Abstract:

医院感染关系到患者安全和医疗质量安全，一旦发生医院感染将会给医院及患者带来不同程度的损失，如增加经济负担、延长住院时间、加重患者基础疾病等。世界卫生组织于2004年创建了患者安全联盟，2007年11月27日在我国北京举行了“全球患者安全倡议活动”启动仪式暨医院感染与患者安全研讨会，2008年卫生部医政司司长王羽在中国参加“全球患者安全倡议活动”中指出，在发达国家现代化医院的住院患者中约5%～10%的患者获得感染，而发展中国家发生医院感染的危险是发达国家的2～20倍，在某些发展中国家，医院感染发病率高达25%［1］。Magill等［2］在美国10个州进行现患率调查，183所医院11 282例患者中452例发生医院感染（4%；95% CI: 3.7%～4.4%），感染主要为下呼吸道感染（21.8%）、手术部位感染（21.8%）、胃肠道感染（17.1%）和器械相关感染（25.6%）。Allegranzi等［3］通过系统回顾和Meta分析指出，发展中国家每100例患者15.50%（95%CI: 12.60%～18.90%)发生医院感染，比欧洲和美国报告的结果高很多。医院感染管理工作越来越受到关注，不断地面临新的形势和挑战。

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ObjectiveTo investigate the genotypes and epidemic of metallo-β-lactamase-(MBL)-producing Pseudomonas aeruginosa(P. aeruginosa) in Changsha. MethodsP. aeruginosa isolated from seven comprehensive hospitals in Changsha were collected and performed identification and antimicrobial susceptibility testing, phenotypes of MBL were detected with EDTA-disk synergy test and E-test, genotypes were determined by polymerase chain reaction (PCR), homology analysis were conducted by enterobacterial repetitive intergenic consensus PCR (ERICPCR). ResultsPreliminary screening by EDTA-disk synergy test and Etest showed that only 10 of 81 isolates were strong positive; PCR result showed that 18 isolates were positive for MBL, 11 of which were IMP-9-type MBL, 1 was IMP-1-type,and 6 were VIM-2-type.  SIM, SPM, GIM, and NDM-1-types were not found. ERIC-PCR showed that 12 strains of IMPproducing P. aeruginosa has multiple types, 6 VIM-2producing strains were of the same type.  ConclusionIMP-9 and VIM-2 are main genotypes in P. aeruginosa in Changsha．
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ObjectiveTo study the homology and clinical distribution of tigecyclineresistant Acinetobacter baumannii (A. baumannii) in a hospital. MethodsMultidrugresistant A. baumannii (MDRAB, n=88) from specimens from  clinical departments of a hospital in 2013-2014 were collected and detected susceptibility to tigecycline; homology of tigecyclineresistant strains were detected by pulsedfield gel electrophoresis (PFGE), clinical characteristics and distribution of infected patients were analyzed. Results88 patients didn’t use tigecycline before MDRAB were isolated. Of 88 MDRAB strains, 4 (4.55%）were resistant to tigecycline, which were No. 10, 31,33, and 87 strains. PFGE results revealed that No. 31,33,and 87 strains were of the same genotype, and with high homology, which distributed in three different departments; No.31 strain was detected from general intensive care unit (ICU), No.33 strain was detected from emergency  ICU, although strains were  detected from different departments, patients were transferred before strains were isolated, and were admitted to departments of gastrointestinal surgery and emergency ICU during the same period; No.87 strain was detected from neurosurgical ICU and patient had never been transferred, the detection time was 7-8 months later than No. 31 and 33 strains. No.10 strain was isolated from emergency ICU, patient was not transferred.ConclusionOf MDRAB isolated in this hospital,  tigecyclineresistant strains are low, most strains are homologous, cross infection may be exists in different departments.

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ObjectiveTo establish an infection model using Caenorhabditis elegans(C. elegans)-extensively drugresistant Klebsiella pneumoniae（XDRKP）system.MethodsClinically isolated XDRKP strains were used to infect C. elegans in the liquid killing assay, the nematode survival and the number of bacteria in C. elegans digestive tract was observed.ResultsC. elegans was significantly retarded after being infected by XDRKP, different concentrations of XDRKP led to different patterns of the worm death. Log-rank test showed that survival curves of C. elegans infected with 1.5×10⁶CFU/mL of XDRKP and E.coli OP50 (control) were not significantly different （χ2=0.08，P>0.05）; survival curves of C. elegans infected with 1.5×10⁷ CFU/mL, 1.5×10⁸ CFU/mL of XDRKP and E.coli OP50 were significantly different（χ2=229.37, 275.98，respectively, both P<0.001）. The survival rates of 1.5×10⁸ and 1.5×10⁷ CFU/mL XDRKP groups were both lower than that of the control group.  Supernatant suspension obtained from test was performed bacterial culture, identification and antimicrobial susceptibility testing, XDRKP was determined.  After being infected with XDRKP  4, 6, 12, and 24 hours, the total number of bacteria in C. elegans were（0.28±0.02）×105 CFU/mL,（0.50±0.38）×10⁵ CFU/mL,（1.73±0.56）×10⁵ CFU/mL, and （2.62±0.53）×10⁵ CFU/mL，respectively, the number of bacteria in C. elegans digestive tract was significantly different at different time points （F=1 363.39，P<0.001）.ConclusionThe infection model of C. elegansXDRKP is established successfully.

Abstract:ObjectiveTo investigate online dating status and human immunodeficiency virus  (HIV) infection among men who have sex with men  (MSM) in Chongqing， and provide basis for effective intervention in HIV infection among MSM.Methods206 MSM in Chongqing were performed structured interview and questionnaire survey，MSM who didn’t conduct HIV testing within half a year were performed laboratory screening， sociological population characteristics and influencing factors of HIV in MSM were analyzed. ResultsThe average age of 206 MSM was (22.08±1.81) years old, 137 (66.50%) received college education and above, HIV infection rate was 21.36%（44/206）. HIV infection rate in MSM who had no fixed partners was higher than those who had  fixed partners; the more sexual partners they had, the greater the risk of HIV infection they got;  HIV infection rate in MSM who had sex with unfamiliar persons or strangers was higher than those who had sex with familiar partners; the higher rate of condom use in sexual behavior, the lower rate of HIV infection was, there were significant differences among the groups(all P＜0.05). Condom use among MSM with different educational levels was significantly different(all P<0.05). ConclusionHIV infection rate in MSM is high in this city, it is necessary to strengthen education about health, network partner, and  behavioral intervention,  reduce the bridge population connecting MSM network, establish social support system of homosexuality, and reduce the risk of HIV infection in MSM.  

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ObjectiveTo investigate the incidence of surgical site infection (SSI) in patients undergoing orthopedic surgery, analyze the risk factors, and provide basis for the prevention and control of SSI.MethodsAll hospitalized orthopedic patients undergoing surgery in a hospital from January 2010 to December 2014  were retrospectively surveyed,  questionnaires were designed, patients’ medical records were reviewed, incidence of SSI was analyzed, risk factors for SSI were analyzed with univariate  and logistic regression methods.ResultsA total of 14 300 orthopedic patients undergoing surgery were investigated, 576 (4.03%) patients had SSI, predominantly  were superficial incision infection (n=429, 74.48%), 615 strains of pathogenic bacteria were isolated from 576 patients, mainly were Staphylococcus aureus (n=137, 22.28%), Escherichia coli (n=84, 13.66%）,and Enterobacter cloacae (n=73,11.87%). The incidence of SSI decreased year by year in patients undergoing orthopedics surgery（χ2=24.706，P＜0.001）; the incidence of SSI in patients with amputation was the highest (22.67%), followed by patients with debridement (7.16%); multivariate logistic regression analysis indicated that long duration of operation, long length of hospital stay, underlying diseases, use of implants, contaminated incision, more intraoperative blood loss, irrational perioperative use of antimicrobial agents, and without using negative pressure drainage were independent risk factors for SSI in patients undergoing orthopedic surgery.ConclusionThe incidence of SSI is high in orthopedic patients undergoing surgery, effective preventive measures should be actively taken according to the related risk factors of SSI,so as to reduce the occurrence of SSI.

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ObjectiveTo understand the distribution and antimicrobial resistance of pathogenic bacteria isolated from patients in the department of infectious diseases in Xiangya Hospital.MethodsThe distribution and antimicrobial susceptibility testing results of pathogenic bacteria isolated from patients in this department in 2011-2015 were analyzed retrospectively.ResultsA total of 560 strains were isolated during 5 years，of which grampositive bacteria and gramnegative bacteria accounted for  44.1% (n=247) and  55.9%（n=313）respectively. 69.8%（81/116）of coagulasenegative staphylococcus and 24.3%（9/37）of Staphylococcus aureus were methicillinresistant (MRCNS, MRSA) respectively. Enterococcus was highly susceptible to vancomycin, linezolid, and phosphonomycin (>81%). Enterobacteriaceae remained highly susceptible to carbapenems (88.9%-100.0%)，and was susceptible to amikacin，cefoperazone/sulbactam, and piperacillin/tazobactam (>84%). Acinetobacter baumannii was the major isolated multidrugresistant organism (MDRO), isolation rate of imipenemresistant Acinetobacter baumannii increased from 50.0% in 2011 to 77.8% in 2015, its resistance rate to imipenem was 64.9%.ConclusionThe majority of clinically isolated pathogenic bacteria from this department is gramnegative bacilli，and detection rate of MDROs showed an upward trend; antimicrobial agents should be chosen according to distribution and antimicrobial resistance of pathogenic bacteria.

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ObjectiveTo investigate the prevalence of healthcareassociated infection(HAI) in medical institutions in Pudong New Area. MethodsTen medical institutions in Pudong New Area were selected as monitored hospitals, crosssectional survey on HAI in each hospital at a given day of November 2013 and November 2014 were conducted. Prevalence of HAI in different levels of hospitals were compared. ResultsThe prevalence rates of HAI in  2013 and  2014 were 4.04% and 3.75% respectively, there was no significant difference between two years（χ2=0.709，P=0.400）. The prevalence rates of HAI in primary, secondary, and tertiary hospitals in 2013 were 0.66%,3.32%, and 4.60% respectively, in 2014 were 0, 3.52%, and 4.01% respectively，prevalence rates of HAI in different levels of hospitals of each year were significantly different （all P＜0.05）. Prevalence rates of HAI were high in departments of neurosurgery, hematology, intensive care units(ICUs), and gerontology. The prevalence rate of infection in ICUs increased obviously,from 10.09% to 18.78%（χ2=3.921，P=0.048），departments of gerontology decreased obviously, from 10.07% to 5.02%（χ2=5.698，P=0.017）.  The main HAI sites were lower respiratory tract (36.72%),  upper respiratory tract (9.96%), and urinary tract (12.89%). 172 pathogenic isolates were detected in 2013, and 177 were detected in 2014, gramnegative bacteria, grampositive bacteria, and fungi accounted for 60.74%,26.37%, and 12.89% respectively. Constituent ratios of pathogens causing HAI between two surveys were not significantly different (χ2=5.819，P=0.830）.ConclusionAmong different levels of hospitals in Pudong New Area, tertiary hospitals have the highest prevalence rate, HAI in ICU increases obviously, the main HAI site is lower respiratory tract, the main pathogens are gramnegative bacteria.

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ObjectiveTo investigate the incidence and influencing factors of healthcareassociated infection (HAI) in inpatients with nasopharyngeal carcinoma during radiotherapy period. MethodsThe occurrence of HAI among patients with nasopharyngeal carcinoma in a tertiary firstclass cancer hospital in Jiangsu Province between July 2012 and June 2014 were analyzed retrospectively. ResultsA total of 1 396 patients were investigated, the incidence of HAI was 2.29%, case incidence of HAI was 2.44%. The most common infection site was oral mucosa (n=24，70.59%）, and most infection occurred 2-4 weeks after the start of the radiotherapy. A total of 38 pathogenic isolates were isolated, 24（63.16%） were grampositive bacteria，12 （31.58%）were gramnegative bacteria，and 2（5.26%）were fungi. Incidences of HAI were high in patients >50 years old, with chemotherapy, length of hospital stay>60 days, and used at least 2 kinds of antimicrobial agents (all P<0.05). ConclusionPrevention and control of HAI in patients with nasopharyngeal carcinoma during radiotherapy period should be strengthened, especially for the elderly, patients with chemotherapy, long length of hospital stay, and extensive use of antimicrobial agents.

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ObjectiveTo investigate the prevalence of healthcareassociated infection (HAI) in a hospital in 2013-2015, and provide reference for the improvement of HAI management. MethodsPrevalence rates of HAI among patients in the First Affiliated Hospital of Zhengzhou University in 2013-2015 were investigated with crosssectional survey method, prevalence rates of HAI and constituent ratios of  HAI sites in patients of different genders and different age groups were analyzed. ResultsIn 2013-2015, 29 605 patients should be investigated, 29 581(99.92%) were actually investigated. Prevalence rates of HAI in 2013-2015 were 2.83%,2.14%,and 1.73%，respectively, difference was  significant(χ2=27.521，P<0.01）, which showed a downward trend year by year. Prevalence rates of HAI in male was significantly higher than that of female (2.47% vs 1.98%, χ2=7.954, P<0.01). The prevalence rates of HAI in the age dimension was roughly Ushaped distribution in 2013-2015. Prevalence rates of HAI in ≥70 age group was the highest( 4.15%), in 0-30 age group decreased with age, in > 30 age group increased with  age. The top three sites for prevalence of HAI were lower respiratory tract (45.67%), upper respiratory tract (9.92%), and urinary tract (8.52%). ConclusionThe prevalence rates of HAI decreased year by year in 2013-2015, which suggests that HAI prevention and control measures are effectively implemented.

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ObjectiveTo investigate the occurrence of postoperative healthcareassociated infection(HAI) in patients with hepatobiliary malignant tumor, explore the related risk factors, so as to provide the basis for taking effective prevention and control measures.MethodsThe occurrence of postoperative HAI in patients with hepatobiliary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed, risk factors for postoperative HAI were analyzed through reviewing and collecting patients’ medical data. ResultsA total of 302 patients were investigated, 42 (13.91%) developed postoperative HAI, no multiple site infection occurred, the main infection site was deep surgical site (n=10, 23.81%）, followed by lower respiratory tract (n=9, 21.43%）and digestive system (n=7, 16.67%). Of 42 infection cases, 38(90.48%）were sent specimens for pathogenic culture, 36 pathogenic strains were isolated, 31 (86.11%) of which were gramnegative bacteria,  and 5 (13.89%) were grampositive bacteria. Multivariate logistic analysis showed that operation duration≥2 hours (OR=1.48), overweight (or obesity)(OR=1.40), and preoperative radiotherapy (OR=2.98) were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P<0.05).ConclusionIncidence of postoperative HAI is high in patients with hepatobiliary malignant tumor, risk factors are long length of operation, overweight (or obesity), and preoperative radiotherapy, effective prevention and control measures against risk factors should be taken.

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ObjectiveTo investigate the situation of medical waste management in medical institutions of Hubei Province, and put forward the improvement strategies.MethodsThe questionnaires were designed according to the relevant standards, situation of medical waste management in 75 hospitals in Hubei Province was investigated by stratified sampling,73 available questionnaires were got.ResultsThe construction of medical waste management software and hardware in 73 hospitals were basically met the requirements of the standards, the qualified rates in organization and system management, classification and disposal of medical waste in departments were all >90%; 83.56% (61/73) of the hospitals carried out the best environmental practice(BEP)  for medical waste; application of more than 40 kinds of disposable medical devices and supplies were reduced; 76.71% (56/73) of hospitals’ soft infusion bags were collected and  recycled by designated company; only 21.54%（14/65） of hospitals send pathological chemical waste liquid to hazardous waste disposal center; disposal ways of orthopedic stainless steel plates were different, 56.16%（41/73）of hospitals treated plates as medical waste, only 35.62%（26/73）of hospitals informed patients how to deal with it, and signed informed consent with patients.ConclusionMedical waste management in medical institutions in Hubei Province has been paid more and more attention, but for special categories of medical waste disposal, such as soft infusion bags(bottles), orthopedic stainless steel plates, and pathological chemical waste liquid, there are some problems, training still needs to be strengthened, the classification and disposal of medical waste needs to be standardized further.

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ObjectiveTo understand the occurrence of catheterassociated urinary tract infection(CAUTI) in patients with  catheterization, and provide evidence for reducing the incidence of CAUTI. MethodsBased on monitoring requirement for  CAUTI in competency building project of healthcareassociated infection(HAI) prevention and control established by Hospital Infection Management Committee of Chinese Hospital Association, CAUTI among patients who hospitalized and received urinary catheterization ≥2 days in a hospital from January to December 2014 were analyzed prospectively, incidences of CAUTI in different patients were compared. ResultsA total of 6 046 patients with  urinary catheterization were monitored, 166 of whom developed CAUTI， incidence of CAUTI was 2.75%, the total urinary catheter days were  31 833 days, incidence of CAUTI was 5.21 per 1 000 urinary catheter days. There was no significant difference in the incidence of CAUTI among patients of different genders （χ2=1.23，P=0.54）；incidence of CAUTI in patients ＞ 60 years old was higher than those ≤60 years （4.72%  vs 2.07%, χ2=30.38，P＜0.01）；incidence of CAUTI in patients with different duration of catheterization was significantly different（χ2= 251.14，P＜0.01）；with the prolongation of  duration of catheterization, incidence of CAUTI also increased（trend  χ2=211.82，P＜0.001）.Patients in department of neurology had the longest average catheterization time（14.84 days）and highest incidence of CAUTI（15.00%, 10.11‰）；patients in the other departments of surgery  had the shortest average catheterization time（3.56  days）and lowest incidence of CAUTI（0.97%,2.74‰）；incidences of CAUTI in patients with urinary catheterization in different departments were significantly different（χ2= 302.24，P＜0.001）. 166 CAUTI patients were isolated 66 isolates of pathogenic strains, 86.36% were gramnegative bacilli, 33.33%  of which were Escherichia coli. ConclusionCAUTI is related to the age of patients and duration of indwelling urinary catheter. Daily assessment on the necessity of indwelling catheter and timely removal of catheter is helpful for reducing the occurrence of CAUTI.

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ObjectiveTo explore the cost of healthcareassociated infection (HAI) management in a tertiary firstclass hospital, provide data support for costeffectiveness and costbenefit analysis of HAI management, and provide scientific evidence for the rational allocation of hospital resources. MethodsMicrocosting study was used to calculate the direct cost of the department of HAI management by collecting the quantity and unit price of each item. ResultsThe total cost of HAI management in this hospital in 2013 were about ￥870 000, including human cost ￥790 000, depreciated fixed assets ￥34 501, lowvalue consumption goods ￥3 800, publicity and training ￥33 600, office consumables ￥5 208; average cost were ￥12.16 per person and ￥529.69 per bed.ConclusionHuman cost is the main cost in HAI management in this hospital.

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ObjectiveTo understand the serological detection of suspected measles cases in Xicheng District of Beijing, and provide basis for monitoring and prevention of measles.MethodsDetection results of 200 blood specimens and age distribution of suspected measles cases  in Xicheng District of Beijing in 2011-2014 were analyzed.   ResultsThe positive rate of serological detection of suspected measles cases in 20112014 was 32.50%（65/200）; positive rates in each year were 12.00%, 4.35%, 33.90%, and 44.09% respectively；there was significant difference in the positive rate of serological tests in different years（P＜0.001）.Of 200 cases, 65 were <5 years old, and 97 were >24 years old,  positive rates of serological detection were 35.38%  and 34.02% respectively; 31 cases (15.50%) received vaccination of measles; vaccine coverage rate in IgM antibody positive cases was lower than IgM antibody negative cases ( 3.08% vs 21.48%， P＜0.001）. ConclusionPositive rate of serological detection decreased in 2012, then increased year by year, for children under 5 years, measles are controlled by immunization with measles vaccine, in order to achieve the goal of eliminating measles effectively,  control and prevention of adult measles is of great significance.

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ObjectiveTo explore effect of application of quality control circle (QCC) on improving the correct rate of hand hygiene (HH) among health care workers (HCWs)  in intensive care unit(ICU). MethodsQCC activity group was set up, the activity theme was established, correct rate of HH among HCWs in March 2014 (preintervention group) was monitored, the causes of incorrect HH behavior were analyzed, goals were set; from May 2014,  QCC activities were initiated, correct rate of HH between before performing QCC activities and September 2014 (postintervention group) was compared. Results834 and 900 times of HH among HCWs were investigated before and after performing QCC activities,  the number of correct HH before and after QCC activities were 360 and 714 respectively, correct rate of HH after implementing QCC was higher than before QCC activities （79.33% vs 43.17%， χ2=240.19， P＜0.05）.  The correct rate of HH  among HCWs of this ICU and HCWs engaging in advanced studies in this ICU after implementing QCC activities were both higher than before QCC activities（χ2=264.44, 6.36，respectively, both P＜0.05）. The main incorrect HH  before and  after  QCC was nonimplementation of HH indication. ConclusionApplication of QCC activities for the management of HH among HCWs can effectively improve the correct rate of HH among HCWs in ICU.

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ObjectiveTo compare the effect of GammaTM wet wipes and 75% alcohol on the disinfection of  Xray protective clothing， and provide reference for choosing  rational disinfection methods.Methods62 pieces of X  ray protective clothing were selected, 30 were from operating rooms, 32 from catheterization  room.  Protective clothing  were randomly divided into trial group and control group, each had 31 pieces. Trial group disinfected clothing with GammaTM wet wipes, control group disinfected  clothing with 75% alcohol, disinfection effect, drying time, and cost  between  both groups were compared.ResultsAverage bacterial colony counts in trial group and control group before disinfection were 2.38 CFU/cm2  and   2.36 CFU/cm2  respectively, qualified rates were 80.64% and 83.87%  respectively. Bacteria were not detected in both groups after disinfection. The average drying time in trial group was shorter than control group（［352.35±9.93］ s  vs［676.13±10.62］ s，t=123.98，P＜0.01）. The cost of disinfecting Xray protective clothing in trial group was 29.60% less than control group. ConclusionEffect of GammaTM wet wipes and 75% alcohol on disinfecting  Xray protective clothing are both reliable, compared with 75% alcohol, GammaTM wet wipes are without  corrosion,  have shorter drying time, and save more cost.

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ObjectiveTo investigate antimicrobial prophylaxis in clean operation, and provide evidence for formulating antimicrobial management measures.Methods12 types of clean operation cases who discharged from a tertiary firstclass hospital in  May of 2011-2014 were selected, 120 cases were selected each year,  patients were divided into group I and group II according to the types of operation, survey forms were designed, assessment  criteria for the rationality of antimicrobial  use was formulated, antimicrobial use in different years was compared.ResultsProphylactic use of antimicrobial agents for clean operation decreased from 93.33% in 2011 to 35.00% in 2013 and 2014; rates of correct medication time increased from 43.75% in 2011 to 97.62% in 2013 and  92.86% in 2014 respectively; rates of medication according to indications, rational choice of antimicrobial agents, and  rational treatment course  increased from 42.86%,60.71%, and 21.43% in 2011 to 100.00% in 2014（all P＜0.05）.ConclusionSpecial rectification activities of antimicrobial use effectively promoted the standard application of antimicrobial agents for clean operation.

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ObjectiveTo investigate the cleaning quality of  frequently touched object surfaces in a hospital, so as to formulate effective evidencebased intervention measures.MethodsFrequently touched object surfaces in common wards, operating rooms, and intensive care unit(ICU) of the hospital between October 2014 and February 2015 were labeled by fluorescent adhesive agents 1-2 times a week, objects were labeled before patients’ discharge and at the end of operation, cleaning quality of frequently touched object surfaces were checked after routine cleaning.ResultsA total of 2 131 object surfaces were monitored, fluorescent adhesive agents on 1 732 objects were cleared, clearance rate was 81.3%，hygienic clean was qualified. 642,650,and 839 objects surfaces in common wards, operating rooms, and ICU were monitored respectively, the clearance rates were 82.1%,75.8%,and 84.9% respectively,  the clearance rates  among three wards were significantly different (χ2 =19.964，P＜0.001）. In common wards, fluorescent clearance rates of call buttons, power switches, and equipments were 51.3%,55.2%, and 58.5% respectively; in operating room,  fluorescent clearance rates of room wall, control panel of anesthesia machine, bedadjusting device, keyboards, and infusion pumps were 38.6%,48.8%,60.0%,61.3%,and 68.4%，respectively; in ICU, fluorescent clearance rates of equipments was 65.9%, all were unqualified.ConclusionThe environmental hygiene quality is generally qualified in this hospital, but the cleaning quality of frequently touched object surfaces needs to be further improved.

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ObjectiveTo investigate the clinical characteristics and risk factors for healthcareassociated infection(HAI) in patients with severe chronic hepatitis B(CHB), and provide  theoretical basis for preventing and controlling HAI.MethodsRetrospective survey was used to investigate the occurrence of HAI in hospitalized patients with severe CHB in a hospital between January 2012 and  January 2015,  risk factors for HAI were analyzed.ResultsA total of 126 patients with severe CHB were investigated,49 patients developed 106 times of HAI, incidence of HAI was 38.89%. The main HAI site was respiratory tract （n=47，44.34%），the next was  abdominal cavity (n=34, 32.08%).  A total of 76 isolates of pathogens were detected, gramnegative bacteria,  grampositive bacteria, and fungi accounted for 53.95%（n=41），43.42%（n=33），and 2.63%（n=2）respectively. Risk factors for HAI in patients with severe  CHB  were patients’ age≥60 years, length of  hospital stay≥30 days, complications, invasive operation,  serum albumin＜35 g/L, and white blood cell count(WBC)<4×109/L.ConclusionIncidence of HAI in patients with severe CHB is high, the majority are respiratory tract and abdominal cavity infection, risk factors are old age, long length of  hospital stay, invasive operation, hypoalbuminemia, and low WBC count.

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ObjectiveTo evaluate the effect of hand hygiene (HH) promotion on awareness, correctness and compliance rates of  HH among health care workers(HCWs).MethodsHH promotion was started to carry out on May 8,2014,  onsite questions, theoretical examination, and direct observation were adopted to survey the  percentage of  HH awareness, correctness of sixstep handwashing method, and compliance to HH among HCWs before and at the phase five of promotion implementation, results before and after implementing promotion were compared.ResultsAfter implementing HH promotion, percentage of  HH awareness, correctness of sixstep handwashing method, and compliance to HH among HCWs increased from 42.50%,35.45%, and 24.00%  to  87.12%, 68.60%, and 43.20% respectively，differences were all significant （all P＜0.05）.ConclusionHH promotion has strengthened HCWs’  HH awareness, standardized HH method, and enhanced compliance to HH.

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ObjectiveTo study the intervention effectiveness of intensive training in medical interns’ occupational exposure protection. MethodsMedical interns in seven colleges and universities in Wuhan between 2011 and 2015 were chosen and divided into control group (675 medical interns in 2011-2013,comprehensive training about healthcareassociated infection control was conducted for once before internship) and intervention group (682 medical interns in 2014-2015, hospitaldepartmenttutor three steps of intensive training was conducted),  the occurrence of occupational exposure and exposure knowledge awareness between two groups were compared. ResultsThe awareness rate of knowledge about occupational exposure protection and the implementation rate of protective measures in intervention group were both  higher than  control group （all P＜0.05）. Incidence of occupational exposure in intervention group was lower than control group (21.70%［n=148］ vs 65.33%［n=441］, χ2=262.91，P＜0.01）；percentage of interns who conducted active serological virus detection and intensified vaccination of hepatitis B virus were both higher than control group (14.66%［n=100］ vs 2.96%［n=20］;  11.73%［n=80］ vs 2.67%［n=18］,respectively). Occupational exposure before and after intervention occurred most frequently when interns were preparing medicine, occupational exposure reporting rate in intervention group was higher than control group (72.97%［108/148］ vs 50.11%［221/441］, χ2=52.78，P＜0.01）.ConclusionThe intensive training of occupational exposure protection among medical interns can improve the awareness and skills of occupational protection, and reduce the occurrence of occupational exposure.

Abstract:

目的探讨实施抗菌药物干预活动对清洁切口手术患者预防应用抗菌药物的效果。方法采用回顾性调查方法，按随机数字表法调查某院住院患者，2012年为干预前，2014年为干预后。调查干预前后两组病例的预防用药率、给药时机、用药时长、联合用药及种类选择等情况并进行比较。结果2012年调查清洁切口手术患者1 555例，预防使用抗菌药物比率为79.87%，2014年调查1 022例，预防使用抗菌药物比率为36.59%，两组比较差异有统计学意义（χ2=493.90，P＜0.05）；两组在用药时机、时长、联合用药情况比较，差异均有统计学意义（χ2值分别为160.62、206.49、24.22，均P＜0.05）。干预前后预防应用抗菌药物均以第二代头孢菌素为主，分别占66.18%、90.03%。干预后无使用第四代头孢菌素和喹诺酮类病例。两组在预防使用抗菌药物种类构成方面比较，差异有统计学意义（χ2=117.12，P＜0.05）。结论通过实施抗菌药物干预活动后，清洁切口预防应用抗菌药物得到进一步规范。

Abstract:

目的了解某中医院老年住院患者下呼吸道感染的病原菌分布及耐药性，为临床抗菌药物的合理应用提供依据。方法收集该院2013年1月—2014年12月老年住院患者下呼吸道感染标本分离的病原菌，并进行药敏分析。结果659份标本共分离病原菌263株，阳性率为39.91％，其中革兰阴性菌153株（58.17％），革兰阳性菌87株( 33.08％)，真菌23株（8.75％）。居前5位的病原菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、肺炎链球菌、铜绿假单胞菌，分别占22.81％、15.59％、14.45％、12.17％、7.61％。药敏试验结果显示革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南的敏感率为75.00%~95.12%；金黄色葡萄球菌对万古霉素的敏感率为100.00%，对利福平的敏感率为84.21%。 结论老年患者下呼吸道感染以革兰阴性菌为主，不同菌株对抗菌药物敏感性不同，临床应加强病原菌培养及药敏检测，合理选用抗菌药物。

Abstract:

随着医疗技术的发展，内镜已广泛应用于临床诊断、治疗及科学研究中。但是近年来大量内镜相关感染不断被报道，其中也不乏暴发事件；由内镜相关感染引起的严重危害，在全球范围内是一个新的公共健康威胁，已引起医务人员和患者的高度重视，因此内镜的医院感染预防与控制工作显得尤为重要。近年来，国内外对内镜医院感染的预防与控制工作进行了大量研究，笔者就内镜的医院感染预防与控制措施及其效果进行综述，以期为内镜的医院感染防控提供借鉴。内镜作为一种侵入性的诊疗设备，直接接触患者体腔和黏膜，并且其材料和形状特殊、结构复杂，不耐高温高压，用后清洗消毒难度大，故易发生内镜相关感染，从2000年开始已出现多次因内镜污染而造成的病原菌感染暴发流行，见表1。病原菌有革兰阴性菌（主要为假单胞菌属）及革兰阳性菌（主要为葡萄球菌属），部分内镜甚至检出多重耐药菌，如耐碳青酶烯类肠杆菌（CRE）［1］、多重耐药铜绿假单胞菌（MDRPA）［2］等；检出的病毒主要有乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）［23］，给内镜的消毒灭菌带来新的考验。内镜室医务人员在诊疗活动中不可避免的接触患者的血液、体液［4］，以及来自患者的多种致病微生物，如幽门螺杆菌、HBV、HCV、分枝杆菌、铜绿假单胞菌、葡萄球菌属和人类免疫缺陷病毒（HIV）等，故职业暴露发生率较高。