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ObjectiveTo explore the direct economic loss caused by healthcareassociated infection(HAI) in general hospitals in China. Methods68 hospitals were selected, a retrospective 1:1 matched survey was conducted to compare the direct medical cost in patients with and without HAI between January 1, 2015 and  December 31, 2015. ResultsA total of 2 123 pairs of patients with and without HAI were included in the survey. The average cost of hospitalization in HAI  and nonHAI groups were  ￥25 845.30 and ￥12 006.14 respectively, ￥13 839.16 on average was increased due to HAI. The average economic loss in provincial and ministerial levels of hospitals were ￥21 409.83. The average economic loss in different regional hospitals were ￥9 725.42-￥18 909.59, and north China ranked the first. Economic loss caused by bloodstream infection and lower respiratory tract infection were more than other sites, which were ￥23 190.09 and ￥18 194.50 respectively. ConclusionHAI resulted in considerable direct economic loss. Prevention and control of HAI, especially bloodstream infection and lower respiratory tract infection should be paid more attention.

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ObjectiveTo summarize the effectiveness in monitoring activities for healthcareassociated infection (HAI) in China in the past 30 years, explore the changing trend in HAI monitoring, find a new model for the monitoring of HAI in China. MethodsA total of 194 comprehensive hospitals and military hospitals in 13 provinces (autonomous regions, municipalities) were selected, questionnaire survey was adopted to investigate the situation of HAI monitoring. ResultsOf 194 hospitals, 184 (94.85%) had available data after being checked, incidence of HAI in secondary and tertiary hospitals were 0.78% and 1.58% respectively， difference was significant (P＜0.01）. Monitoring was divided into two stages, cumulative percentage of each monitoring activity before 2006 and during 20062016 were respectively as follows: environmental hygiene were 73.91% and 100.00%, disinfection efficacy 69.57% and 97.28%, overall comprehensive monitoring  64.67% and 98.91%, surgical site infection(SSI) 13.04% and 94.57%, ICU HAI  4.89% and 87.50%, neonatal HAI 1.75% and 60.82%, multidrugresistant organisms(MDROs) 5.43% and 95.65%, hand hygiene compliance  2.17% and 93.48%, antimicrobial agents 15.22% and 87.50%. The reporting rate of HAI  outbreak in tertiary hospitals was higher than secondary hospitals ( 33.33% ［n=37］ vs 16.44%［n=12］, P=0.01）. ConclusionThe monitoring of HAI in China starts late, but develops rapidly, defects still exist in HAI monitoring system, reporting rate of HAI cases is still high, reporting rate of HAI outbreak is low.

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ObjectiveTo understand the development of healthcareassociated infection(HAI) management organizations in China in the past 30 years.MethodsDevelopment of HAI management organizations in 12 provinces (municipalities, autonomous regions) in China was surveyed.ResultsA total of 166 hospitals were surveyed， 96 (57.83%) were tertiary hospitals. Among 164 hospitals which had a history of development of HAI management department，46(28.05%) before 1995， 63(38.14%) in 1995-2005， and 55(33.54%) in 2005-2015 set up HAI management departments. HAI management professionals per 1 000 beds in 165 hospitals decreased from 4.80 in 1995 to 4.09 in 2015， occupational categories in HAI management departments in 1995-2015 were significantly different (χ2=26.22， P＜0.01). The constituent ratios of education background and profession of HAI management professionals in each province in 1995-2015 were significantly different（χ2=242.91,  47.10， respectively, all P＜0.01）. In 1995 and 2005,  70.81%,  53.30% of professionals were with college degree or below;  in 2015, the percentage of professionals with bachelor’s degree, doctoral degree, and master’s degree were 53.79%, 2.45%, and 22.86%  respectively. Most professionals were nursing staff，but the percentage decreased from 58.38% in 1995 to 45.96% in 2015.ConclusionAlthough HAI management organizations have developed for 30 years and made some achievements， there still remain some problems, the proportion of professionals needs to be enhanced, and personnel structure should be optimized.

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ObjectiveTo understand the status of awareness of hand hygiene(HH) knowledge and compliance among health care workers (HCWs) in China,  and provide scientific basis for further improvement of HH practice. MethodsA multicentre retrospective survey on awareness of HH knowledge and compliance was conducted in 200 nationwide hospitals in 2015. ResultsThe awareness rates of HH methods and HH indications among HCWs were 86.5% and 82.5% respectively; cleaning staff had the lowest awareness rate of HH indications（69.9%）, followed by the other interns and advancedstudy students （70.2%）, as well as medical technicians (79.8%); attendants had the lowest awareness rate of HH methods(76.9%), followed by advancedstudy students and interns（81.0%）, and cleaning staff （82.4%）； HH knowledge awareness rate among HCWs in secondary hospitals was lower than tertiary hospitals，and the districtlevel hospitals had the lowest awareness rate of HH. HH compliance rate and correct rate were 70.1%  and 74.9% respectively; the interns and advancedstudy students were at a low level of compliance and correct rates (61.4% and 60.9% respectively); the municipal hospitals had the lowest compliance and correct rates，nonteaching hospitals were lower than teaching hospitals. ConclusionHH in primary hospitals is weak,  HH of interns， advancedstudy students，as well as attendants and cleaning staffs are not enough, HH management should be strengthened,  awareness and compliance of HH should be improved.

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ObjectiveTo understand the current situation and existing problems in the training of healthcareassociated infection(HAI) management, and provide scientific basis for strengthening the management of HAI prevention and control system. MethodsA questionnaire survey was adopted to investigate situation of training on HAI in 15 provinciallevel HAI training agencies in China during the past 30 years, and basic condition of training on HAI management in recent 5 years. ResultsAmong 15 provinciallevel training agencies, 66.67%（n=10） were responsible by  HAI management quality control centers, 80.00% have already conducted training in each city, 53.33%  carried out training for 10 to 20 times, 33.34% performed training for  ≤2 times per year. Of 33 728 trainees in 2011-2015, 41.30% were 41-50 years old, 61.82% were nursing staff, 50.56% had bachelor degree, 43.96% were with the intermediate professional title. Most trainers were HAI prevention and control experts in their respective province, accounting for 68.07%, the curriculums were mainly designed on professional course, and only 26.78% were involved in management. ConclusionProfessional structure of HAI management personnel is not reasonable, faculty is imbalance, knowledge update is lacking, and HAI training and education system need to be improved further.

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ObjectiveTo understand the development situation of healthcareassociated infection (HAI) management departments in the rational antimicrobial application and management in hospitals in China. MethodsA total of 166 hospitals from 12 provinces, municipalities, autonomous regions, and military hospitals were selected for survey, the participation of HAI management departments in the rational clinical antimicrobial application and management in different years was compared. ResultsOf 166 hospitals,  68（40.96%） in 2005， 119（71.69%） in 2010，and 160（96.39%） in 2015 participated in the establishment of management organizations for rational antimicrobial application (χ2=121.143, P＜0.001). The percentage of HAI management departments participating in antimicrobial management increased from  10.24%（n=17） in 2005 to 22.29%（n=37）in 2010, and 31.33%（n=52）in 2015(χ2=22.172, P＜0.001). The percentages of HAI management departments participating in formulating catalogues for antimicrobial varieties and classification, stipulating permission for antimicrobial use, joining antimicrobial management teams, monitoring bacterial resistance, managing antimicrobial prophylaxis in clean incision, supervising clinical antimicrobial use, conducting clinical consultation, and evaluating prescription were 10.87%-30.72% in 2005，25.90%-65.06% in 2010，and 36.14%-95.18%  in  2015 (all P＜0.01）. Intensity of antimicrobial use ( defined daily dose /100 beddays,DDD / 100 beddays) decreased from 69.16 in 2005 to 41.40 in 2015，antimicrobial usage rate decreased from 46.98% in 2005 to 36.90% in 2015，among patients  receiving therapeutic antimicrobial use, specimens sending for pathogenic detection increased from 20.58% in 2005 to 49.39% in 2015. ConclusionDepartments of HAI management in China play important role in management of rational antimicrobial application.

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ObjectiveTo realize the current situation of prevention and control of catheterassociated urinary tract infection (CAUTI) since the development of healthcareassociated infection(HAI) management  in China in the recent 30 years. MethodsRandom cluster sampling was used to select 165 secondary and tertiary hospitals in 13 provinces and cities in China,  questionnaires were filled in, the content included time, scope, method, data feedback, and incidence of CAUTI monitoring. ResultsOf 165 hospitals, 92.12% (152/165)  have implemented targeted monitoring, the implementation rate in tertiary hospitals was higher than secondary hospitals (98.08%［102/104］ vs  81.97%［50/61］,  χ2=13.748，P＜0.001）. Most hospitals (82.24%［125/152］）only implemented monitoring in intensive care units(ICUs)  or partial ICUs. HAI management professionals, HAI control doctors and nurses in 69.08%（105/152）of hospitals jointly took responsibility for CAUTI monitoring. 95.39% (145/152）of hospitals diagnosed CAUTI by combination of clinical manifestations and laboratory examination results. 98.68%（150/152）of hospitals have gradually implemented intervention measures, such as strictly mastering the indications of urinary indwelling catheters, hand hygiene of health care workers, nonfrequent change of urinary indwelling catheters, and necessity for daily assessment of catheterization. 75.66% (115/152) of hospitals conducted feedback of monitored results to the whole hospital. Incidences of CAUTI in pre2010, 2010, and 2015 were 3.10‰, 4.72‰, and 1.89‰  respectively. ConclusionIn the recent 30 years, monitoring on CAUTI in China has obtained achievement, CAUTI monitoring is gradually standardized and scientific, but the development at all levels of medical institutions is still imbalance,  which needs to be improved further.

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ObjectiveTo investigate the current status of preoperative skin preparation in abdominal surgery in China, and put forward suggestions for improvement. MethodsFrom April to May, 2016, 187 secondary and above hospitals in China were selected, questionnaires were used to investigate the methods for hair removal, skin disinfection on operative field, and application of surgical adhesive drape in abdominal surgery. ResultsA total of 187 hospitals in 14 provinces were investigated, of which 108 and 79 were tertiary and secondary hospitals respectively.  87.70% of hospitals performed conventional preoperative hair removal in abdominal surgery, the percentage of conventional depilation in secondary hospitals was higher than tertiary hospitals（93.67% vs 83.33%, χ2=4.520，P=0.033）. 85.98% of hospitals selected bladeshaving, 7.93% and 23.78% applied chemical depilation and electric depilation respectively. Most hospitals (98.17%) performed skin preparation in the wards, mainly by ward nurses (98.17%), and conducted on the day of surgery (56.10%). 86.63%, 29.95%, and 3.74% of hospitals used iodophor, iodine plus alcohol, and chlorhexidine respectively for disinfecting skin on operative field.  92.51% of hospitals used skin incision/surgical adhesive drape (74.57% used selectively). ConclusionMost hospitals in China conventionally perform preoperative hair removal in abdominal surgery, and the primary method for depilation is bladeshaving, nearly half of the hospitals performed depilation on the day of surgery. Iodophor is the major skin antiseptic, surgical adhesive drape is widely used, but it is utilized in limited types of surgery.

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ObjectiveTo understand the current situation of occupational exposure and protection among health care workers(HCWs), and provide evidence for formulating  preventive measures of occupational exposure. MethodsFrom April 6, 2016 to May 6, 2016,  questionnaire surveys were conducted in 158 different levels of hospitals in 13 provinces in China，occupational exposure, protection management, and monitoring of occupational exposure in the first year, 2010, and 2015 was surveyed by cluster random sampling method. ResultsOccupational exposure in 81.65%（129/158）of hospitals was responsible by healthcareassociated infection management departments;  98.73%（156/158） of hospitals set up the relevant rules and regulations; 77.22%（122/158） of  hospitals had missing report of occupational exposure. A total of 11 116 times of occupational exposure occurred (1 542 cases in the first year,  2 474 in 2010, and 7 100 in 2015). Of  various types of occupational exposure, sharp injury accounted for 96.76%; among HCWs  sustained occupational exposure, nursing staff accounted for 53.90%; the major department that HCWs who sustained occupational exposure were general wards, operating rooms, and intensive care units;  the main medical appliances related to occupational exposure were syringes, scalp needles, and surgical suture needles; highrisk behavior causing occupational exposure were intravenous injection, putting needles into the sharp containers, and  surgical suturing;  among occupational exposure sources,  HBV accounted for 58.69%. ConclusionHCWs in China face a high risk of occupational exposure, occurrence of occupational exposure should be reduced through government legislation, application of safety appliances, standardizing behavior of HCWs, proper using of personal protective equipment, strengthening education and training of HCWs, and establishing a sound occupational exposure report, evaluation and followup system.

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ObjectiveTo understand the current situation and development trend of  scientific research in healthcareassociated infection (HAI) management in China since 1986, and provide the basis for improving the research ability of HAI management. MethodsA questionnaire survey was conducted in 170 hospitals of 13 provinces and military systems in China through multistage stratified sampling method, surveyed content included publication of papers written by HAI management professionals, publication of HAIrelated books, application of scientific research projects and awards of scientific research. ResultsOf 170 hospitals, 63 were secondary hospitals, and 107 were tertiary hospitals. During the period of 1986-2015, the professionals of HAI management have published 2 596 papers, 2 555 were in Chinese, 41 were in English. 105 and 2 491 papers were written by professionals in secondary hospitals and tertiary hospitals respectively. The number of published papers written by professionals in tertiary hospitals increased significantly after 2011. In 1986-2015, a total of 68 books on HAI management were written by investigated hospitals, 35 (51.47%) of which were written in 2011-2015. A total of 217 HAIrelated research projects were applied in 1986-2015, 213 (98.16%) were applied by tertiary hospitals. Most research projects were applied after 2011, accounting for 57.60%(n=125).  ConclusionScientific research on HAI management in China  has entered a stage of rapid development,  more and more HAI professionals begin to engage in research work.

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ObjectiveTo understand the development history and current situation of healthcareassociated infection(HAI) management in children’s hospitals in China during the past 30 years.MethodsA retrospective survey was conducted in 20 children’s hospitals, the investigated contents included: basic situation of hospitals, HAI management organizations and professionals, the support of hospital leaders for the management of HAI, training on HAI  knowledge,  monitoring on HAI, and so on.ResultsUp to 2015, 20 hospitals all set up independent HAI management departments and HAI management committees, 46.15%（6/13） of  hospitals with more than 1 000 beds were understaffed in HAI management. There were a total of 88 professionals in HAI management in 20 children’s hospitals in 2015, 53.41% （n=47）of professionals had bachelor degree, 34.09% (n=30) were with intermediate professional title, 46.59%（n=41）were nursing staff. Up to 2015, incidences and missing report rates of  HAI,  antimicrobial usage rates, incidences of HAI in neonates all decreased compared with 2006. In 2015, 20(100.00%) hospitals all carried out monitoring on antimicrobial application, multidrugresistant organisms,  disinfection and sterilization, and provided personnel protective equipment.  In 2015, 9（45.00%）hospitals used nontouch faucets in all wards, 19（95.00%）hospitals supplied handdrying paper towel and alcoholbased hand rub in all wards. None of professionals in these hospitals participated in nationallevel  training on HAI for ≥3 times in 1996, professionals in 11 hospitals （55.00%）participated in nationallevel  training for ≥3 times in 2015.ConclusionIn the past 30 years,the management of HAI in children’s hospitals in China has basically met the requirement, monitoring on HAI gradually  improved, but allocation of HAI professionals and personnel quality ability still need to be strengthened.

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ObjectiveTo investigate the current situation of healthcareassociated infection(HAI) organization management systems in primary medical institutions.Methods95 primary medical institutions in 5 provinces (autonomous regions, municipalities) in China were investigated.ResultsOf 95 primary medical institutions，82(86.32%) established HAI management groups, 65 (68.42%) set up antimicrobial management departments, 87(91.58%) assigned professionals  for antimicrobial management. Before 2010, only 26 antimicrobial management departments were set up, which  increased to 65（68.42%）in 2015. Hospitals established rules and regulations on medical waste management (n=93, 97.89%）, disinfection and sterilization(n=87, 91.58%）, disposable sterile medical device (n=87, 91.58%）, HAI prevention and control measures (n=79, 83.16%）, occupational health and safety protection for health care workers(n=76, 80.00%）,outbreak reporting system (n=73, 76.84%）, hand hygiene (n=69, 72.63%）, and monitoring on HAI (n=56, 58.95%).ConclusionCurrent situation of HAI organization management systems in primary medical institutions needs to be improved, health administrative departments should strengthen supervision to improve the level of HAI prevention and control.

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ObjectiveTo understand the current situation of medical waste management in primary medical institutions in China. MethodsThe management of medical waste in 95 primary medical institutions in 5 provinces of China in 2016 were investigated. ResultsOf 95 primary medical institutions, 90(94.74%) dispose medical waste by centralized processing, 92(96.84%) separately collect medical waste, 89(93.68%) have  specific locations for temporary waste storage and handover registration, 46(48.42%) have wastewater treatment facilities, and are responsible by fulltime or parttime personnel. Before 2000, only 4 (4.21%) primary medical institutions carried out medical waste classification management and centralized disposal, which increased to 92（96.84%）and 90(94.74%) respectively in 2014; before 2000, only 5（5.26%）primary medical institutions conducted temporarily medical waste storage and treatment, which increased to 89（93.68%）in 2014.ConclusionMedical waste management in primary medical institutions has been improved significantly, but there still remain some problems, training relevant to waste management knowledge needs to be strengthened among health care workers, medical waste management procedures should be standardized, sound medical waste management and supervision system should be improved.

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ObjectiveTo investigate the current situation of healthcareassociated infection(HAI) management in secondary and above medical institutions in Shaanxi Province, analyze development trend, and put forward suggestions for improvement. MethodsIn MayJune, 2016, 170 secondary and above hospitals in 10 cities were selected for surveying through stratified random sampling method. Survey content included basic situation of hospitals, HAI management,  HAI monitoring, and so on. ResultsAvailable questionnaires were obtained from 165 hospitals (43 tertiary hospitals, and 122 secondary hospitals). Of 165 hospitals, more than 90% have established HAI management organizations and regulations, but  hospital risk management should be paid more attention, only 63.03% of hospitals perfected the risk management system and 66.06% conducted risk assessment. 99.09% of  hospitals implement training on HAI to all staff regularly and 88.41% conducted effective feedback.In the aspect of staff allocation, 88.48% of the hospitals assigned enough professionals for HAI management, but only 34.55% have specific training programme for these personnel. Only 33.94% of hospitals have special funds for HAI control; in the aspect of monitoring on HAI, 21.21% of hospital installed and used HAI monitoring software; In the aspect of implementation of monitoring programme, about 90% of hospitals developed monitoring on HAI cases and environmental hygiene， but only 34.55% and 23.64% of hospitals conducted targeted monitoring on intensive care unit and neonatal intensive care unit respectively.ConclusionOrganizational structure of HAI management in Shaanxi Province is perfect, relevant rules and regulations are basically established, basic monitoring projects are universal， but the awareness of risk management needs to be strengthened, professional allocation and professional quality development are both imbalance, informational monitoring is inadequate.

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ObjectiveTo understand the status of healthcareassociated infection (HAI) management in Inner Mongolia Autonomous Region，analyze the existing problems, and put forward the management countermeasures. MethodsA questionnaire survey was adopted to investigate status of HAI management in 143 secondary and above hospitals in Inner Mongolia Autonomous Region. ResultsOf 143 hospitals, 43（30.07%）were tertiary hospitals, and 100（69.93%）were secondary hospitals. All hospitals established HAI management committees. 88.81%（n=127）of hospitals set up independent HAI management departments. Only 10 (6.99%) HAI management departments had laboratories, HAI management staff in 7 (4.90%)  hospitals were in charge of scientific research projects, personnel in 26 (18.18%）hospitals in HAI management departments participated in scientific research projects. 117 (81.82%) hospitals conducted targeted monitoring on HAI, 128 (89.51%）,89（62.24%）, and  90（62.94%）hospitals conducted monitoring on HAI cases, multidrugresistant organisms, as well as antimicrobial use and resistance respectively, 63（44.06%）hospitals established the information system of HAI monitoring, the percentage of tertiary hospitals participating in HAI monitoring was higher than secondary hospitals, difference were all significant(all P<0.05). ConclusionFacilities and scientific research in Inner Mongolia Autonomous Region still need to be strengthened, HAI monitoring in secondary hospitals also needs to be improved further.

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Development situation of healthcareassociated infection management organizations in Xinjiang regionDING Lili, YU Lingli, WANG Peng, LIU Yan, Gulimire·AERKEN

Abstract:

随着社会经济与口腔医学的发展，越来越多的人开始重视口腔疾病诊疗和预防保健，我国2005年调查显示口腔疾病患病率高达97.6%［1］，口腔诊疗服务的需求量不断增加，提供口腔诊疗服务的医疗机构数量也在迅速增加。由于我国各地区经济、教育、医疗等发展不均衡，口腔医疗机构开展诊疗服务时面对巨大的挑战，而口腔专业的医院感染管理工作又相对滞后，总结口腔医学专业医院感染管理发展中取得的成就，出现的问题，以及解决这些问题的一些历史经验方法和研究等，对于今后制定适合全国的口腔专业医院感染管理相应的标准、技术操作指南，提高口腔专业医疗质量和安全等具有重要的参考价值。通过查阅1985—2015年口腔医学相关文献，专家访谈，检索文献和查阅相关法律法规以及管理文件，了解口腔专业感染控制发展历史。