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ObjectiveTo investigate the types of staphylococcal cassette chromosome mec (SCCmec) gene and antimicrobial resistance of communityacquired methicillinresistant Staphylococcus aureus(CAMRSA) isolated from outpatients and inpatients in a hospital.MethodsMRSA strains isolated between May 2011 and August 2015 in a hospital and the relevant case data were collected, polymerase chain reaction(PCR) method was used to identify mecA gene of MRSA and SCCmec gene of CAMRSA, antimicrobial susceptibility testing of CAMRSA were performed and analyzed.ResultsA total of 305 MRSA isolates were collected, 296 of which were mecA positive, 29.73%（88/296） were CAMRSA. The genotyping of CAMRSA showed that 48 strains were SCCmec type Ⅳ, 36 were SCCmec type V, the other 4 strains were undefined. Antimicrobial susceptibility testing results showed that susceptibility rates of CAMRSA to vancomycin, linezolid, and tigecycline were all 100%, resistance rates to penicillin and oxacillin were both 100%; resistance rates of SCCmec type IV and SCCmec type V CAMRSA strains to levofloxacin, rifampicin, and ciprofloxacin were all significantly different (all P<0.05), to ampicillin/sulbactam, furantoin, and erythromycin were all >58%.ConclusionThe main SCCmec type of CAMRSA are type IV and type V in this hospital, antimicrobial resistance rate is high, clinicians should pay high attention, and use antimicrobial agents according to antimicrobial susceptibility testing results.

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ObjectiveTo identify the occurrence and microorganism profile of deviceassociated healthcareassociated infections (DAHAIs) in the intensive care unit (ICU) of a university hospital in China.MethodsFrom January 1 to November 30, 2015, patients admitted to the ICU of a university hospital in China for more than 48 hours were performed prospective descriptive study. DAHAIs were defined according to the criteria of the Centers for Disease Control and Prevention (CDC) of U.S., descriptive statistical analysis was performed.ResultsOf 254 patients admitted to ICU, the overall incidence of DAHAIs was 15.35%, with 10.23 cases of DAHAIs per 1 000 ICUdays; the incidence of ventilatorassociated pneumonia (VAP), catheterassociated urinary tract infection (CAUTI), and central lineassociated bloodstream infection (CLABSI) were 7.05 per 1 000 ventilatordays, 4.91 per 1 000 urinary catheterdays, and 3.22 per 1 000 central linedays, respectively. The main infection site was lower respiratory tract, accounting for 48.27%, followed by bloodstream system(27.59%), urinary tract(22.99%), and gastrointestinal tract(1.15%). The major isolated microorganism was Acinetobacter baumannii (21.52%).ConclusionThe surveillance system can identify the epidemiological status of DAHAIs and make effective control measures to ensure the healthcare safety.

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ObjectiveTo study the distribution and homology of foodborneassociated extendedspectrum βlactamases (ESBLs)producing Escherichia coli (E. coli).MethodsESBLsproducing E. coli were isolated from different food specimens in Shaoguan from 2014 to 2015, strains were typed with pulsedfield gel electrophoresis (PFGE) and BioNumerics software.Results11 strains of diarrheacausing E. coli and 29 strains of ESBLsproducing E. coli were isolated from 347 different sources of food specimens. PFGE analysis showed that 29 strains could be divided into 21 cluster groups, group A was predominant pattern, which included 7 strains（J2, J3, J4, J7, J9, B4, S3）, group B included 2 strains (J6, J8), the other strains were sporadic clones. Similarity coefficient (SC) of 3 strains (J2, J7, J9) from health practitioners was 100%，SC of strains from drinking water and patients with diarrhea (B4) was 97.1%，SC of S3 strain and 4 strains (J2, J3, J7, J9) from health practitioners were all＞90.0%.ConclusionFoodborneassociated ESBLsproducing E. coli are widely distributed in food, water, animal, and populations, and can be transmitted through food chain, surveillance should enhanced to avoid further spread.

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ObjectiveTo investigate the carriage and homology of carbapenemase genes of multidrugresistant Acinetobacter baumannii (MDRAB) in Wujiang area.MethodsA total of 44 nonduplicated MDRAB isolated from patients in 3 general hospitals in Wujiang area from January 2010 to December 2013 were collected. Minimum inhibitory concentrations(MICs) were detected, carbapenemase genes OXA51, OXA23, OXA24, OXA58, IMP, TEM, SHV, and GES were amplified with polymerase chain reaction(PCR), homology of strains was detected with pulsedfield gel electrophoresis(PFGE).Results44 MDRAB strains were mainly collected from sputum (93.18%), mainly distributed in intensive care unit (ICU), department of respiratory diseases, and department of neurosurgery, accounting for 45.45%, 27.27%, and 13.64% respectively; MDRAB were both sensitive to minocycline and polymyxin B, resistance rates to piperacillin, ampicillin/sulbactam, ceftazidime, gentamicin, amikacin, and ciprofloxacin were all 100.00%, resistance rates to imipenem and meropenem were both 97.73%. 44 MDRAB strains were all detected OXA51, OXA23 and TEM genes, 12 strains were positive for GES gene, 1 strain was positive for OXA58 and SHV respectively, OXA24 and IMP genes were not found ; MDRAB were divided into 7 types of GA, which included 19, 3, 9, 3, 1, 4, and 5 strains respectively, type A was mainly from two large general hospitals in Wujiang area (Wujiang First People’s Hospital and Shengze Hospital), type B, D and E strains were not detected in Wujiang First People’s Hospital, type E strain was only 1 isolate and was from Yongding Hospital, the other types were sporadically distributed.ConclusionMultidrug resistance of clinically isolated Acinetobacter baumannii is serious in Wujiang area, OXA23 and TEM genes are major causes of multidrug resistance in Acinetobacter baumannii, the main types are A and C, which present clonal spread.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing lower respiratory tract (LRT) infection in an intensive care unit(ICU), and provide reference for empiric therapy.Methods2 613 pathogenic strains isolated from LRT of patients in an ICU in 2011-2015 were performed statistic and antimicrobial susceptibility analysis.ResultsOf 2 613 strains, 2 308（88.33％) were gramnegative bacteria，236(9.03％) were grampositive bacteria, and 69(2.64％) were fungi. The top 5 pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Serratia marcescens, accounting for 33.64%，16.42%，15.19%，7.35%, and 4.90% respectively. Resistance rates of Acinetobacter baumannii to most antimicrobial agents were＞75.00%，resistance rate to imipenem was 80.32%；resistance rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, and Serratia marcescens to imipenem were 16.08%-34.38%, to amikacin, cefepime, and piperacillin/ tazobactam were all＜30.00％. Susceptibility of grampositive bacteria to vancomycin and linezolid were both 100.00%. Resistance rates of Staphylococcus aureus and Staphylococcus heamolyticus to oxacillin were 81.77% and 100.00% respectively.ConclusionGramnegative bacteria are the main pathogens isolated from LRT in ICU patients, and nonfermentative bacteria ranked the first. Antimicrobial resistance are serious for most pathogens, antimicrobial agents should be chosen rationally according to antimicrobial susceptibility testing results.

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ObjectiveTo investigate the types, antimicrobial resistance, and disinfectant resistance of pathogens isolated from hospital environmental inanimate surfaces and hands of health care workers (HCWs).MethodsPathogens isolated from hospital environmental inanimate surfaces and hands of HCWs in intensive care units and general wards in 16 hospitals in Beijing were performed bacterial identification, antimicrobial susceptibility testing, and disinfectant resistance testing. The carriage of antimicrobial resistance genes and disinfectant genes in pathogens were also detected.ResultsA total of 979 specimens were collected from inanimate surfaces and hands of HCWs in 16 hospitals, 75（7.66%）pathogenic strains were isolated, 78.67% of which were gramnegative bacilli. The top 3 pathogens were Pseudomonas aeruginosa (P.aeruginosa, n=24), Enterobacter cloacae (E. cloacae, n=14), and Klebsiella pneumoniae (K. pneumoniae, n=4). One P. aeruginosa strain was resistant to aztreonam, gentamycin, tobramycin, ciprofloxacin, and levofloxacin; One E. cloacae strain was resistant to piperacillin, 7 strains were resistant to nitrofurantoin; 4 K. pneumoniae strains were all resistant to piperacillin, 2 were resistant to cephalosporins, and 1 was resistant meropenem. P. aeruginosa had 7 drugresistant genes, positive rate of mir was 100.00%; E. cloacae had 4 drugresistant genes, positive rates of tem 1and shv were both 100.00%; K. pneumoniae had 5 drugresistant genes, positive rates of shv and mir were both 100.00%. The resistant rates of P. aeruginosa and E. cloacae to chlorhexidine gluconate were 4.17% and 57.14% respectively, to trichloroisocyanuric acid were both 50.00%, positive rates of drugresistant genes （qacE△1sul 1）were 79.17% and 57.14% respectively； K. pneumoniae had no resistance to two kinds of disinfectant, dugresistance gene was not found.ConclusionMultiple common pathogens which can cause healthcareassociated infection exist in hospital environmental inanimate surfaces and hands of HCWs, which are dominated by gramnegative bacilli, pathogens had resistance to antimicrobial agents and disinfectant in different degrees.

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ObjectiveTo study the risk factors for healthcareassociated infection (HAI) in burn patients undergoing surgery, and provide theoretical basis for the effective reduction of HAI in burn patients.Methods480 burn patients who underwent surgery in a tertiary firstclass comprehensive hospital from January to December 2015 were surveyed retrospectively, risk factors for HAI were analyzed.ResultsAmong 480 burn patients, 38 had 44 times of HAI, incidence and case incidence of HAI were 7.92% and 9.17% respectively. The main infection sites were surgical site (n=19, 43.18 %), bloodstream (n=8, 18.18%), and lower respiratory tract(n=5, 11.36%). Univariate analysis result showed that combined diabetes， timing of surgery, duration of surgery，stay in intensive care unit，length of hospital stay, mechanical ventilation, central venous catheterization, and urinary tract catheterization were all related with the occurrence of HAI (all P< 0.05); Multivariate logistic regression analysis showed that duration of operation≥3 hours（OR=4.455，P＜0.001), length of hospital stay＞30 days（OR=4.417，P＜0.001), and urinary tract catheterization（OR=4.215，P＜0.001) were all risk factors for HAI in burn patients undergoing surgery.ConclusionStrengthening perioperative management, shortening duration of surgery，reducing unnecessary urinary catheterization, and shortening length of hospital stay can effectively reduce the occurrence of HAI in burn patients undergoing surgery.

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ObjectiveTo study the occurrence, risk factors, and direct economic losses caused by healthcareassociated infection(HAI) in hemodialysis patients in a hospital.Methods840 patients who underwent hemodialysis in this hospital from April 2012 to September 2014 were selected, incidence of HAI, related factors, and economic losses due to HAI were investigated.ResultsAmong 840 hemodialysis patients, 89 patients developed 104 times of HAI, HAI density was 4.27‰. Multivariate regression analysis showed that young age and old age, combined multiple diseases, long duration of hemodialysis, two or more intubation sites, prolonged intubation, long length of hospital stay were all risk factors for HAI（OR=1.123-2.325）; Fees for bed, consultation, examination, treatment, nursing, medicine, and others in HAI group were all significantly higher than noninfected group（H=49.6-1 038.9, all P<0.01）, difference in medicine fees was most significant.ConclusionRisk factors for HAI are young age and old age, combined multiple diseases, long duration of hemodialysis, two or more intubation sites, prolonged intubation, and long length of hospital stay, the occurrence of HAI can increase the economic burden of hemodialysis patients.

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ObjectiveTo understand the identification and in vitro antifungal susceptibility of Penicillium marneffei(PM) in yeast phase, and guide clinic antifungal application. MethodsStrains isolated from blood and bone marrow of 23 patients infected with PM in a hospital between 2009 and 2016 were collected, colony morphology of PM in yeast phase was observed, susceptibility to itraconazole, voriconazole, amphotericin B, and fluconazole were detected with Etest method.ResultsColony morphology of PM were as follows: direct microscopic examination of Wright’s staining of tissue specimens found visible oval or round spore with apparent septum, and mainly located in macrophage; Gram staining of blood culture specimens found that strains were with bulbous and slightly curved ends, occasionally branched and with septum. PM was dimorphic fungi, presented mycelium at 28°C, produced red pigment and diffused into medium; PM presented yeast form at 35°C, there were typical colony morphology. Minimum inhibitory concentrations (MICs) of itraconazole, voriconazole, amphotericin B, and fluconazole to PM in yeast phase were 0.002-0.016, 0.012-0.125, 0.002-0.500, and 0.500-16.000 μg/mL respectively.ConclusionTypical colony morphology and fungal spore of PM in bone marrow and peripheral blood are important features for identification. PM is most susceptible to itraconazole, followed by voriconazole and amphotericin B, while fluconazole is less susceptible.

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ObjectiveTo explore characteristics and risk factors for surgical site infection(SSI) in patients in the department of neurosurgery, so as to provide theoretical basis for prevention and control of SSI.MethodsClinical data of patients who were admitted to a department of neurosurgery from January to December 2015 were collected with retrospective survey method, SSI and risk factors in patients were analyzed.ResultsAmong 715 patients undergoing neurosurgery, 40(5.59%) had SSI. SSI mainly occurred in patients following cerebral vascular surgery, accounting for 7.69%, followed by patients following intracranial tumor surgery(5.94%). 40 patients were all with organ space/ intracranial infection. Difference in SSI in patients with different types of operation, duration of operation, length of hospital stay, and National Nosocomial Infections Surveillance (NNIS) scores were all significant(all P＜0.05).ConclusionIncidence of SSI in patients in the department of neurosurgery are related with operation type, duration of operation, length of hospital stay, and operation risk index, preventive measures should be taken to reduce the incidence of SSI.

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ObjectiveTo investigate the direct economic losses caused by healthcareassociated infection(HAI) in patients with acute lymphoblastic leukemia (ALL) and acute nonlymphoblastic leukemia (ANLL).MethodsAll acute leukemia (AL) adult patients who were admitted to a hematology ward in a hospital between January 2011 and December 2013 were included in the study, HAI group(case group) and nonHAI group (control group), ALL group and ANLL group were matched respectively in a 1:1 ratio, hospitalization expenses and length of hospital stay were compared.ResultsA total of 994 patients were included, 166 were with ALL, 828 with ANLL, there were 181 pairs of case group and control group, and 15 pairs of ALL group and ANLL group. Direct economic losses in ALL group and ANLL group were 13 089.0 ￥ and 21 565.0 ￥ respectively ; extension of length of hospital stay due to HAI were 10.5 and 10.0 days respectively, differences were statistically significant between case group and control group (both P<0.05). The total hospitalization expense, as well as fees for bed, consultation, treatment, laboratory examination, nursing, medicine, traditional Chinese medicine, and blood transfusion in ANLL group were all higher than ALL group, but there were no significant difference.ConclusionHAI in patients with AL can increase hospitalization cost and prolong length of hospital stay.

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ObjectiveTo investigate infection status and distribution characteristics of human immunodeficiency virus (HIV) infection among voluntary blood donors in Xiangyang area in 2009-2014, and provide evidence for recruiting blood donors from lowrisk population.MethodsBlood specimens of 326 856 voluntary blood donors in Xiangyang area between January 2009 and December 2014 were detected antiHIV with enzyme linked immunosorbent assay(ELISA), positive specimens in HIV screening were performed confirmatory testing, epidemiological analysis was conducted on the positive detection results.Results41 (0.13‰) voluntary blood donors were confirmed positive for HIV in Xiangyang area, positive rate among each year was significantly different (χ2=27 801.87，P<0.01). Except marital status and infection routes, difference in positive rates among donors of different gender, age, area, occupation, educational attainments, and number of blood donation were all significantly different(all P<0.01). Among HIVinfected voluntary blood donors, 87.80% were male, 41.46% and 31.71% were aged between 18-25 and 36-45 respectively，56.10% were through heterosexual transmission, and 43.90% were through male homosexual transmission. The percentage of workman and public service personnel infected with HIV were high, accounting for 21.95% and 17.07% respectively，60.97% of confirmed positive HIV were from city area, 56.10% only received junior middle school/technical secondary school education, 65.85% of HIVinfected persons were infected at the initial donation.ConclusionIn order to ensure blood safety, blood center should increase publicity efforts, carry out health consultation before blood donation, and recruit blood donors from lowrisk populations, nucleic acid detection should be carried out to shorten HIV detection window period.

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ObjectiveTo investigate the incidence of surgical site infection(SSI) and compliance to bundle intervention measures on SSI following total abdominal hysterectomy in patients in department of gynaecology of a tertiary firstlass hospital, and evaluate the efficacy of bundle intervention measures in prevention and control of SSI.MethodsFrom March 2014 to October 2015, all gynecology patients undergoing total abdominal hysterectomy were as targeted monitored subjects, MarchSeptember 2014 was baseline investigation stage, October 2014 to October 2015 was intervention stage(new bundle intervention measures were performed), compliance to bundle intervention measures and incidence of SSI before and after intervention were compared.ResultsA total of 222 episodes of total abdominal hysterectomy were monitored, the incidence of SSI was 5.86%, the operation P75 time were 2 hours. Compared with the baseline stage, the compliance to most traditional intervention measures improved after intervention, the largest increase in the compliance to interventions was followup after surgery (increased by 64.16%), followed by preoperative perineal disinfection(increased by 39.07%) and hand hygiene(increased by 21.34%). Compliance to new intervention measures was 100.00%. Incidence of SSI following total abdominal hysterectomy after intervention was significantly lower than before intervention(2.27%［3/132］ vs 11.11%［10/90］), difference was significant (χ2=7.583, P＜0.05）.ConclusionTargeted monitoring on SSI following total abdominal hysterectomy can improve compliance to bundle intervention measures and decrease incidence of SSI.

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ObjectiveTo investigate the baseline condition of initial and acquired drug resistance in patients with pulmonary tuberculosis in Xi’an city, and provide a scientific basis for the prevention and control of drugresistant tuberculosis.MethodsPatients with positive Mycobacterium tuberculosis(MT) culture and received initial treatment and retreatment in tuberculosis clinics of 14 districts (counties) in Xi’an  and Xi’an Chest Hospital in 2015 were included in the study, antimicrobial susceptibility testing of 4 kinds of firstline antituberculosis drugs were performed.ResultsThe overall drug resistance rate of MT in Xi’an city was 31.9%, multidrug resistance rate (MDR) was 7.0%. Drug resistance rate and MDR in initial treatment group were 27.3% and 3.5% respectively, in retreatment group were 59.5% and 28.6% respectively, drug resistance rate and MDR in retreatment group were both higher than initial treatment group (both P<0.001).ConclusionThe overall drug resistance rate of pulmonary tuberculosis patients in Xi’an city is lower than the whole nation, but MDR is slightly higher than the national level, although TB prevention and control work has achieved some success, the situation is still serious, the management of patients with initial treatment should be strengthened to reduce the occurrence of drug resistance.

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ObjectiveTo study the epidemiological characteristics and influencing factors of handfootmouth disease(HFMD) outbreaks in kindergartens, so as to provide reference for control and prevention of HFMD.MethodsPapers published between 2009 and 2015 about HFMD outbreaks in kindergartens were retrieved from Wanfang database and China National Knowledge Infrastructure(CNKI), then collected papers were analyzed.ResultsData about 39 cases of HFMD outbreaks were obtained, 35 cases occurred in 2008-2012, 1 case occurred respectively in  2007, 2013, 2014, and 2015. 33.34% and 23.08% of outbreaks occurred in May and April. Outbreaks lasted 5-52 days, with a median of 11 days, 30.77% of outbreaks lasted more than 2 weeks. The attack rates of the whole kindergartens were 1.90%-39.74%, attack rates of whole kindergartens were 5%-15% among 65.79% of outbreaks，attack rate of whole kindergartens was ＞20% among 13.16% of outbreaks. 85.71% of outbreaks involved more than 20% of classes, 25.71% of which involved all classes. Both EV71 and CoxA16 caused HFMD outbreaks in kindergartens, two kinds of viruses were both detected in some outbreaks; there were no significant difference in attack rate of whole kindergartens, attack rate of classes with highest incidence, class involving rate, and duration of epidemic between EV71 and CoxA16 epidemic groups（all P>0.05）.ConclusionOnce an HFMD outbreak occurred in a kindergarten, epidemic intensity would be high, both EV71 and CoxA16 can cause HFMD outbreak. There is no obvious correlation between class size and attack rate.

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ObjectiveTo understand the cleaning status of hospital environment, and evaluate the effect of fluorescence labeling method plus feedback and training on hospital environmental cleaning effectiveness.MethodsA total of 27 departments in a hospital were investigated, 1 cleaning staff and 2 inpatients were selected from each department, cleaning staff’s knowledge about cleaning and disinfection of environmental object surfaces, as well as cleaning status of inpatients’ wards were surveyed, cleaning efficacy of hospital environmental object surfaces were detected with fluorescence labeling method, the surveyed results were performed timely feedback to clinical departments, training on cleaning and disinfection knowledge was conducted, the effective cleaning rate of environmental object surface before and after the training was compared.ResultsA total of 27 cleaning staff were surveyed, the correct response rate for cleaning frequency was 96.30%，awareness rate for section concept was 96.30%，accuracy rate of cleaning order was 92.59%，accuracy rate of postcleaning immersion time of sanitary wares in disinfectant was 85.19%，accuracy rates of replacing, drying, and repeated immersing wiping cloths were 81.48%，48.15%，and 25.93% respectively， rates of correct disinfectant formulating method and mop drying time were both 0. Among 54 investigated patients, bed units and ground of wards of 28 patients were cleaned both 1-2 times /day; bed units of 8 patients had never been wiped, 18 patients in 9 departments cannot be conducted statistics due to completely inconsistent responses with the other patients of the same departments. The effective cleaning rates of environmental object surfaces before and after the training were 34.62% and 64.96% respectively，difference was significant（χ2=21.81，P＜0.01）.ConclusionFluorescence labeling method plus feedback and training can improve cleaning efficacy of hospital environmental object surfaces.

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ObjectiveTo assess the knowledge, attitude and practice among health care workers(HCWs) in key departments on prevention and control of healthcareassociated infection(HAI), take intervention measures, and provide scientific basis for the prevention and control of HAI in medical institutions.MethodsAll HCWs in departments of pediatrics, respiratory diseases，and emergency were surveyed, change in knowledge, attitude and practice among HCWs with different professional titles on prevention and control of HAI before and after the intervention were compared.Results317 HCWs participated in the survey, there were 275 (86.75%) available questionnaires before intervention and 311(98.11%) after intervention. After intervention, scores for HCWs with senior, intermediate, junior and below professional titles on knowledge were (9.15±2.36）, （7.69±2.05）, and （7.73±2.32）respectively，which were all higher than（6.46±2.12）,（5.30±1.55）,（6.16±1.80） before intervention，difference was statistically significant（all P＜0.05）. After intervention, scores for HCWs of junior and below professional titles on attitude and practice were （91.50±9.26） and （86.40±14.52）respectively，which were both higher than （85.95±13.36） and （76.01±15.25）before intervention，differences were both statistically significant（both P＜0.05）; while scores for HCWs of senior and intermediate professional titles on attitude and practice were not statistically significant（both P>0.05）.ConclusionCompared with the knowledge about HAI prevention and control, more effect needs to be put for achieving change in HCWs’ attitude and practice towards HAI prevention and control; change in attitude and practice among HCWs of junior and below professional titles on HAI prevention and control is easier to be implemented.

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目的了解某院中段尿标本分离病原菌及其对抗菌药物的耐药性，为临床抗菌治疗提供实验室参考依据。方法对该院2012年10月1日—2015年9月30日临床送检的中段尿标本分离病原菌进行鉴定和药敏试验，应用WHONET 5.6软件对药敏结果进行分析。结果1 501份中段尿标本共检出病原菌658株，其中革兰阳性菌151株，占22.95%，以凝固酶阴性葡萄球菌和肠球菌为主；革兰阴性菌456株，占69.30%，其中大肠埃希菌占45.44%；真菌51株，占7.75%。病原菌对常用抗菌药物耐药性差异较大，其中大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中超广谱β内酰胺酶（ESBLs）菌株的检出率分别为52.84%、41.67%和33.33%，ESBLs菌株的耐药性高于非产超广谱β内酰胺酶菌株。结论该院中段尿标本分离的病原菌以大肠埃希菌为主，分离菌株对常用抗菌药物耐药严重。

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目的了解基层医务人员职业暴露的特点，提高医务人员职业防护意识，减少职业暴露的发生。方法调查2012年1月—2015年8月该院发生职业暴露上报医院感染管理科的医务人员职业暴露情况。结果178名医务人员共报告职业暴露197例次，以30岁以下者居多，占79.21%；以护士、实习进修人员为主，所占比率分别为41.57%、34.83%。针刺伤及锐器损伤（79.70%）是主要的暴露方式，暴露源疾病以乙型肝炎病毒为主（18.78%）。结论护士、实习进修人员是职业暴露的高危人员，医院应加强职业安全教育，实施标准预防，减少医务人员职业暴露。

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下呼吸道是医院细菌感染最常见的感染部位，鲍曼不动杆菌（Acinetobacter baumannii，AB)因易定植、易变异和多耐药等特点，成为下呼吸道感染最常见的病原菌，而多重耐药鲍曼不动杆菌(multidrugresistant Acinetobacter baumannii，MDRAB)引发的下呼吸道感染病死率非常高，临床治疗尤为困难［1-3］。以往认为，下呼吸道在生理条件下处于无菌状态，从患者下呼吸道标本分离的AB应视为病原菌，然而随着分子生物学技术研究的深入，发现下呼吸道也可出现AB的无症状定植状态。若将定植误诊为感染，易导致过度使用广谱抗菌药物，延长住院时间，并加重患者经济负担，增加耐药菌及其医院传播的风险。若将感染误诊为定植，则可能导致感染扩散，延误病情，甚至产生严重后果。故正确鉴别来源于患者下呼吸道标本的AB是感染还是定植，对临床治疗和控制MDRAB感染意义重大。如何判断培养的病原体为定植还是感染，是困扰临床医生的重要问题，相关学者一直在研究和探寻成熟有效的解决方法。本文对下呼吸道AB感染与定植的研究情况作一综述。

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氯己定又名洗必泰，化学名称为1,6双己烷，又名双氯苯双胍己烷，英文名chlorhexidine。氯己定属于胍类低效消毒剂，与高浓度醇类互配后能达到中效消毒水平，已被人们使用60多年［1］。氯己定有很多种复合制剂，常见的有醋酸氯己定、葡萄糖酸氯己定、氯己定醇、盐酸氯己定等，盐酸氯己定由于在水中溶解度较低，其制剂以膏剂、涂膜剂为主，实际应用中基本已被淘汰［2］。临床上常使用的氯己定复合制剂有氯己定漱口液、氯己定醇皮肤消毒剂、氯己定沐浴液等。近10年来，国际上对氯己定的研究主要集中在葡萄糖酸氯己定上［3-5］。关于氯己定全身擦浴能否减少医院感染的发生，目前尚无定论。本文通过文献检索，研究氯己定擦浴对多重耐药菌（MDRO）和导管相关血流感染（CRBSI）的预防作用。目前氯己定消毒剂的临床应用，主要用于全身术前准备、口腔护理、手卫生及皮肤的消毒。

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