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ObjectiveTo understand the pathogens causing neonatal septicemia, as well as changing trend of antimicrobial resistance, and provide evidence for clinical antiinfection treatment. MethodsResults of blood culture and antimicrobial susceptibility testing of pathogens from neonates with septicemia  who were admitted to the department of neonatology of a hospital from January 2009 to December 2014 were analyzed retrospectively, distribution of pathogens and antimicrobial resistance between 2009-2011 and 2012-2014 were compared. ResultsA total of 259 strains were isolated from blood specimens, grampositive bacteria, gramnegative bacteria, and fungi were 175(67.57%), 65(25.10%), and 19（7.33%）respectively. Coagulasenegative staphylococcus (CNS) was the main pathogen during 6 years, followed by Klebsiella pneumoniae(K. pneumoniae); the constituent ratio of the extendedspectrum βlactamase (ESBLs)producing strains increased from 10.56% to 15.38%, constituent ratio of fungi increased from 4.93% to 10.25%（P＞0.05）; The sensitivity of grampositive bacteria to vancomycin, teicoplanin, and linezolid were all 100.00%, 82.28%-88.33% of CNS and 75.00%-100.00% of Staphylococcus aureus were methicillinresistant; the resistance rates of K. pneumoniae and Escherichia coli to the thirdgeneration cephalosporins  were 42.86%-86.67%，to cefoperazone/sulbactam increased from 17.39% and 14.29% to 33.33% and 30.00% respectively, meropenem and imipenemresistant strains were not found. Resistance rate of Candida albican to fluconazole increased from 20.00% to 50.00%，all detected fungi remained sensitive to amphotericin B. ConclusionCNS are the major pathogens in neonatal septicemia, followed by K. pneumoniae, constituent ratio of fungal infection has increased. Antimicrobial agents should be chosen according to blood culture and antimicrobial susceptibility testing results.

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ObjectiveTo investigate the common bacteria and change in antimicrobial resistance in an intensive care unit (ICU) in the past 5 years, and provide evidence for rational use of antimicrobial agents.MethodsBacteria isolated from ICU patients in a tertiary firstclass hospital from 2009 to 2013 were collected, identified, and performed antimicrobial susceptibility testing.ResultsA total of 1 196 bacteria isolates were isolated in 2009-2013, the top five species were Acinetobacter baumannii (A. baumannii, 29.60%), Pseudomonas aeruginosa (P. aeruginosa, 14.38%), Staphylococcus aureus (S. aureus, 12.21%), Escherichia coli(E. coli, 12.21%), and Klebsiella pneumoniae(K. pneumoniae, 11.37%). Resistance rates of S. aureus to oxacillin, gentamycin, clindamycim, ciprofloxacin, and rifampicin showed a decreasing tendency from 2009 to 2013(all P＜0.05)， and no strain was detected to be resistant to vancomycin during 5 years. Resistance rates of P. aeruginosa to ceftazidime, cefepime, aztreonam, gentamycin, amikacin, tobramycin, and piperacillin/tazobactam decreased gradually (all P＜0.05), imipenem resistance rates were 32.26%-46.43% in 2009-2012 and 16.00% in 2013; A. baumannii  maintained a low level resistance to amikacin, tobramycin, and compound sulfamethoxazole（all P＜0.05），resistance rates to imipenem were all >80% in 2009-2011 and 10.53% in 2013, A. baumannii had high resistance rates to most antimicrobial agents(resistance rates were >80%) during 5 years. Resistance rates of K. pneumoniae  and E. coli to piperacillin/tazobactam, cefazolin, cefepime, amikacin, and  aztreonam had a decreased tendency in 2009-2013(all P＜0.05).ConclusionThe common bacteria causing infection in the ICU of this hospital showed a downward trend， which may be related to the introduction of national policies and management of hospital, continuous management of antimicrobial agents is suggested, antimicrobial agents should be used rationally to prevent the increase of bacterial resistance.

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ObjectiveTo explore the impact of healthcareassociated septicemia (HAS) on hospitalization expense as well as length of hospital stay， so as to optimize the allocation of healthcare resources, and provide scientific basis for reducing the economic burden caused by septicemia. MethodsHospitalized patients with confirmed HAS in a tertiary firstclass teaching hospital between June 1, 2012 and May 31, 2015 were investigated retrospectively, control group was set up in a 1:1 ratio, hospitalization expense and length of hospital stay between two groups were compared.ResultsA total of 285 cases and 285 controls were enrolled in the study, the median of hospitalization expense in case group was higher than control group (￥19 718.39 vs ￥9 289.04, P<0.05）; the median of length of hospital stay in case group was longer than control group (14.89 days vs 9.22 days， P<0.05）. The disease burden caused by septicemia in different age groups and departments were different. The improvement rate of case group was lower than control group (76.49% ［218/285］ vs 83.51% ［238/285］，χ2=2.562， P=0.009）. ConclusionAs the common blood stream infection in hospitalized patients, septicemia not only increased the expense of diagnosis and treatment, but also affected turnover rate of hospital bed. Rapid and effective diagnosis and treatment is significant o prevent and control septicemia.

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ObjectiveTo understand the status and pathogenic characteristics of healthcareassociated infection (HAI) in cardiovascular surgical intensive care unit (ICU) patients undergoing heart transplantation.MethodsPatients who underwent heart transplantation in a hospital between July 1, 2013 and June 30, 2014 were performed targeted monitoring.ResultsOf 66 patients undergoing heart transplantation, 16 developed 18 times of  HAI, incidence of HAI was 24.24%. Incidence of HAI and ventilatorassociated pneumonia(VAP) in patients undergoing heart transplantation were both higher than nontransplantation patients (24.24% vs 6.24%, χ2=33.718; 7.58% vs 1.72%, χ2=12.199，respectively, both P＜0.001）.The infection tyes were as follows: lower respiratory tract infection(n=7)， VAP (n=6), bacteremia (n=3), superficial incision infection (n=1), as well as skin and soft tissue infection (n=1). The isolated pathogens were fungus (n=8), Klebsiella pneumoniae(n=3), Staphylococcus aureus (n=2), Acinetobacter baumannii (n=2), Enterobacter cloacae (n=1), Acinetobacter haemolyticus (n=1), and Citrobacter freundii (n=1).ConclusionIncidence of HAI is high in patients undergoing heart transplantation, the main infection type is lower respiratory tract infection, the major pathogen is fungus.

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ObjectiveTo evaluate effect of intensive insulin treatment(IIT) on healthcareassociated infection (HAI) rate in patients with acute stroke and stress hyperglycemia.MethodsDatabases, including PubMed, Embase, Cochrane Library, WanFang, and China National Knowledge Infrastructure（CNKI） Data, were electronically searched, relevant journals and references of the included literatures were also searched manually, literatures were selected according to the uniform inclusion and exclusion criteria, incidence of HAI and mean blood glucose in patients who received IIT for acute stroke were assessed systematically.ResultsA total of 13 randomized controlled trials (RCT) involving 1 032 patients were included in this systematic review. Metaanalysis results showed that 10 studies involving 832 patients were finally enrolled for comparing HAI rate, HAI rates in IIT group and conventional insulin treatment group were 28.3% and 56.1%， respectively(Z=4.50)， difference between two groups was statistically significant  (RR=0.53 ［95 %CI: 0.40 to 0.70］, P＜0.001)； A total of 328 patients in 5 studies were finally included in the comparison of blood glucose, difference in mean blood glucose between two groups was statistically significant( MD=-2.52 ［95% CI: -4.30 to -0.74］, P=0.006). Funnel plot of HAI rate revealed that there was publication bias.ConclusionIIT is used for the regulation of stress hyperglycemia in acute stroke, it can reduce the incidence of HAI and blood glucose in patients.

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ObjectiveTo analyze risk factors and complication characteristics of healthcareassociated infection(HAI)  in patients with lung cancer, and provide evidence for the formulation of HAI management strategy. MethodsHAIrelated articles were retrieved from China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database, Vip database,PubMed, and Embase, all data were conducted Metaanalysis. ResultsA total of 19 articles involving 8 069 hospitalized patients with lung cancer (1 280 had HAI) were included. Metaanalysis on combined values of medical factors for HAI were as follows:  OR(95%CI) of antitumor therapy(radiotherapy and chemotherapy)， number of chemotherapy (≥2 times), antimicrobial prophylaxis, immunosuppressant therapy, and invasive operation were 3.13(1.82,5.39), 9.20(3.04,27.87), 3.23(1.77,5.91), 2.00(1.56,2.57), and 2.28(1.81,2.88), respectively； Metaanalysis on combined values of complication factors for HAI were as follows:  OR(95%CI) of pulmonary diseases，chronic obstructive pulmonary disease (COPD)， diabetes, renal dysfunction， malnutrition, hypoalbuminemia, neutropenia,and leukopenia were 2.65 (1.74, 4.02), 2.40 (1.76, 3.27), 2.25(1.85, 2.73), 2.56(1.18, 5.52), 5.51 (1.70, 17.89), 2.05(1.56, 2.70), 3.38(1.40, 8.18), and 2.10 (1.22, 3.62), respectively. ConclusionHAIrelated factors of medical treatment and complications in patients with lung cancer are diversity, risk factors for HAI in patients with lung cancer are antitumor therapy， immunosuppressant therapy, antimicrobial prophylaxis, invasive operation, pulmonary diseases， COPD，diabetes, renal dysfunction， malnutrition, hypoalbuminemia, neutropenia, and leucopenia.

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ObjectiveTo understand the current management situation of hand hygiene (HH) among health care workers(HCWs) in stomatology medical institutions in Zunyi, and provide basis for the scientific management of HH.MethodsIn OctoberDecember 2014, the onsite observation and questionnaire survey were adopted to investigate current management situation of HH in 127 stomatology medical institutions in Zunyi.ResultsThe rates of qualified installation of sink, faucet, detergent, alcoholbased hand rub, and handdrying facilities were 60.63%, 11.02%, 92.13%, 22.05%, and 37.80% respectively. Except detergent and sink, the installation of other HH supplies in stomatology medical institutions in Zunyi were not ideal. The correct rate of HH among HCWs was 33.07%（42/127）， qualified rates of HH methods among HCWs in departments of stomatology, comprehensive outpatient departments, stomatological clinics, and teethcleaning clinics were 50.00%, 23.08%, 23.53%, and 0 respectively.ConclusionHH facilities are not perfect in primary stomatology medical institutions in Zunyi, health administrative departments’ supervision on HCWs’ HH  is inadequate, the awareness rate of HH knowledge and compliance to HH among HCWs are both low.

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ObjectiveTo evaluate the intervention efficacy of ATP bioluminescence assay in environmental hygiene quality in an intensive care unit (ICU).MethodsFrom December 2013 to February 2014, the baseline status of object surfaces in the ICU of a hospital was detected, then ATP bioluminescence assay was adopted to detect and intervene ICU object surfaces, environmental hygiene quality was evaluated.ResultsIn the baseline survey, a total of 627 object surfaces were monitored，qualified rate was 61.2%(n=384). The median of relative light unit (RLU) of head of bedrails, telephone keyboards, doorknobs, and computer mice were all > 300. Before,during,and after intervention, qualified rates of object surfaces were 61.2%, 76.6%, and 90.0% respectively （χ2=142.23，P＜0.001）; after intervention, qualified rate of ICU working environment, main instruments and equipments, and other medical devices  were all higher than before intervention (85.5% vs 48.8%, 98.3% vs 84.4%, 92.6% vs 69.1%，all  P＜0.05).ConclusionATP bioluminescence assay can easily and quickly detect disinfection efficacy, it is helpful for timely and effective intervention in ICU, and improving the qualified rate of environmental hygiene.

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ObjectiveTo explore clinical features and antimicrobial resistance of lower respiratory tract infection (LRTI) with Streptococcus pneumoniae (S. pneumoniae) isolated from children in Nanjing.MethodsClinical data of children with confirmed S. pneumoniae LRTI through sputum culture at a children’s hospital in Nanjing between July 2013 and June 2014 were analyzed retrospectively, S. pneumoniae strains were performed antimicrobial susceptibility testing through KB method and minimum inhibitory concentration (MIC) testing.ResultsAmong 197 children with S. pneumoniae infection, 72.59% were ＜3 years old, 63.96% occurred in autumn and winter， 57.87％ had elevated leukocyte count, cough and fever were the most common clinical symptoms, complications of digestive and circulatory system were also common. The resistance rates of S. pneumoniae to azithromycin, penicillin, and erythromycin were 94.92%, 92.98%, and 88.83% respectively; the sensitivity rates to vancomycin, chloramphenicol, meropenem, ceftriaxone, and ofloxacin were all ＞90%, vancomycin was up to 98.98%.ConclusionThe percentage of S. pneumoniae LRTI is high in children< 3 years old, most occur in autumn and winter, resistance rates to azithromycin, penicillin, and erythromycin are all high, antimicrobial agents should be selected for the treatment of infection according to antimicrobial susceptibility testing.use

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ObjectiveTo study application effectiveness of different concentrations of chlorhexidine oral care solution in patients with orotracheal intubation. MethodsA total of 120 patients who were admitted to the general intensive care unit (ICU) of a hospital and undergoing mechanical ventilation via orotracheal intubation for >48 hours between January 2012  and  December 2013 were included in the study, they were divided randomly into three groups, 40 in each group. Trial group, control group I, and control group II were provided with 2%,0.2%, and 0.12% chlorhexidine oral care solution, respectively. Differences in halitosis, oral mucosal infection, onset time and incidence of ventilatorassociated pneumonia (VAP) among  three groups were observed and compared. ResultsThere were  significant difference in incidence of VAP  and earlyonset VAP between trial group and  control group I, trial group and  control group II, respectively(both P<0.05); incidence of  VAP in  control group II was higher than trial group（47.50% vs 20.00%，P=0.009）. Conclusion2% chlorhexidine oral rinsing and swabbing can effectively reduce incidence of VAP in patients with orotracheal intubation.

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ObjectiveTo investigate the effect of preoperative chlorhexidine bath for reducing the incidence of surgical site infection(SSI) in patients undergoing spinal surgery.MethodsAll patients who undergoing spinal surgery (with no implants) in the department of neurosurgery of a hospital between January 2013 and December 2014  were monitored, the selected patients were divided into control group (JanuaryDecember of 2013, no intervention measures were taken) and trial group(JanuaryDecember of 2014, 1.8%-2.2% chlorhexidine bath for two nights before operation), incidence of  SSI between two groups of patients before and after intervention was compared, interventions effect was evaluated.ResultsA total of 1 043 patients undergoing spinal surgery were enrolled, 41(3.93%) had SSI， incidence of SSI  rates in control group and trial group were 6.47% and 2.34% respectively， the difference was statistically significant (P=0.001). According to the incidence of SSI in control group, actual infected patients in  trial group were 27 less than the anticipated patients with infection.The average hospitalization expense in SSI group and nonSSI group were ￥33 641.00 and ￥23 072.50 respectively，each patient could save  ￥10 568.50 on average. Therefore, through the intervention measures, ￥285 349.50 of hospitalization expense could be saved. Except ￥2 100 of trial material cost and ￥12 820 of manual labour cost, ￥270 429.50 of social cost was ultimately saved. The mean length of hospital stay in control group and trial group were 10 (8-12) days  and 9 (8-12) days respectively，rank test showed that the difference was not statistically significant（Z=-0.68，P=0.50）.ConclusionChlorhexidine bath intervention can not only reduce SSI rate， but also save the expense of hospitalization, whether it can shorten the length of hospital stay needs to be further studied.

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ObjectiveTo understand the risk factors for poor prognosis of severe adenovirus pneumonia (SAP) in children, and provide guidance for clinical diagnosis and prognosis.MethodsClinical data of 91 hospitalized children who diagnosed with SAP in Chongqing Children’s Hospital of Chongqing Medical University between January 2012 and  January 2014 were analyzed retrospectively.ResultsOf 91 SAP children, 23（25.27%）had poor prognosis. Univariate analysis showed that risk factors for poor prognosis of SAP were age of onset, congenital heart disease and other serious underlying diseases, mechanical ventilation therapy, acute respiratory distress syndrome (ARDS), atelectasis and other serious radiological changes, and emergence of two and more  extrapulmonary complications (all P<0.05）. Multivariate regression analysis showed that congenital heart disease and other serious underlying diseases, and emergence of two and more  extrapulmonary complications were independent risk factors for poor prognosis of SAP  (all P<0.05）.ConclusionCongenital heart disease and other serious underlying diseases, emergence of two and more extrapulmonary  complications are independent risk factors for poor prognosis of SAP, active intervention should be conducted during the process of clinical diagnosis and treatment, so as to improve the prognosis.

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ObjectiveTo investigate the occurrence of postoperative healthcareassociated infection(HAI) and its risk factors in neurosurgical patients undergoing removal of intracranial tumor, so as to provide theoretical basis for formulating intervention measures.MethodsProspective survey was adopted to monitor the occurrence of postoperative HAI in patients who admitted to the department of neurosurgery of a hospital and underwent selective removal of intracranial tumor between April 2013 and December 2014 , risk factors for HAI were analyzed with univariate and multivariate logistic regression analysis.ResultsA total of 1 218 patients were surveyed, 163 patents developed 193 times of postoperative HAI, incidence of postoperative HAI was 13.38%, case incidence of HAI was 15.85%. The main HAI site was  intracranial site（n=125，64.77%）, the next was lower respiratory tract （n=55，28.49%）. Multivariate logistic regression analysis showed that operation grade and subtentorial operation were independent risk factors for postoperative HAI in neurosurgical patients undergoing removal of intracranial tumor, OR and 95%CI were 4.352（1.878-10.080）and 1.812（1.280-2.564） respectively. ConclusionRisk of postoperative HAI in neurosurgical patients undergoing high grade operation and subtentorial  removal of intracranial tumor is high, effective prevention and control measures should be taken to prevent the occurrence of HAI.

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ObjectiveTo evaluate the diagnostic value of chest Xray film of pulmonary emphysema (PE) signs for infantile bronchitis.MethodsClinical data of 60 infants with bronchitis (case group) in a hospital between January 2010 and December 2014 were analyzed retrospectively, and compared with data of 30 infants with nonrespiratory diseases (control group).ResultsOf 60 infants with bronchitis in case group, 95.00%（57/60） showed manifestations of PE on Xray, and 18.33%（11/60）of whom were with mild PE（apical or intercostal pneumocele）, 76.67%（46/60） were with typical PE (diaphragm descent); one case （3.33%）in control group showed intercostal pneumocele, the other 29 cases (96.67%）were normal Xray findings and without signs of PE. The sensitivity, specificity and accuracy of PE signs on chest Xray film for diagnosing infantile bronchitis were 95.00%, 96.67%, and 95.56% respectively.ConclusionSigns of PE on chest Xray film have important diagnosis value for infantile bronchitis.

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ObjectiveTo evaluate the efficacy and safety of linezolid in the treatment of grampositive coccus infection in the elderly.MethodsClinical data of patients (>60 years old) infected with grampositive coccus and treated with linezolid for 10 days between January  2013 and December 2014 were collected, the therapeutic efficacy of linezolid were analyzed, laboratory indexes before and 14 days after   linezolid treatment were compared, possible adverse effects were analyzed.ResultsA total of 70 old patients were enrolled, the majority of patients were infected in lower respiratory tract (62.86%)  and were infected with Staphylococcus aureus (42.86%, of which 19 were MRSA), more than 80% of the patients were >70 years old, had length of stay > 30 days, and admitted in ICU, more than 70% of the patients were with deep venous catheterization and indwelling urinary catheterization. Platelet count (PLT) after 14 days of linezolid treatment was significantly lower than before treatment（［132.00±45.00］×109/L vs ［156.00±78.00］ ×109/L, P=0.009); the total therapeutic efficacy of linezolid was 81.43%(57/70), while the rate of adverse effects was 17.14% (12/70).ConclusionLinezolid is effective for treatment of grampositive coccus infection in the elderly, and may be a good choice of empirical treatment. PLT should be intensively monitored during the process of linezolid therapy.

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ObjectiveTo evaluate the efficacy of disinfection and isolation measures in a hospital that received and treated the first case of imported Middle East respiratory syndrome（MERS）in China.MethodsThe first MERS case in China was admitted in the negative pressure room of the intensive care unit in a hospital on May 28, 2015, a series of disinfection and isolation measures were taken for controlling and preventing MERS coronavirus (MERSCoV) infection.ResultsOne case of MERS confirmed by Guangdong Provincial Center for Disease Control and Prevention (CDC) and Chinese CDC were admitted in a hospital at 2:30 of May 28, 2015, throat swabs and blood specimens of patients were detected as positive for MERSCoV by realtime polymerase chain reaction. On the 3rd day, 8th day, 2 week after admission, and on June 21, throat swabs, blood, stool, and sputum specimen culture were negative respectively; before patient’s discharge, throat swabs, sputum, blood, and stool specimen culture were all negative for consecutive two times, there was no fever for 10 consecutive days, clinical symptoms were improved, patient finally recovered and was discharged on June 26. Detection of MERSCoV were all negative for nasal swabs, throat swabs, and blood specimens from all health care workers (HCWs) participated in the treatment for MERS;  all HCWs were performed physical examination from June 26 to July 10, none of them felt discomfort, there was no infection occurred among them. On the 7th, 13th day of admission, and following terminal disinfection, specimens of environment and object surface were taken and performed detection of MERSCoV, all were negative.ConclusionStrict implementation of disinfection and isolation measures can effectively cut off the routes of MERSCoV transmission and protect the safety of  HCWs.

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ObjectiveTo understand colonization of pathogens in nasal vestibular of health care workers (HCWs) in intensive care unit(ICU), and provide evidence for strengthening the prevention and control of healthcareassociated infection (HAI) in ICU. MethodsOn may 2015, colonization status of pathogens in nasal vestibular of uninfected HCWs in ICU were actively screened, bacterial culture, isolation and identification were performed. The surveyed results were analyzed and compared with antimicrobial resistance of pathogens from patients at the same stage. ResultsA total of 96 HCWs were surveyed, 43 pathogenic strains were isolated from different HCWs’  nasal vestibular, isolation rate and carriage rate were both 44.79%. The main pathogenic bacteria was Staphylococcus aureus(n=15， 34.88%）, followed by Enterobacter aerogenes(n=9， 20.93%） and Klebsiella pneumoniae(K. pneumoniae,  n=7，16.28%）. There was a high detection rate of pathogens from nasal vestibular of doctors, HCWs who smoked frequently and those who never exercised (all P<0.05). There were 1 strain of imipenemresistant K. pneumoniae among 43 pathogenic strains. Resistance rate of 7 K. pneumoniae from HCWs to ampicillin/sulbactam, cefazolin, and furantoin were all >50.00%, resistance rates to cefotaxime and imipenem were 28.57% and 14.29% respectively； resistance rates of 11 strains of K. pneumoniae from patients to furantoin was 100.00% during the same stage, but were sensitive to other commonly used antimicrobial agents. Resistance rate of 4 strains of Escherichia coli (E. coli)to ampicillin was 75.00%, to gentamicin, tobramycin, levofloxacin, ciprofloxacin, and compound sulfamethoxazole were all 50.00%， 6 strains of E. coli isolated from patients during the same period were found to be resistant to most commonly used antimicrobial agents. ConclusionColonization rate of pathogens is high in nasal vestibular of HCWs in ICU, active screening and monitoring on colonization of pathogens in HCWs’  nasal vestibular is significant for preventing the occurrence and cross transmission of HAI among HCWs and patients.

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目的总结中国埃博拉治疗中心卫生防疫工作中遇到的问题及对策，为未来类似传染病的防控和医疗中心的管理提供借鉴。方法中国医疗队于2014年11月中旬奔赴利比里亚抗击埃博拉病毒病（EVD），笔者作为抗埃援利医疗队中的一员，全程参与了医疗队卫生防疫组的日常工作，将卫生防疫工作遇到的问题及对策进行总结。结果面对含氯消毒剂泄漏、氯气污染、焚烧炉故障等问题，卫生防疫组积极采取了调整放水策略、防护氯气危害、维修旧炉并安装新炉等应对措施。由于处置得当，保证了医疗队各项工作的顺利开展，实现了医务人员“零感染”的目标。结论合理的设计、详尽的预案和对突发情况的灵活处理，是卫生防疫工作成功的关键，此次经验可以为以后的传染病疫情防控工作提供借鉴。

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目的探讨重症监护病房（ICU）留置导尿管患者发生导尿管相关泌尿道感染（CAUTI）的危险因素及感染病原体分布。方法回顾性调查2014年1—12月某院综合ICU收治的留置导尿管患者，调查患者基本情况、导尿管使用情况及CAUTI发病情况，分析CAUTI发生的危险因素及病原体分布。结果共调查留置导尿管患者778例，52例患者发生CAUTI，发病率为6.68%。单因素分析结果显示女性、年龄≥60岁、入住ICU时间≥7 d、留置导尿管时间≥3 d、有慢性基础疾病、使用抗菌药物两种及以上是CAUTI发生的危险因素。多因素分析结果显示入住ICU时间≥7 d和留置导尿管时间≥3 d是发生CAUTI的独立危险因素，OR及95%CI分别为30.64（19.71～64.97）、38.69（21.38～74.03）。CAUTI患者感染病原菌以革兰阴性（G-）菌为主（59.04 %），其中大肠埃希菌占26.51%。结论留置导尿管患者发生CAUTI与多种因素有关，应结合患者病情尽量减少患者入住ICU时间及其留置导尿管时间，结合病原学检查结果合理使用抗菌药物。

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目的探讨风险管理在重症监护病房（ICU）导管相关感染防控中的应用效果。方法对2013年1月—2014年12月入住某院ICU的患者实施风险管理，2013年为实施风险管理前组，2014年为实施风险管理后组。观察呼吸机、留置导尿管及中心静脉导管的使用率及相关感染发病率，并进行统计分析。结果2013年1月—2014年12月共监测ICU患者481例，实施风险管理后，2014年的呼吸机、留置导尿管及中心静脉导管的使用率较2013年均降低（38.73%、81.49%、54.10% vs 55.31%、82.87%、61.37%，均P＜0.05），2014年ICU患者呼吸机相关肺炎（VAP）、导尿管相关尿路感染（CAUTI）及导管相关血流感染（CRBSI）发病率均较2013年降低（9.79‰、1.30‰、0.84‰、vs 10.15‰、2.84‰、1.92‰，均P＜0.05）。结论实施风险管理可以有效降低ICU患者导管使用率及相关感染发病率，有利于针对性地做好医院感染防控工作。

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目的了解某院医院感染现状、常见感染部位及抗菌药物使用情况。方法采取床旁调查和查阅病例相结合的方法，分别于2012、2013、2014年的某日对该院所有住院患者进行调查。结果共调查住院患者6 205例，实查 6 062例，实查率为97.70%；2012—2014年医院感染现患率分别为4.04%、3.17%、4.51%，社区感染现患率为13.90%、14.93%、16.53%。医院感染高发科室依次为内科重症监护病房（ICU）、外科ICU、肾病一科，感染高发部位依次为下呼吸道、上呼吸道、表浅切口、泌尿道。3年中抗菌药物使用率分别为21.81%、24.29%、24.67%，以治疗为目的的抗菌药物细菌培养送检率依次为65.93%、74.07%、66.49%。结论该院医院感染科室以ICU为主，感染部位以下呼吸道最常见。

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目的了解某院实习护士职业暴露现况并分析原因，为降低实习护士职业暴露风险提供理论依据。方法自行设计调查问卷，对2014年9月份甘肃省妇幼保健院来自甘肃省10所大中专院校的实习护士进行调查。结果共发放230份问卷，实际回收214份，有效问卷214份，问卷回收有效率93.04%。实习护士职业暴露发生率为29.44%（63名），发生职业暴露后正确处置率为39.68%（25名）。不同生源地、基础教育程度、年龄段和学历的实习护士职业暴露发生率比较，差异均无统计学意义（均P＞0.05）。实习护士职业暴露相关概念知晓与否职业暴露发生率比较，差异有统计学意义（P<0.05）；个人防护知识、防护用品使用知识知晓与否职业暴露后正确处置率比较，差异均有统计学意义（均P＜0.05）；其余各组比较差异无统计学意义（均P＞0.05）。logistic回归分析结果显示，是否进行各种培训职业暴露发生率比较，差异均无统计学意义（均P＞0.05）。结论实习护士个人防护意识欠缺，职业暴露发生率较高；影响职业暴露发生的原因主要为学校及实习单位对实习护士的职业暴露及个人防护知识的培训不重视，培训效果差。

Abstract:

目的了解某市基层医院清洁手术围手术期抗菌药物应用现状。方法查阅某市11个乡镇卫生院2014年出院的清洁手术患者病历共685份，记录患者信息并进行统计分析。结果685例清洁手术患者中，围手术期预防性使用抗菌药物者484例（70.66%），其中选用第一代头孢菌素预防感染的仅93例（19.21%）。联合用药情况：单一用药460例（95.04%），二联用药18例，三联用药6例。手术当天给药272例（56.20%），术后未再使用抗菌药物32例。术后0～48 h给药86例，术后用药时间＞48 h者366例（75.62%），用药时间最长为9 d。结论基层医院清洁手术围手术期普遍存在抗菌药物应用不合理现象，应采取措施，规范抗菌药物的使用。

Abstract:

关节假体周围感染（periprosthetic joint infection， PJI）是关节置换术后的严重并发症。据2001—2009年全美国人工髋膝关节置换术统计数据，术后PJI的发病率为1.0%～2.4%［12］，其中全髋关节置换术后的PJI发病率为2.5%（722/28 883）［3］。关节置换术是Ⅰ类切口手术，切口附近皮肤定植的葡萄球菌和其他革兰阳性球菌是导致手术部位感染的主要病原体；革兰阴性杆菌所致PJI所占比例低，但其感染来源、感染途径，以及预防与控制措施方面的研究报道较少［3］。本文对某院近年发生的2例髋关节置换术后革兰阴性杆菌PJI病例进行调查分析，并进行相关文献回顾，为术后PJI的预防和控制提供思路。

Abstract:

细菌与人类的关系始终处于共生平衡的破坏与恢复之间，随着医学的发展，抗菌药物及化学消毒剂是治愈疾病、消灭细菌的利器，然而也导致细菌产生新的防御机制和侵袭性。感染的预防和控制一直是医院乃至整个医学发展的棘手问题，目前人类对抗菌药物滥用现象已有所重视，各个国家和地区均采取相应的监控措施促使抗菌药物合理的应用。然而细菌的耐药现象不再局限于对抗菌药物，对消毒剂的抗性也不断增加。不同的是，抗菌药物通过具体途径和作用靶点杀灭/抑制病原微生物，而消毒剂则以非特异多靶点机制起作用，使得对其抗性的研究更为复杂^［1］。当细菌产生消毒剂抗性后，呈现出细菌选择性，即那些适应性和抵抗力更强的细菌得以存活，导致更难控制和治疗的感染^［2］。