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《医疗废物管理条例》明确医疗卫生机构在医疗、预防、保健以及其他相关活动中产生的具有直接或者间接感染性、毒性以及其他危害性的废物；2016版《国家危险废物名录》明确指示，医疗废物是一种具有感染性和毒性等特性的危险废物。针对感染性医疗废物（包括锐器）的管理处置，重点解决的难题有两个：一是感染控制，重在消除医疗废物所具有的感染性危险废物特性，防止感染传播与扩散；一是污染防治，控制医疗废物处理处置过程中产生的二次污染物排放。医疗废物处置技术如何发展，处置技术和源头分类如何衔接，如何构建医疗废物处置设施运行管理以及监督管理模式，医疗废物是否要实施资源化等问题多年来一直未形成统一的模式，进而给业内人士实施医疗废物管理和处置带来困惑，在具体管理环节呈现出各种问题，不利于实现医疗废物无害化安全管理和处置。

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ObjectiveTo establish a risk warning model for surgical site infection（SSI）, provide support for screening high risk population and finding suspected cases. MethodsClinical data of 5 067 patients who underwent abdominal surgery in 6 domestic hospitals from January 2013 to December 2015 were collected retrospectively, all cases were randomly divided into modeling group and validation group according to a 6:4 ratio,  warning model was established by employing logistic regression, the area under the receiver operating characteristic curve (AUC) was used to evaluate discriminant ability of evaluation model, the maximum Youden index was as the optimum cutoff point. ResultsFor the warning model of highrisk patients, AUC was 0.823, sensitivity and specificity were 78.81% and 74.33% respectively, positive predictive value and negative predictive value were 19.67% and 97.78% respectively. For the discriminant model of suspected infection cases, AUC was 0.978, sensitivity and specificity were 93.38% and 95.62% respectively, positive predictive value and negative predictive value were 62.95% and 99.45% respectively.ConclusionThe earlywarning model established in this study has better discrimination ability, which can provide a reference for the development of early warning and discrimination of healthcareassociated infection information system.

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ObjectiveTo establish emergency disposal procedures of healthcareassociated infection(HAI) in Pudong New Area, evaluate onsite investigation method, identify the key links and risk factors for infection, and timely control HAI outbreak. MethodsFrom January 2012 to December 2014, epidemiological investigation on HAI outbreaks in 65 hospitals in Pudong New Area was performed, emergency plan for disposal procedures of HAI was initiated, the emergency disposal procedures of each event was evaluated by experts. ResultsThere were 6 infection outbreaks occurred in Pudong New Area from January 2012 to December 2014, all were HAI, and no communityassociated infection existed simultaneously; 6 cases of HAI outbreaks involved 119 persons, the major were hospitalized patients (n=99,83.19%) and care workers (n=16,13.45%); 5 outbreaks all detected Norovirus, the main transmission route was close contact of nurses with patients during care for patients; the evaluation of each incident revealed that the total score was >90. ConclusionThe emergency disposal procedure of HAI suitable for Pudong New Area has been established, the effect is good and proved effective according to the expert evaluation on practical outbreaks.

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ObjectiveTo identify the hightouched object surface in different special intensive care units(ICUs) through the observation and statistical analysis on the number of touching with common object surfaces in different ICUs, so as to provide basis for hospital environmental management. MethodsDirect observation method was used to observe the daily activities of health care workers, the number of touching with various common object surfaces was recorded, Poisson distribution was adopted to statistically analyze the data. ResultsThe average number of touching from high to low was as follows : medical record folder（n=28.00）, chair（n=18.38）, emergency rescue cart（treatment cart, n=17.29）, bed surface（n=13.90）, intravenous infusion line（n=13.76）, medical pen（n=13.38）, and intravenous transfusion pump（n=11.81）, these objects accounted for 64.01% of all surface touching number. Different special ICUs were slightly different, general ICU hightouch object included the first 6 categories; cardiothoracic surgery ICU included the above 7 categories besides keyboard and mouse; internal medicine ICU included the first 6 categories and mobile phone. ConclusionHightouched object surface varied with different special ICUs of the same hospital, hospital should make the corresponding disinfection management measures according to the actual situation of hightouched surface of each department, so as to reduce the incidence of healthcareassociated infection.

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ObjectiveTo understand the general selfefficacy level of patients with tuberculosis(TB patients) and its influencing factors, provide evidence for improving the general selfefficacy of TB patients. MethodsAll TB inpatients in a comprehensive pulmonary hospital were conducted facetoface survey through a general questionnaire and general selfefficacy scale, selfefficacy level of TB patients and its influencing factors were analyzed. ResultsMean scale of general selfefficacy of 402 TB patients was (20.4±4.2), of which only 14 cases（3.5%）showed a high level selfefficacy. 163（40.5%）, 225（56.0%）, and 14（3.5%）patients were with low（10～）,medium（20～）, and high（30～） selfefficacy scale. The general selfefficacy level of TB patients was influenced by the course of disease（P<0.001）, residence（P=0.012）, whether or not attended the lecture on tuberculosis education（P=0.034）, whether or not conducted physical exercise（P=0.053，stepwise multiple linear regression analysis: P=0.017）, working status（P=0.027）, No. of hospitalization due to TB（P=0.002）, family economic situation（P=0.027）, and education level（P=0.020）. ConclusionTB patients’ selfefficacy level is low, and the general selfefficacy level and its influencing factors should be assessed by health care workers during the followup for patients, individualized nursing intervention for improving the TB patients’ selfefficacy level should be developed.

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ObjectiveTo explore the distribution and antimicrobial resistance of pathogens causing lower respiratory tract infection in patients, and provide basis for rational choice of antimicrobial agents in clinic. MethodsAll bronchoalveolar lavage fluid specimens in a hospital from January 1, 2013 to December 31, 2014 were performed culture, antimicrobial susceptibility testing of isolated strains was performed with KirbyBauer method. ResultsA total of 999 strains were isolated from 7 702 bronchoalveolar lavage fluid specimens, 398 (5.17%), 326 (4.23%), and 275（3.57%） strains were bacteria, fungus, and Mycobacterium respectively. The main bacteria were Pseudomonas aeruginosa(P. aeruginosa, n=97), Acinetobacter baumannii(A. baumannii, n=87), Klebsiella pneumoniae(K. pneumoniae, n=62), Staphylococcus aureus(S. aureus, n=44), and Haemophilus influenzae (n=28); the main fungi were Candida albicans (n=161), Aspergillus fumigatus (n=41), and Aspergillus flavus(n=38); the main Mycobacterium were Mycobacterium tuberculosis(n=271). Antimicrobial susceptibility testing results showed that resistance rates of P. aeruginosa to the commonly used antimicrobial agents (except ticarcillin/clavulanic acid and levofloxacin) were all<30.00%. Resistance rates of A. baumannii to ampicillin/sulbactam, imipenem, amikacin, gentamicin, and tobramycin were all >80.00%, but to the other commonly used antimicrobial agents were 36.84%-60.53%. Among 62 strains of K. pneumoniae, 20 were extendedspectrum βlactamases(ESBLs)producing strains. Antimicrobial resistance rates of ESBLsproducing strains were obviously higher than nonESBLsproducing strains. Among 44 S. aureus strains, 26 were methicillinresistant S. aureus (MRSA), resistance rate of S. aureus to penicillin was 97.73%, to vancomycin, teicoplanin, and linezolid were all 0, to the other antimicrobial agents were 9.09%-61.36%. ConclusionBacteria is the major pathogen causing lower respiratory tract infection in hospitalized patients, but fungus and Mycobacterium can not be ignored. Resistance rates of P. aeruginosa to commonly used antimicrobial agents is relatively low, but resistance of A. baumannii is more serious.

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ObjectiveTo investigate the distribution and antimicrobial resistance of bacteria isolates from intensive care units(ICUs) in Shandong Province．MethodsAntimicrobial susceptibility data about clinical strains isolated from ICUs of 101 hospitals and general wards(nonICUs) of 106 hospitals in Shandong Province in 2014 were analyzed statistically．ResultsA total of 24 458 strains of bacteria were isolated, of which gramnegative and grampositive bacteria accounted for 80.37% and 19.63% respectively．The top five pathogens in ICUs were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. Resistance rates of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens obtained from ICUs to carbapenems, piperacillin/tazobactam, cefoperazone/sulbactam, and amikacin were all higher than those from nonICUs（all P＜0.01）. Resistance rates of Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus spp. from ICUs were all higher than those from nonICUs（P＜0.05）. Resistance rates of Acinetobacter baumannii isolated from ICUs to imipenem and meropenem were 78.0% and 79.0% respectively；while Pseudomonas aeruginosa were 25.5% and 21.6% respectively, resistance rates to other antimicrobial agents were all <30.0%. Isolation rate of methicillinresistant Staphylococcus aureus from ICUs was higher than that from nonICUs（39.7% vs 26.0%, P＜0.05）.ConclusionAntimicrobial resistance of bacteria isolated from ICUs is serious, rational use of antimicrobial agents should be guided according to the results of antimicrobial susceptibility testing result, so as to prevent the spread of drugresistant bacteria.

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ObjectiveTo investigate the prevalence rates of healthcareassociated infection (HAI) and antimicrobial use in a psychiatric hospital. MethodsThe annual crosssectional survey on HAI among all hospitalized psychiatric patients from 0:00 to 24:00 of June 20, 2012-2015 were conducted, HAI during 4 years were analyzed. ResultsA total of 2 584 hospitalized patients were surveyed, 47 patients had 48 episodes of HAI， the prevalence rate and case prevalence rate of HAI were 1.82% and 1.86% respectively；prevalence rates in 2012-2015 were 2.09%, 1.56%, 1.48%, and 2.11% respectively（χ2=1.23, P=0.75）. The top three departments of high prevalence rates were male section of medical rescue department（3.80%）, male section of acute intervention department（3.31%）, and department of geriatric psychiatry（2.78%）. The top three infection sites were upper respiratory tract (31.91%), lower respiratory tract (29.79%), and gastrointestinal tract(14.89%); 28 strains of pathogenic bacteria were detected, the top three pathogens were Escherichia coli (28.58%), Klebsiella pneumoniae (17.86%), and Staphylococcus aureus (14.29%); antimicrobial use rates in 2012-2015 were 10.91%, 5.78%, 5.41%, and 5.06% respectively, which decreased year by year（χ2=23.13，P＜0.01）. ConclusionPrevalence rates of HAI in four consecutive years maintained a low level in this hospital, antimicrobial usage rates decreased year by year.

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ObjectiveTo investigate the prevalence rates of healthcareassociated infection(HAI) and communityassociated infection(CAI) in hospitalized patients in Wuhan City, and provide a scientific basis for the prevention and control of HAI. MethodsConvenience sampling method was used to select 33 hospitals in Wuhan City, all hospitalized patients were surveyed by bedside investigation and medical record reviewing, SPSS 16.0 software was used for data analysis. ResultsA total of 36 222 hospitalized patients were investigated, of whom 1 116 (3.08%) had HAI, 6 968 (19.24%) had CAI. The prevalence rate of HAI was highest in hospitals with ≥900 beds（3.40%）, and the prevalence rate of CAI was highest in hospitals with＜300 beds （43.70%）. Of departments, general intensive care unit had the highest prevalence rate of HAI(32.88%), department of respiratory diseases had the highest prevalence rate of CAI (78.34%). A total of 699 pathogens were isolated from patients with HAI, the top three were Pseudomonas aeruginosa (18.03%), Acinetobacter baumannii (16.31%) and Staphylococcus aureus (12.88%), a total of 1 149 pathogens were isolated from patients with CAI, the top three were Escherichia coli (14.45%), Pseudomonas aeruginosa (11.23%), and Mycoplasma (10.01%). The main infected sites of both HAI and CAI were the lower respiratory tract, accounting for 48.24% and 45.15% respectively. ConclusionHAI and CAI have different characteristics, it is necessary to take targeted measures according to key departments and key sites, so as to reduce the occurrence of HAI effectively.

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ObjectiveTo analyze the epidemiological characteristics of a healthcareassociated infection(HAI) outbreak due to multidrugresistant Acinetobacter baumannii (AB) in an intensive care unit(ICU), and provide basis for the prevention and control of HAI. MethodsEpidemiological investigation and environmental hygiene monitoring methods were adopted to investigate patients who had pulmonary infection after they were admitted to the ICU of a hospital in April 126, 2015, risk factors were analyzed and corresponding preventive control measures were taken.Results A total of 15 cases of extensively drugresistant AB(XDRAB) healthcareassociated lower respiratory tract infection occurred. 15 strains of AB were isolated from 15 patients. No. 1, 3, 4, 5, No. 6, 7, 8, 9, and No. 10, 11 patients were detected AB with the same antimicrobial susceptibility testing results respectively; occurrence time of infection was relatively centralized. A total of 43 specimens from environmental surface and hands of health care workers(HCWs) were collected, detection rates of AB from bedside cabinet, monitor button, and hands of HCWs were 100.00%(1/1), 75.00%（6/8）, and 66.67%（4/6）respectively. AB were not detected from specimens of treatment table, infusion pump button, and doctors’ nasal swabs. By late May 2015, there were no new such cases in ICU. ConclusionThis AB HAI may be spread through environmental surface and hands of HCWs in ICU, AB isolated from patients is extensively antimicrobial resistant, active treatment of patients and strict disinfection and isolation measures can effectively control further prevalence.

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ObjectiveTo investigate the causes of a healthcareassociated lower respiratory tract infection(HALRTI) outbreak due to Enterobacter cloacae(E. cloacae), and provide basis for clinical prevention and control of HAI. MethodsEpidemiological data of patients with E. cloacae HALRTI following bronchoalveolar lavage(BAL) in the departments of respiratory disease and thoracic surgery of a hospital were collected, antimicrobial resistance analysis on isolated pathogens from patients and environment was performed, pulsedfield gel electrophoresis (PFGE) was used for genotyping. ResultsOn March 8-16, 2013, a total of 15 patients underwent BAL in the fiberobronchoscopy room in the departments of respiratory disease and thoracic surgery of a hospital, 13 of whom developed E. cloacae LRTI, 4 cases were community-associated infection (the initial case was included), the other 9 cases were HAI; 8 environmental specimens were detected 2 strains of E. cloacae, the strains were from vacuum suction joint of fiberbronchoscope and scissors used for trimming disposable controllable sputum suction pipeline. 15 strains of E. cloacae from environment and patients were screened by antimicrobial susceptibility testing, 11 strains were with similar antimicrobial susceptibility testing result, 2 of which were environmental strains, 6 were from inpatients, and 3 were from patients in community. PFGE typing of 11 strains revealed that there were 8 strains with the same genotype, 6 of which were from patients in department of thoracic surgery, 2 were from vacuum suction joint of fiberbronchoscope and scissors used for disposable controllable sputum suction pipeline; the other 3 strains were of the same genotype, and from departments of respiratory disease and thoracic surgery. ConclusionThis outbreak is due to contamination of bronchofibroscope by the same E. cloacae strain, the strain is susceptible to the clinic commonly used antimicrobial agents, such events should be paid attention in clinic, the key to control infection is to take necessary measures for cutting off the spread of the epidemic.

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ObjectiveTo investigate the health care workers’(HCWs) knowledge and attitude towards perioperative warming  as well as patients’ warming status, provide reference for warming in perioperative period and reduce surgical site infection(SSI). MethodsConvenience sampling was used to select 198 HCWs in surgical department and operating room as well as 160 patients undergoing operation. HCWs were investigated by referring foreign literatures and designing questionnaires, onsite observation method was used to collect information about warming measures implemented for surgical patients. ResultsThe median (quartile range) of scores of HCWs’ knowledge and attitude towards patients’ perioperative warming were 9 (2.25) and 25 (1.25) respectively. There was no statistical significance in scores of knowledge and attitude among HCWs with different age, education degree and occupation(all P>0.05). The awareness rates of hypothermia, active warming, and passive warming modes were 21.21%, 43.94%, and 30.81% respectively. 80.30%, 89.90%， and 86.36% of HCWs thought that it was essential to keep warming before, during and after surgery. 68.13% of surgical patients were warmed by covering cotton quilt and shoulder pad during operation. ConclusionHCWs hold positive attitude towards perioperative warming, but they lack sufficient knowledge about perioperative warming, it is necessary to improve facilities of perioperative warming.

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ObjectiveTo investigate the condition and causes of needlestick injuries among health care workers(HCWs), and explore effective strategies for preventing needlestick injuries. MethodsNeedlestick injuries recorded by healthcareassociated infection management department in a hospital between January 2013 and December 2015 were surveyed retrospectively. Results164 HCWs suffered needlestick injuries, including 71 (43.29%) doctors, 81 (49.39%) nurses, and 12 (7.32%) other HCWs. The number of injuries in 2013, 2014, and 2015 were 47（28.66%）, 54（32.93%），and 63（38.41%）respectively. 152（92.68%）, 9（5.49%），and 3（1.83%）injuries were caused by contaminated medical instruments, uncertaincontaminated medical instruments, and noncontaminated medical instruments. Among 164 cases of needlestick injuries, 67(40.85%) occurred in operating rooms, 141 (85.98%) were finger injuries; the main causes of needle stick injuries were carelessness, busy work and nonstandard manipulation(n=115, 70.12%）, most doctors suffered needle stick injuries due to the lack of experience (52.11%), most nurses suffered needle stick injuries due to carelessness, busy work and nonstandard manipulation(93. 83%). ConclusionNeedle stick injuries among HCWs increased year by year, strategies should be implemented to reduce the occurrence of needle injuries, including strengthening occupational protection consciousness among HCWs, strengthening construction of healthcareassociated infection management system, and improving medical environment.

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ObjectiveTo understand the cleaning quality of dental handpieces in Suzhou City, analyze the relevant factors that influencing cleaning effect. MethodsA crosssectional study was performed with the proportional system sampling method, questionnaires were adopted to investigate the cleaning location, cleaning method and process of dental handpieces, the ATP fluorescence detection method was conducted to detect cleaning quality. ResultsIn 10 administrative regions of this city, a total of 72 medical institutions were selected, 25 were public medical oral diagnosis and treatment institutions, 47 were private clinics. Cleaning effect of automatic handpiece cleaning machine was better than traditional manual cleaning (unqualified rate :3.95% vs 11.96%, P＜0.05）, unqualified rate of handpieces cleaned by cleaning personnel without inadequate knowledge was higher than that by personnel with adequate knowledge(14.88% vs 3.57%, P＜0.05）.Qualified rate of cleaning: different cleaning locations ranged from 5.00% to 11.23%, cleaning equipment was inadequate and sufficient 11.89% and 7.29% respectively, cleaning personnel were not designated and designated 12.16% and 9.83% respectively, but the difference were not statistically significant (all P>0.05). The quality of cleaning of handpieces could be improved if waiting time of cleaning ≤30 minutes, enzymes were used during cleaning, and purified water was used at the end rinse( all P<0.05); whether there was drying process and used lubricant, difference were both not significant.ConclusionUsing automatic handpiece cleaning machine, cleaning personnel with adequate knowledge, cleaning waiting time ≤30 minutes, enzyme use during the cleaning process, and purified water use at the end rinse can improve the quality of cleaning of dental handpieces.

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ObjectiveTo investigate the current status of multidrugresistant organism (MDRO) infection in the general surgery department of a tertiary firstclass hospital, and understand the efficacy of comprehensive intervention measures. MethodsTargeted monitoring on MDROs was implemented among patients who were hospitalized in a general surgery department for>48 hours between March 2015 and October 2016, comprehensive intervention measures were taken since January 2016. MDRO infection before and after intervention was compared. ResultsBetween March 2015 and October 2016, a total of 6 406 hospitalized patients were monitored, 155(2.42%) developed MDRO infection. The most common infection sites were abdominal cavity(hydrops, bile) (n=76, 49.03%) and surgical site (n=43, 27.74%). MDRO infection rate dropped from 2.79% (99/3 549) before intervention (MarchDecember, 2015) to 1.96% (56/2 857) after intervention (JanuaryOctober, 2016) (χ2=4.612, P=0.032). There was no difference in MDROs between before and after intervention, the major were both Escherichia coli. ConclusionComprehensive intervention measures can reduce the incidence of MDRO infection in the general surgery department of this hospital.

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目的了解医院感染发生情况及变化趋势，为医院感染管理提供依据。方法采用横断面调查方法调查2010年8月25日、2012年11月14日、2014年10月14日某三级甲等综合医院患者医院感染现患情况，并采用单因素及logistic回归方法分析医院感染危险因素。 结果医院感染现患率3年依次为5.80%、4.86%、3.87%，差异有统计学意义（χ2=7.004，P=0.030）。外科的医院感染现患率由2010年的4.63%下降为2014年的2.67%，重症监护病房（ICU）的医院感染现患率由2010年的31.04%上升为2014年的41.50%，差异均有统计学意义（均P＜0.05）。3年医院感染部位均以下呼吸道为主，均占50%以上。检出医院感染病原菌174株，,主要为鲍曼不动杆菌（37株）、肺炎克雷伯菌（26株）、大肠埃希菌（24株）等。多因素分析结果显示年龄、住院时间、气管切开、使用呼吸机是患者发生医院感染的独立危险因素。结论应加强对重点部门（如ICU病区）、重点人群（如老年患者、使用呼吸机、气管切开的患者等）的医院感染监测，并采取有效预防控制措施，减少医院感染发生。

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目的了解输血前及手术前患者人类免疫缺陷病毒抗体（抗HIV）、梅毒螺旋体抗体（抗TP）、丙型肝炎病毒抗体（抗HCV）和乙型肝炎病毒表面抗原（HBsAg）四项感染指标的检测结果，并探讨其临床意义。方法回顾性调查某院2014年7月—2015年6月17 517例拟输血或手术患者四项感染指标结果，并进行统计分析。结果17 517例受检者总阳性2 635例，阳性率15.04%，抗HIV、抗TP、抗HCV和HBsAg的阳性率分别为0.62%（109例）、2.91%（509例）、1.22%（214例）和10.86%（1902例）。其中男性抗HIV、抗TP和HBsAg阳性率均高于女性（χ2值分别为46.67、16.01和23.58，均P＜0.05）。四项感染指标均以＜20岁组阳性率最低，抗HIV、抗TP和抗HCV以40~59岁组阳性率最高，而HBsAg以20~39岁组阳性率最高。结论输血前及手术前对患者进行四项感染性疾病指标的检测可以确定患者患以上四种传染性疾病的情况，对防止医院感染和减少医疗纠纷具有重要意义。

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目的探讨微信群联合系统化干预对慢性乙型肝炎患者抗病毒治疗依从性的影响。方法调查某院2012年5月—2014年6月门诊或住院患者中使用恩替卡韦抗病毒治疗的慢性乙型肝炎患者的治疗依从性。按随机数字表将研究对象随机分为试验组及对照组。试验组通过建立微信群并联合系统化干预，对照组则予常规临床知识宣教和护理干预，比较两组患者治疗依从性。结果共随访160例患者，试验组及对照组各80例。治疗4~24个月，试验组患者抗病毒治疗依从性均高于对照组，差异具有统计学意义（均P＜0.05）。但随着随访时间的延长，试验组与对照组患者治疗依从性第24个月均低于第12个月，差异具有统计学意义（均P＜0.05）。患者治疗依从性差原因主要有：缺乏乙型肝炎疾病相关知识、缺乏用药指导和监督、费用高、疗程长及自觉病情好转。对照组缺乏乙型肝炎疾病知识及缺乏用药指导和监督两方面概率高于试验组，差异具有统计学意义（均P＜0.05）。治疗48周后试验组与对照组患者血清ALT、AST、HBeAg、HBV DNA均低于治疗前（均P＜0.001）。结论微信群联合系统化干预模式有助于提高慢性乙型肝炎患者抗病毒治疗依从性，值得推广。

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目的了解肿瘤医院医院感染现状，为有效预防和控制医院感染提供依据。方法依据全国医院感染监测网的要求，采用床旁调查和查阅病历相结合的方法分别选取2010—2014年每年的某一日为调查日进行医院感染横断面调查。结果2010—2014年共调查1 912例患者，发生医院感染81例，医院感染现患率为4.24%。2010—2014年每年医院感染现患率分别为：6.53%、4.98%、3.92%、3.70%、2.30%。不同年份医院感染现患率比较，差异有统计学意义（χ2=6.196，P＜0.05）。医院感染现患率较高的科室为放疗四科（10.00%）、妇科肿瘤科（8.86%）。医院感染部位主要为呼吸道（49例，60.49%），其中包括上呼吸道14例（17.28%）。共分离医院感染病原菌66株，其中革兰阳性菌39株，占59.09%，主要病原菌为肺炎链球菌（16株，占24.24%）、甲型链球菌（5株，占7.58%）等。抗菌药物使用率为35.41%。不同年份抗菌药物使用率比较，差异有统计学意义（χ2=129.893，P＜0.05）。治疗性使用抗菌药物标本送检率升高，2013、2014年均达70%以上。结论通过连续规范的医院感染横断面调查，可了解医院感染发生的重点科室、重点部位等，可依据其特点采取针对性的措施，减少医院感染的发生。

Abstract:

目的了解曲靖市医疗机构消毒效果现状及干预效果。方法调查2012年8—9月辖区内67所医院（干预前，其中三级医院5所、二级医院62所）、2014年6—9月辖区内90所医院（干预后，其中三级医院5所、二级医院65所、一级医院20所）的室内空气、物体表面、医护人员手、使用中消毒剂(含氯消毒剂、戊二醛)、消毒后内镜的细菌菌落数及致病菌情况，评价干预效果。结果干预后，曲靖市二级、三级医疗机构Ⅰ、Ⅱ类环境空气，医务人员手，物体表面，使用中的含氯消毒剂，消毒后内镜合格率（92.11%～100.00%）均高于干预前（80.00%～93.75%），差异均有统计学意义（均P＜0.05）。2014年三级医院消毒效果合格率为100.00%，二级医院为97.01%，一级医院为90.20%。  结论曲靖市医疗机构消毒效果合格率明显提高，所采取的干预措施能显著提高消毒灭菌效果。

Abstract:

假鼻疽伯克霍尔德菌，又称类鼻疽伯克霍尔德菌，是一种非发酵革兰阴性杆菌，具有高致病性、强传染性、易于培养、对多种抗菌药物天然耐药等特点［1］，广泛分布于东南亚和澳大利亚等热带地区，我国主要分布于广东、广西、海南一带，其余地区鲜有报道［23］。主要的临床类型有：急性败血症型、亚急性、慢性和亚临床型4类［4］。急性败血症型，患者多有疫区居住史，好发于免疫力低下者，起病急，进展快，病情重，抗菌药物治疗效果差，病死率高［5］。

Abstract:

2015年CHINET中国细菌耐药性监测显示，不动杆菌属菌种占全部菌种的10.7%，其中鲍曼不动杆菌占93.4%。鲍曼不动杆菌从2011年开始在监测菌种中所占比例开始上升，其对抗菌药物的耐药性也逐年增加。鲍曼不动杆菌是一种氧化酶阴性的非发酵革兰阴性杆菌，是临床上常见的条件致病菌之一。在一定条件下容易引起机体感染，如血流系统感染、呼吸道感染、伤口感染、泌尿系统感染、菌血症等［1］。随着新型广谱抗生素在临床的广泛应用及医院管理的不当，鲍曼不动杆菌的耐药率逐年升高，已成为全球关注的重要问题，给临床治疗带来极大挑战，甚至出现泛耐药鲍曼不动杆菌，其对β内酰胺酶类、氨基糖苷类、喹诺酮类、四环素类等多种抗菌药物均出现耐药性，导致病死率增高［2］。经研究表明，多种中药有抑菌作用，具有较好的治疗前景，尤其当与传统抗菌药物联合使用后有较好的抑菌效果，且花费少，副作用低，患者易接受。因此，寻求中药天然抗菌药物已成为解决细菌耐药问题的新途径。

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