of HAI were both  2.24%, incidence in patients aged <65 years  (265 years old) was 0.98% （234/23 998），and ≥65 years  was 3.53%（834/23 628）, difference was significant between two groups (χ2=354.44, P<0.001). HAI rate in patients aged ＜65, 65~, 70~, 75~, 80~, 85~, and ≥90 years was 0.98%, 1.59%, 1.28%, 2.77%, 5.20%, 6.93%, and 9.43% respectively.  The major infection site was lower respiratory tract (59.95%, n=500), the main detected pathogens were Pseudomonas aeruginosa (19.43%) and Escherichia coil(18.72%).ConclusionThe incidence of HAI in the elderly patients increased with age increasing, the main infection site is lower respiratory tract.

Abstract:

目的探讨某院腹腔镜胆囊切除术围手术期预防使用抗菌药物的合理性及整改效果。方法查阅2012年1月1日—2013年12月31日普通外科475例腹腔镜胆囊切除术患者病历资料，2012年病例划分为整改前组，2013年病例划分为整改后组。评价其围手术期预防用抗菌药物的合理性并进行比较。结果腹腔镜胆囊切除术围手术期抗菌药物预防使用率由整改前的94.47％（239/253）下降至整改后的2.25％（5/222），两组比较，差异有统计学意义（ χ2=406.054，P<0.001）；预防性使用抗菌药物合理率从66.80%（169/253）提高至98.20%（218/222），差异有统计学意义（ χ2=78.507，P<0.001）；平均抗菌药物费用明显下降。结论医院通过开展抗菌药物临床应用整改活动，有效降低了腹腔镜胆囊切除术围手术期抗菌药物预防使用率及费用，提高了预防用抗菌药物的合理性。

Abstract:

目的了解外科手术部位感染（SSI）的危险因素。方法采用回顾性调查方法对2012年1月—2013年12月手术患者的SSI情况进行分析。结果2年共监测手术患者889例，发生SSI 10例，感染率为1.12%。多因素logistic分析结果表明，性别、手术危险指数、基础疾病、术前给药情况4个变量是SSI高危因素。结论医务人员应当针对外科手术部位感染的危险因素，加强SSI的预防与控制措施，降低SSI发生率。

Abstract:

布鲁菌病是由布鲁杆菌引起的一种人畜共患传染病，包括羊种菌、牛种菌、猪种菌、森林鼠种菌、绵羊副睾种菌、犬种菌6个生物种，我国羊种菌占绝对优势［13］。布鲁菌病在我国为国家法定乙类传染病。布鲁菌病流行广泛，具有明显的地区性。我国主要发生在内蒙古、东北、西北等地牧区，南方地区很少见。但是随着市场经济的发展，牲畜的交易和流通日益频繁，病随畜走的现象更加明显，近年来中南地区各大中城市均有散发病例报道［15］。为积累、提高非流行区域对该病的诊疗经验，本文总结了本院收治的首例布鲁菌病患者的临床诊断及实验室鉴定经验

Abstract:

手术衣作为手术过程中必要的防护服装，用于降低医务人员接触病原微生物的风险，同时也能降低病原微生物在医务人员与患者之间相互传播的风险，是手术操作中无菌区域的安全屏障［1］。近年来，随着医学界对血源性传播疾病研究的不断深入，手术过程中医务人员及患者采取的防护措施也越发受到关注。国内外多项研究［16］充分论证了手术过程中存在人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）等血源性传播疾病病原体的感染风险，以上病毒均可通过破损的皮肤或黏膜接触传播。