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ObjectiveTo study the characteristics of antimicrobial resistance and molecular epidemiology of Staphylococcus aureus (S. aureus) in the intensive care units(ICUs) of a hospital. MethodsClinical isolates of S. aureus collected from ICUs between January and December 2014 were identified and performed antimicrobial susceptibility testing, then typed by staphylococcal protein A (spa) typing and multilocus sequence typing (MLST) methods. ResultsOf 160 isolates of S. aureus, 120 (75.00%) were methicillinresistant S. aureus (MRSA). Resistance rates of  MRSA to erythromycin, clindamycin,and levofloxacin were all >80%; methicillinsensitive S. aureus (MSSA) were sensitive to cefazolin, resistance rates to erythromycin, clindamycin, and levofloxacin were 62.50%,35.00%, and 10.00%  respectively. spa typing and MLST results showed that the main types of 120 isolates of MRSA were ST239t030,ST239t037, and ST5t2460, the major epidemic strains were ST239t030 (n=105,87.50%）, and were isolated from 8 ICUs; MSSA had more types, ST59t437 were detected only from department of neurology(n=8) and department of digestive diseases（n=2）, ST6t701,ST398t3625,ST398t1793, and ST121t2092 were isolated  from departments of neurology（n=7）,  anesthesiology（n=5）, neurosurgery（n=4）,and cardiac surgery（n=4）respectively.  ConclusionIsolation rate of MRSA in ICUs in this hospital is high, ST239t030 is the main type, which prevailed in hospital; different types of MSSA have epidemic trends in various departments.

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ObjectiveTo study whether methicillinresistant Staphylococcus aureus (MRSA) will increase the burden of patients with hospitalacquired pneumonia (HAP). MethodsPatients with Staphylococcus aureus HAP in a hospital between January 1, 2013 and  November 31, 2014 were selected,  patients with MRSA HAP were as case group, patients with methicillinsensitive Staphylococcus aureus( MSSA) HAP were as control group, propensity score matching (PSM) analysis were conducted to compare the prognosis of MRSA HAP and MSSA HAP (length of hospital stay, duration from infection to discharge, mortality, total therapeutic cost). ResultsAPACHE II score in case group was higher than control group before PSM was conducted, length of hospital stay and  duration from infection to discharge were both longer than control group (40［20,94］d vs 28［21,53］ d; 19［10,46］ d vs 17［8,29］d, respectively, both P<0.05). APACHE II score in case group and control group after conducting PSM was not significantly different（P＞0.05），data were balanced and comparable; there were no significant difference in length of hospital stay between two groups (28［21,52］d vs 28［21,53］d), duration from infection to discharge (15［9,25］d vs17［8,29］ d), mortality(10.87% vs 15.22%), and total therapeutic cost (121 013.5［80 747.21, 176 200］ yuan vs 119 911.2［66 994.08,241 184.7］yuan)（all P＞0.05）.ConclusionAPACHE II score is an important factor affecting prognosis; after balancing this factor, there is no difference in the prognosis of patients with MRSA and MSSA HAP, MRSA HAP can not increase the burden of disease.

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ObjectiveTo investigate the incidence and risk factors of surgical site infection(SSI) in neurosurgical patients in a tertiary firstclass hospital,and provide reference for the prevention and control of SSI.Methods47 neurological patients with SSI (49 patients developed SSI, 2 were excluded from study due to the lack of appropriate control subject)  from December 31, 2011 to December 31,2012 were as infected group, and 94 patients without SSI (1∶2 matching) were as noninfected group, risk factors for SSI were analyzed retrospectively.ResultsThere was no significant difference in general condition of two groups of patients (all P>0.05); among 3 708 patients, 49(1.32%) developed SSI; intracranial infection was the main type of SSI (89.80%)；27 patients were performed cerebrospinal fluid (CSF) bacteriological detection, 6 (22.22%) of whom were positive for CSF bacteriological detection. Univariate conditional logistic regression analysis showed that risk factors for SSI in neurosurgical patients were operational risk assessment score （OR=2.04）,frequency of preoperative antimicrobial use（OR=3.15）, frequency of intraoperative antimicrobial use（OR=2.58）, duration of operation（OR=2.70）,surgical blood loss（OR=1.72）,indwelling drainage tube（OR=4.30）, duration of indwelling drainage tube after operation（OR=2.06）, and time for initial dressing change（OR=1.66）; Multivariate  conditional logistic regression analysis showed that the independent risk factors for SSI were frequency of preoperative antimicrobial use（P=0.03，OR=4.86）,  duration of operation（P=0.05，OR=2.89）, and time for initial dressing change after operation （P=0.01，OR=1.92）.ConclusionRisk factors  for SSI in department of neurosurgery are multiple, duration of operation, duration of indwelling drainage tube after operation, and time for initial dressing change after operation are major risk factors.

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ObjectiveTo explore causes of fever in patients after the surgery for congenital heart disease(CHD), and put forward corresponding prevention and control measures. MethodsClinical data of patients undergoing surgery for CHD in the department of pediatric surgery of a hospital between January  and May 2013 were analyzed retrospectively, the whole process of operation and postoperative nursing were observed, environmental hygiene monitoring was performed at the same time. Results26 patients all had fever after operation,  fever in 21 cases (80.77%) was caused by noninfectious factors, 5(19.23%）by infectious factors (ventilatorassociated pneumonia in 4 cases, type I incision infection in 1 case).  6 cases were absorption fever,20 were abnormal fever,  difference in patients’ age, duration of invasive manipulation (ventilator, urinary catheter, gastric tube) between two groups of patients were all statistically significant (all P<0.05), patients in the absorption fever group were with older age and short invasive manipulation time. Bacteriological detection rate in 26 patients was 76.92% (n=20), a total of 58 specimens were detected, 7 were positive(from sputum specimens of 4 patients), 5 isolates(71.43%) were  Pseudomonas aeruginosa. A total of 52 environmental specimens were collected for detection,  the qualified rate was 80.77% (n=42). ConclusionNoninfectious factors are the main causes of postoperative fever in patients with CHD, health care workers should enhance the awareness of sterilization, standardize all kinds of  medical manipulation, and reduce postoperative fever.

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ObjectiveTo investigate the status of microbial contamination in domestic washing machines, and provide basis for strengthening hygiene and health management. MethodsOnthespot sampling, laboratory microbial detection, and questionnaire survey were performed to investigate and analyze the hygiene treatment and microbial contamination of domestic washing machines of Beijing residents. ResultsSource water of 115 washing machines were collected, no bacteria were detected.The  total number of bacteria and fungi in washing water from 115 washing machines was 0-135 000 CFU/mL (13 206 CFU/mL on average)  and  0-690 CFU/mL (229 CFU/mL on average)  respectively. There was significant difference in  bacterial colony forming unit in washing water from washing machines of different length of service （P＜0.05）. 15 specimens of washing water from 15 washing machines were performed bacteriological detection, 17 kinds of bacteria were detected, most of which were opportunistic pathogenic bacteria. The major detected bacteria was  Pseudomonas aeruginosa (66.67%), followed by Staphylococcus aureus （60.00%） and Escherichia coli (53.33%). Survey showed that 32.17% of residents reflected the washing machines had peculiar smell and mildew spots, 48.69% of users chose to open the covers for ventilation,38.26% adopted local wiping and cleaning of filter bags, only 10.43% chose to soak with disinfectant, while 24.35% didn’t know how to deal with. ConclusionMicrobial contamination of domestic washing machines is serious, improper use and maintenance of washing machine is not conducive to health.

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ObjectiveTo evaluate the effect of traditional Chinese medicine sputum discharge liquid on preventing ventilatorassociated pneumonia(VAP). MethodsA randomized doubleblind, placebocontrolled study  was conducted, according to the inclusion and exclusion criteria, patients with respiratory failure and mechanical ventilation in the intensive care unit (ICU) of a hospital in 2011-2014 were selected and divided into treatment group and control group. Treatment group received sputum discharge liquid in addition to conventional treatment, control group adopted simulation agent based on conventional treatment. The incidence, treatment effectiveness, occurrence time, and prognosis of VAP between two groups of patients were compared. ResultsA total of 139 patients were monitored, 70 cases in treatment group and 69 in control group.  The incidence of VAP in treatment group and control group were  37.14% (n=26) and 57.97％(n=40) respectively; the average onset time of VAP in treatment group and control group were (76±3.2）hours  and （45±8.9）hours after admission to ICU respectively; treatment effectiveness rates in treatment and control group were 88.46% and 55.00% respectively; the incidence, occurrence time,and treatment effectiveness rates of VAP between two groups of patients were both significantly different (all P<0.05). There were no significant difference in blood routine, liver and kidney function, urine routine, stool routine, and  electrocardiogram results between two groups of patients (all P>0.05). ConclusionIntervention in patients with mechanical ventilation by sputum discharge liquid can reduce the incidence of VAP, and has a positive effect on the prognosis of disease and pulmonary infection in patients.

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ObjectiveTo investigate the epidemiological characteristics and risk factors for healthcareassociated infection(HAI) in a newly built rehabilitation hospital. MethodsA prospective survey  was adopted to monitor HAI among all patients admitted to a newly built rehabilitation hospital between January 2011 and December 2014, related data were collected and analyzed  statistically. ResultsA total of  22 126 patients (male, n=12 023;female,n=10 103) were monitored, age were 4 months100 years old. HAI rate was 3.25%(n=720),HAI case rate was 3.34% (n=738). Patients in department of spinal rehabilitation had the highest HAI rate ( 9.76%); the main HAI site was lower respiratory tract (n=388，52.57%)；a total of 186 pathogenic isolates were detected, 154（82.80%） were gramnegative bacteria, 25（13.44%）were grampositive bacteria,and 7（3.76%）were fungi. Multivariate logistic regression analysis showed that  paralysis  (OR,1.77 ［95% CI,1.24-2.53］), length of hospital stay ≥60 days（OR，4.62 ［95% CI,3.28-5.10］), age ≤10 years old (OR,1.55 ［95% CI, 1.33-2.93］), age ≥60 years old (OR,4.59 ［95% CI, 1.02-20.59］), chronic underlying diseases(OR,1.56 ［95% CI, 1.37-11.34］), invasive procedure (OR,3.33 ［95% CI,1.21-6.86］), and coma(OR,6.77［95% CI,5.41-7.05］) were  major risk factors for HAI in patients in the rehabilitation hospital. ConclusionInvestigation on newly built rehabilitation hospital is helpful for realizing the occurrence status of HAI, health care workers can carry out the corresponding prevention and control measures.

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ObjectiveTo compare different disinfection methods for skin and bottle caps on the detection rate of coagulase negative staphylococcus(CNS) from blood culture,  and provide  basis for improving collection process and accuracy of blood culture. MethodsBlood specimens from the neonatal department of a hospital between June 2012 and August 2014  were collected, blood specimens cultured between June 2012 and June 2013 were as control group (routine disinfection during blood collection process), and blood specimens cultured between August 2013 and August 2014 were as intervention group (improved disinfection method for skin and bottle caps), detection rates of CNS between  two groups were compared. ResultsIn control group, 41 isolates of pathogens were isolated from 543 blood culture specimens,positive rate was 7.55%；in intervention group,21 isolates of pathogens were isolated from 853 blood culture specimens, positive rate was 2.46%. The detection rate of CNS in control group was 4.97% (n=27), 12 (2.21%) of which were methicillinresistant coagulasenegative staphylococcus (MRCNS); the detection rate of CNS in intervention group was 0.82%（n=7）, 6 (0.70%) of which were MRCNS. Difference in detection rates of CNS and MRCNS between  two groups were both statistically significant（χ2=24.07,5.92，both P＜0.05）. ConclusionImproving disinfection methods for skin and caps of blood culture bottles during blood collection can decrease the detection rate of CNS.

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ObjectiveTo analyze the distribution and antimicrobial resistance of Escherichia coli (E. coli) causing  infection in a county hospital, and provide  basis for clinical treatment of  E. coli infection. MethodsFrom 2012 to 2014, all kinds of clinical specimens in a hospital were performed bacterial culture, identification， and antimicrobial susceptibility testing； extendedspectrum βlactamases (ESBLs) were initially screened by broth microdilution method, and confirmed by disc diffusion method； data were  statistically analyzed by WHONET 5.6 and SPSS 19.0 software. Results271 isolates of E. coli were detected,  and mainly isolated from midstream urine (26.94%). The detection rate of ESBLsproducing E. coli was 49.82%, most were isolated from sputum specimens ( 56.52%), but there was no significant difference in detection rates of ESBLsproducing E.coli isolated from different specimens （P＞0.05）. Antimicrobial susceptibility testing results showed that the resistance rate of E.coli to penicillins was the highest (>90%), to cefalotin and cefuroxime were both >75%, susceptibility rates to amikacin and piperacillin / tazobactam were both high (resistance rates＜10%), carbapenemresistant strain was not found, resistance rates of ESBLsproducing strains to most antimicrobial agents were significantly higher than nonESBLsproducing strains.ConclusionE. coli is mainly isolated from midstream urine specimens, antimicrobial resistance of ESBLproducing  strains is more serious.

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ObjectiveTo understand perioperative antimicrobial prophylaxis in clean incision  operation and intervention effect, promote rational use of antimicrobial agents. MethodsPatients with type Ⅰ incision operation in a hospital were monitored, March 2013 was as preintervention group, March 2014 was as postintervention group. Special rectification activities  on clinical application of antimicrobial agents in hospital was carried out from August 2013, perioperative antimicrobial prophylaxis in two groups was compared. ResultsBefore and after intervention, 367 and 324 cases of clean incision operation were investigated, perioperative antimicrobial prophylaxis in patients undergoing clean incision operation  after intervention was lower than before intervention (46.60% vs 77.38%,P＜0.001）；among patients with prophylactic use of antimicrobial agents, usage rates of combined  antimicrobial agents decreased from 18.66% before intervention to 4.64% after intervention, single application of antimicrobial agents was adopted after intervention. Medication 0.5 - 2 h  preoperative and at the beginning of anesthesia induction before and after intervention were 43.66% and 54.30% respectively, preoperative medication rate increased (P<0.05); duration of medication≤48 h before and after intervention were 9.15% and 29.14% respectively，duration of medication decreased obviously （P＜0.001）. The main used antimicrobial agents were cephalosporins, before intervention were cefuroxime, ceftriaxone,and cefminox; after intervention were cefuroxime,  clindamycin, and  cefminox. ConclusionSpecial rectification activities on clinical application of antimicrobial agents improved the rationality of perioperative antimicrobial use in clean  incision operation, implementation of intervention measures should be further strengthened, and make perioperative prophylactic use more standardized.

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ObjectiveTo understand environmental quality status of clean operating rooms in municipal hospitals of Xi’an, and provide reference for ensuring the clean quality of operating rooms.MethodsOnsite specimen collection and detection were conducted  to detect and analyze the cleanlinss of air in clean operating rooms in 15 hospital of  Xi’an.ResultsA total of 51 operating rooms were monitored, secondary and tertiary hospitals had 24 and 27 operating rooms respectively; 26 were gradeI and 25 were gradeⅢ operating rooms. The qualified rates of  dust particle≥0.5μm / particle size in  gradeI and gradeⅢ clean operating rooms were 76.92% and 80.00% respectively, ≥5μm / particle size were 73.08% and 88.00%  respectively. The qualified rates of dust particle counts in gradeI and gradeⅢ clean operating rooms were 61.54% and 80.00% respectively，difference was not significant（χ2=2.092，P＞0.05）. The qualified rate of dust particle counts in clean operating rooms in tertiary hospitals was significantly higher than secondary hospitals(85.19% vs 58.33%, χ2=4.600，P<0.05）. The qualified rates of airborne microbes in operating zone of secondary and tertiary hospitals were 87.50% and 92.59% respectively(P>0.05), in surrounding zone were 95.83% and  92.59% respectively (both P>0.05).ConclusionDust particle and airborne microbes in some clean operating rooms in municipal hospitals of Xi’an are beyond the standard, supervision and management  should be strengthened.

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ObjectiveTo evaluate the effect of medical hygiene wipes on disinfecting object surface and compliance to use in an intensive care unit (ICU). Methods30 beds in the ICU at a hospital were randomly selected and divided into three groups: A, B and C, each group had 10 beds. Group A were only provided hygiene wipes, group B used towel soaked in chlorinecontaining disinfectant (disinfected towel), group C were  provided both medical hygiene wipes and disinfected towel for selected use. Compliance to different disinfection methods, and disinfectant efficacy on object surface were compared.ResultsThe rate of compliance to disinfection in group A was higher than group B ( 78.78% vs 42.12%, χ2=68.56，P＜0.05）；except medical disposal trolley and ventilator,  compliance to disinfection of the other object surface in group A were all higher than group B ( all P＜0.05）.Except ventilator, adenosis triphosphate (ATP) values before and after disinfection of object surface in group A and B  were both significantly different (both P＜0.05）, disinfectant efficacy of group A was superior to group B.  Group C used medical hygiene wipes more than disinfected towel（［836  times，91.57%］ vs ［77 times，8.43%］）.Nurses spent (20.15+ 3.00) minutes on preparing disinfectant every day, and （15.02±2.00）minutes  on washing  used disinfected towel, while  hygiene wipes could be used immediately, discarded after use, and was timesaving. ConclusionUse of medical hygiene wipes is convenient, rapid,and without irritating odor,  it also improves disinfection effect on object surface and ICU health care workers’  compliance to disinfection

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ObjectiveTo investigate the causes of a suspected outbreak of lower respiratory tract infection (LRTI) caused by carbapenemresistant Acinetobacter baumannii (CRAB) in the general intensive care unit(ICU) of a hospital, and provide scientific evidence for effective control of healthcareassociated infection(HAI).MethodsEpidemiological investigation on patients infected with CRAB and onsite monitoring on ICU environmental hygiene from March 4 to 23,2014 were performed, active prevention and control measures were taken.ResultsA total of 7 patients developed CRAB infection, the total length of stay during epidemic period were 160 days, the infection density of LRTI was 43.75‰（7/160）, 4 of 5 patients at No.02 bed had CRAB LRTI. Univariate analysis revealed that adopting conventional sputum suction procedure was a risk factor; the qualified rate of bacterial count on the object surfaces was 31.75% (20/63). CRAB was also isolated from outer frame of suction device of No.02 bed, which had the same antimicrobial pattern as CRAB from 7 patients’ sputum. After taking a series of controlling measures, there was no CRAB infection case after March 24,2014, this outbreak was effectively controlled.ConclusionThis suspected HAI outbreak may be caused by inadequate disinfection of outer frame of suction device contaminated by CRAB, and horizontally transmitted through manipulation of sputum suction by health care workers. Clean and disinfection of ICU environmental object surfaces is of great importance for preventing HAI.

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ObjectiveTo explore the application value of hospital execution culture in healthcareassociated infection(HAI)  management. MethodsAll departments in a hospital from January 1, 2013 to December 31, 2014 were studied.  From January 1, 2014, ideas and fostering methods for  hospital execution culture  were applied in HAI management, the working enthusiasm, working ability, and working achievements of health care workers (HCWs) on HAI  control before and after the application of execution culture  were compared. Results53 departments in the hospital were surveyed annually in  2013 and 2014. Working enthusiasm: the number of departments participating in hospitalwide training increased from 24 (45.28%) to 49 （92.45%）, the number of departments that carried out subsequent training increased from 21（39.62%）to 48（90.57%），departments that initiatively carried out selfinspection increased from 10（18.87%）to 43（81.13%）, differences were all significant (all P<0.001). Working ability: percentage of HCWs knew knowledge about hand hygiene as well as prevention and control measures for multidrug resistance bacteria increased from 49.05% (103/210)  and 37.14% (78/210) to 96.30% (208/216) and  97.22% (210/216) respectively; while in 2013, only 2 departments (3.77%) performed regular rectification on daily work, which increased to 19 departments （35.85%）after training，differences were all significant (all P<0.001). Working achievements: the qualified rate of correct hand hygiene among HCWs increased from 8.57%(18/210)  to 87.04%(188/216); implementation rate of multidrug resistance bacteria isolation increased from 50.00% to 80.08%，pathogenic detection in patients receiving therapeutic  antimicrobial agents increased from 28.85% to 51.30%, differences were all significant（all P＜0.001）. ConclusionFostering of hospital execution culture has improved the enthusiasm and work ability of HCWs to participate in HAI management, promoted the implementation of HAI management, and is a  powerful tool for the management of HAI.

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目的了解常规消毒方法对乙型肝炎表面抗原（HBsAg）阳性患者使用过的胃镜乙型肝炎病毒（HBV）污染的清除情况。方法检测2014年12月1—31日于某院行胃镜检查的HBsAg阳性患者使用后的胃镜，根据检查时患者有无黏膜损伤分为黏膜损伤组和黏膜完整组，分别于初洗前、初洗后、消毒后进行3次采样，进行HBsAg、HBVDNA定量检测。结果黏膜损伤组胃镜初洗前HBsAg检测阳性率为93.33%（28/30）、HBVDNA定量检测阳性率为53.33%（16/30），黏膜完整组初洗前HBsAg 定量检测阳性率为80.00%（24/30）、HBVDNA定量检测阳性率为20.00%（6/30）；初洗前两组HBVDNA阳性率比较差异有统计学意义（P＜0.05）；初洗后仅黏膜损伤组HBsAg阳性2例（6.67%），余均为阴性；消毒后两组HBsAg与HBVDNA检测结果均为阴性。结论HBsAg阳性患者使用后的胃镜可以通过规范的常规清洗和消毒达到消毒效果。

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目的探讨清菌片电热熏蒸法对幼儿园室内空气的消毒效果。方法选择幼儿园活动室（约30 m2），每间活动室有幼儿33～42名（大、中、小班），均在幼儿学习和活动时采样。试验组采用生命岛清菌片电热熏蒸法，对照组采样时未采用任何空气消毒方法，监测活动室内空气细菌菌落总数。结果共采样8间幼儿园活动室，其中试验组6间，对照组2间。活动室内平均空气细菌菌落数：试验组消毒前为（1 772.87±510.91）CFU/m3，对照组第1次采样为（2 004.30±833.68）CFU/m3，两组比较差异无统计学意义（t=-0.370，P=1.262）。不同采样时间空气细菌菌落数比较差异无统计学意义（F=3.909，P=0.078）；不同消毒方法之间空气细菌菌落数存在差异（F=14.982，P=0.008）；两组活动室内均未检出溶血性链球菌和金黄色葡萄球菌；试验组消毒1 h时空气细菌平均清除率为46.55%。结论生命岛清菌片能有效降低幼儿园活动室内有人活动状态下的空气细菌菌落数。

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目的分析重症监护病房（ICU）中心静脉导管相关感染（CVCRI）特点及病原菌分布。方法回顾性分析某院2007年4月—2013年12月2 870例中心静脉置管患者，判断有无发生CVCRI，并分析其影响因素及感染病原菌。结果共调查2 870例患者，发生CVCRI 34例，感染发病率为1.18%。感染患者穿刺部位以股静脉为主（17例，占50.00%）；科室分布以内科ICU为主（26例，占76.47%）。不同导管类型、操作人员CVCRI发病率比较，差异均有统计学意义（均P＜0.05）；不同导管腔数CVCRI发病率比较，差异无统计学意义（P＞0.05）。共分离病原菌37株，其中革兰阳性（G+）菌18株（48.65%），以耐甲氧西林表皮葡萄球菌（MRSE）为主（8株，占21.62%）；革兰阴性（G-）菌11株（29.73%），以产碳青霉烯酶肺炎克雷伯菌（3株，占8.11%）为主；真菌8株。结论医务人员全面、综合考虑CVCRI影响因素，选择合适的置管部位，并规范操作，有助于降低中心静脉置管患者CVCRI发病率。

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为有助于解决全球多重耐药菌感染问题，有必要加速抗生素的研发。针对微生物拥有的巨大生物合成潜力的核糖体工程(ribosome engineering)，利用链霉素、庆大霉素和利福霉素等与微生物核糖体或RNA聚合酶的相互作用，有助于快速、简便地筛选出对应的突变菌株，进而改进其环境耐受性，提高其次级代谢产物的产量或产生新的天然产物。本文主要综述核糖体工程在抗生素产量提升，以及新抗生素发现等方面的研究进展。