• LIU Ning , ZHAO Juan , LI Yanming , YAN Qun , ZHONG Yiming , YANG Fang , LIU Wenen
•2018, 17(4):277-282. DOI: 10.3969/j.issn.1671-9638.2018.04.001
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ObjectiveTo observe distribution and antimicrobial resistance of pathogens from blood culture of children with leukemia, and study risk factors. MethodsFrom September 2013 to November 2016, species and antimicrobial resistance types of 131 strains of pathogens isolated from blood culture of 110 children in a pediatric hematology ward were analyzed, childrens’ clinical data were also analyzed statistically. Results131 strains (5.23%) of pathogens were isolated from 2 505 blood culture specimens, gramnegative bacilli and grampositive cocci accounted for 52.67% and 43.51% respectively, the top 3 pathogens were Escherichia coli (15.27%), Klebsiella pneumoniae (15.27%), and Staphylococcus hominis (12.98%). Gramnegative bacilli were highly resistant to ampicillin, cefazolin, ceftriaxone, and ampicillin/sulbactam, but sensitive to amikacin, cefoperazone/sulbactam, piperacillin/tazobactam, and carbapenems; grampositive cocci had higher resistance to penicillin, oxacillin, erythromycin, and clindamycin, but were sensitive to tigecycline, linezolid, vancomycin, and quinupristin/dalfopristin. Univariate analysis showed that mixed infection, diarrhea, Pseudomonas aeruginosa infection, and Acinetobacter baumannii infection were related to mortality due to bloodstream infection in children with leukemia. ConclusionPathogens causing bloodstream infection in children with leukemia is widely distributed, antimicrobial resistance rate is high, it is very important to take active precaution and rational treatment according to antimicrobial susceptibility testing result.
• LIU Chenggang , XIE Tian , ZHANG Kunjiang , CHEN Weijun , ZHANG Yijun , LI Guochang
•2018, 17(4):283-288. DOI: 10.3969/j.issn.1671-9638.2018.04.002
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ObjectiveTo explore the expression levels of serum nitric oxide (NO) and nitric oxide synthase(NOS) between Han and Uyghur nationality patients with antituberculosis druginduced liver injury(ATDLI). MethodsPatients with confirmed ATDLI in Chest Hospital of Xinjiang Uyghur Autonomous Region and First Affiliated Hospital of the Medical College of Shihezi University between January 2015 and May 2016 were chosen and divided into Han group and Uyghur group. By detecting the expression levels of NO and NOS in serum of ATDLI patients, expression levels of serum NO and NOS in ATDLI patients of different gender, body mass index (BMI), and liver function injury were compared.Results100 ATDLI patients in Han group and 135 in Uyghur group were recruited in study. Expression levels of NO and TNOS in Han group were (134.24±27.60) μmol/L and (33.01±4.23) U/mL respectively, in Uyghur groups were (97.10±17.41) μmol/L and (27.41±3.95) U/mL respectively, serum levels of NO, TNOS, iNOS, and eNOS in Han patients were all higher than Uyghur patients, difference was statistically significant (P<0.01). In Han ATDLI group, serum levels of NO and TNOS in male patients were both higher than female patients (P<0.05); in Uyghur ATDLI group, serum levels of NO, TNOS, and iNOS in male patients were all higher than female patients(P<0.01). The expression levels of serum NO, TNOS, and iNOS of Han group were all higher than the same gender in Uyghur group (P<0.001), difference in levels of NO and TNOS among different body mass index (BMI) groups in Han and Uyghur patients were both statistically significant (P<0.01). In both group, levels of NO and TNOS in obese patients were both higher than lean patients and normal weight patients (P<0.05). The correlation analysis showed that NO levels of Han and Uyghur groups were both positively correlated with BMI (r= 0.444, 0.677, respectively, P<0.01). There were significant differences in serum NO and NOS levels between Han and Uyghur patients with different degrees of liver injury (P<0.05); NO and NOS levels in both groups with mild liver injury were both lower than those with moderate and severe injury (P<0.001).ConclusionSerum NO and NOS levels between ATDLI Han group and Uyghur group are different, serum NO level is related to BMI, and it can increase with the degree of liver injury.
• JIA Min , JIANG Yuanshan , ZHU Jianhua , GAO Jiajia , WANG Yongtao , HU Zhimin , LIU Zhigang
•2018, 17(4):289-293. DOI: 10.3969/j.issn.1671-9638.2018.04.003
Abstract:
ObjectiveTo study antimicrobial resistance and genotyping of methicillinresistant Staphylococcus aureus (MRSA). MethodsA total of 967 norepetitive strains of Staphylococcus aureus (S. aureus) isolated from a hospital between January 2014 and November 2015 were collected, antimicrobial susceptibility testing, mecA gene, and PantonValentine leukocidin gene (PVL gene) were detected; staphylococcal cassette chromosome mec(SCCmec) typing, multilocus sequence typing(MLST), S. aureus protein A(spa) gene typing, and S. aureus accessory gene regulator(agr) typing were performed with multiplex polymerase chain reaction. ResultsOf 967 strains of S. aureus,210 (21.72%) were MRSA; detection rate of MRSA from sputum specimen was higher than that of skin and soft tissue specimen(68.09% vs 11.83%, P<0.05); vancomycin and linezolidresistant S. aureus strains were not found, susceptibility rates of MRSA to gentamicin, tetracycline, erythromycin, clindamycin, levofloxacin, ciprofloxacin, moxifloxacin, nitrofurantoin, and rifampicin were all lower than those of methicillinsensitive Staphylococcus aureus (MSSA), differences were all statistically significant(all P<0.05);antimicrobial susceptibility rate of MRSA to compound sulfamethoxazole was higher than MSSA, difference was significant(P<0.05). Susceptibility rates of MRSA isolated from skin and soft tissue to gentamicin, levofloxacin, ciprofloxacin, moxifloxacin, and rifampicin were 86.90%-95.24%,while MRSA isolated from sputum were only 1.56%-15.63%. Of 967 strains of S. aureus, 210 harbored mecA gene, 10 harbored PVL gene, 8(3.81%) of 210 MRSA strains weren’t typed. The main types of MLST, SCCmec, spa, and agr were ST 239 (n=177 strains), type Ⅲ(n=177 strains), t 030 (n=177 strains), and typeⅠ(n=196 strains) respectively. ConclusionThe main epidemic clone of MRSA strain in this hospital is ST239MRSASCCmec IIIt030, antimicrobial resistance is serious, monitoring on drugresistant strains in hospital should be strengthened.
• LIN Yunwan , ZHOU Yong , ZHANG Xu , LI Xiaoning , ZHAO Zhengyang , LIU Yuan
•2018, 17(4):294-298. DOI: 10.3969/j.issn.1671-9638.2018.04.004
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ObjectiveTo understand the clone correlation of carbapenemresistant Acinetobacter baumannii (CRAB) in the environment of intensive care units(ICUs) in Guangzhou City, identify genotypes, and provide basis for prevention and control of healthcareassociated infection(HAI).Methods39 strains of CRAB isolated from environment of ICUs in 7 hospitals in Guangzhou City were collected, susceptibility to 10 kinds of antimicrobial agents was detected by KirbyBauer method, OXA gene of strains was detected by polymerase chain reaction (PCR), clone polymorphism analysis was performed with pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST).ResultsAmong 39 strains of CRAB, resistance rate to levofloxacin was the lowest(56.4%), resistance rates to other 9 antimicrobial agents were all>90%. PCR results showed that 39 strains(100%) of CRAB all carried OXA51 gene, 37(94.9%) carried OXA23 gene, but OXA24 and OXA58 genes were not found. PFGE showed that 38 CRAB strains were divided into 5 clones, group A was the main epidemic clone, MLST analysis showed that the main clone of CRAB was ST195.ConclusionTransmission of CRAB clone carrying OXA23 gene exists in the ICU environment of Guangzhou City, cleaning and disinfection of ICU environment should be intensified, so as to reduce HAI caused by CRAB.
• HE Lei , QIU Jingfu
•2018, 17(4):299-303. DOI: 10.3969/j.issn.1671-9638.2018.04.005
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ObjectiveTo understand the homology of carbapenemresistant Acinetobacter baumannii (CRAB) isolated from hospitalized patients in a hospital, and provide evidence for the prevention of CRAB spread in hospital.MethodsAntimicrobial susceptibility testing of 62 strains of CRAB isolated from all kinds of clinical specimens from hospitalized patients between August 2015 and November 2016 was performed, homology and epidemic characteristics were analyzed by pulsedfield gel electrophoresis (PFGE).Results62 strains of CRAB were mainly from sputum specimens (88.71%), all were resistant to ceftazidime, cefepime, imipenem, meropenem, and ciprofloxacin, resistance rate to levofloxacin was the lowest (25.81%). 62 strains of CRAB were divided into 14 different types (A-N), type B, D, E, J, and M only contained 1 strain respectively, type F contained 5 subtypes, type A, G, H, and K had 3 subtypes respectively, type C and I had 2 subtypes respectively. Clinical data of the main cloned strains were analyzed, 32 strains (51.61%) were isolated from patients in intensive care unit (ICU), and 12 strains (19.35%) from patients who had ever stayed in ICU.ConclusionThere are two forms of Acinetobacter baumannii prevailed in hospital, which are external and internal spread, infection control should be strengthened.
• GUO Xiaobing , RAO Yuting , HE Xiaohong , TIAN Fuyun , HU Xiaoxin , REN Yihui , LIU Na
•2018, 17(4):304-309. DOI: 10.3969/j.issn.1671-9638.2018.04.006
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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens isolated from blood specimen, and provide laboratory basis for clinical treatment of bloodstream infection. MethodsPathogens isolated from blood specimen in a hospital laboratory from January 1, 2015 to December 31, 2016 were identified and performed antimicrobial susceptibility testing. ResultsA total of 1 061 pathogenic strains were isolated from blood specimen, of which gramnegative bacillus, grampositive coccus, and fungus accounted for 53.35%(n=566),36.10%(n=383), and 10.55%(n=112) respectively, the major gramnegative bacillus, grampositive coccus, and fungus were Escherichia coli(E. coli) and Klebsiella pneumoniae(K. pneumoniae), coagulasenegative Staphylococcus, and Candida parapsilosis respectively. Strains were mainly isolated from intensive care unit(ICU, n=308, 29.03%), followed by hematology department and pediatric internal medicine department. Resistance rates of E. coli and K. pneumoniae to imipenem were 2.65% and 40.12% respectively. Extendedspectrum betalactamase (ESBL)producing E. coli and K. pneumoniae accounted for 62.96% and 33.14% respectively. Linezolid and vancomycminresistant Staphylococcus spp. were not found, isolation rates of methicillinresistant coagulasenegative Staphylococcus and methicillinresistant Staphylococcus aureus were 83.61% and 45.45% respectively, one vancomycinresistant Enterococcus faecium and one linezolidresistant Enterococcus faecium were isolated respectively. ConclusionThere are multiple species of pathogens isolated from blood specimen, distribution and antimicrobial resistance of pathogens casing bloodstream infection should be monitored regularly to guide the empiric antimicrobial therapy.
• WANG Yao , WANG Hongzhi , LI Qi , LIU Linjuan , WANG Guangfa
•2018, 17(4):310-315. DOI: 10.3969/j.issn.1671-9638.2018.04.007
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ObjectiveTo analyze susceptibility of clinically isolated Pseudomonas aeruginosa (PA) to carbapenems, and observe the effect of classified management of antimicrobial agents on carbapenem susceptibility.MethodsPA isolated from Peking University Cancer Hospital between October 2012 and March 2014 were collected, univariate analysis and multivariate logistic regression analysis were adopted to study the risk factors for nonsusceptibility to carbapenems, susceptibility of PA to carbapenems before and after the implementation of classified management of antimicrobial agents was analyzed. ResultsA total of 125 strains of PA were isolated, mainly from patients with esophageal cancer (n=30, 24.0%) and colorectal cancer (n=29, 23.2%); the main specimens were drainage fluid and wound secretion (n=62, 49.6%); the main source departments were surgical wards (n=86, 68.8%). Univariate analysis showed that nonsusceptibility of PA to carbapenems was related to strains from surgical wards, hospitalization within 3 months, carbapenem exposure, and length of hospital stay>4 weeks. Logistic regression analysis showed that 3 independent risk factors were: strains from surgical wards, exposure to carbapenems, and length of hospital stay>4 weeks. Susceptibility of PA to carbapenems after implementation of antimicrobial management was 74.6%, which was higher than 53.4% before management (P=0.015). ConclusionStrains from surgical wards, carbapenem exposure, and length of hospital stay>4 weeks are independent risk factors for nosusceptibility of PA to carbapenems; susceptibility of PA to carbapenems is increased after strict implementation of antimicrobial classified management system.
• BAI Xue , YANG Youli
•2018, 17(4):316-319. DOI: 10.3969/j.issn.1671-9638.2018.04.008
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ObjectiveTo investigate the establishment and staffing status of healthcareassociated infection(HAI) management departments in secondary and tertiary medical institutions in Tianjin City. MethodsQuestionnaires were designed by staff in HAI Quality Control Center of Tianjin City, then distributed to all medical institutions to fill out, content of survey included establishment of HAI management departments, No. of HAI management staff, fulltime and parttime HAI management personnel, education level, professional qualifications, age, length of engaging in HAI management, participation in training and exchange and so on.ResultsA total of 90 hospitals were surveyed, of 81 hospitals with>100 beds, 61 (75.31%) set up independent HAI management departments; staffing of 68(75.56%)hospitals were qualified; among 221 HAI management personnel, 52.49% received undergraduate education, 57.92% were nursing staff, 41.63% were aged 40-50 years old, 71.04% engaged in HAI management work for 1-10 years, 131 (59.28%) and 207 (93.67%) personnel participated in nationallevel training or Tianjin municipallevel training on HAI in the last 3 years. ConclusionThe establishment and staffing of HAI management departments in this city should be further standardized, composition of HAI management personnel needs to be further optimized, management teams should be young and stable, training and education should be regular.
• YI Shaohua , WANG Meirong , CHEN Bizhen , QU Meijin , WANG Anyang , JIA Rui
•2018, 17(4):320-324. DOI: 10.3969/j.issn.1671-9638.2018.04.009
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ObjectiveTo understand the status of healthcareassociated infection(HAI) management in traditional Chinese medicine hospitals as well as integrated traditional Chinese and Western medicine hospitals in Fujian Province, analyze the existing problems and weak links, and put forward corresponding improvement measures.MethodsA questionnaire was designed through literature and expert consultation, from March to April 2016, 42 secondary and above traditional Chinese medicine hospitals as well as integrated traditional Chinese and Western medicine hospitals in 8 cities of Fujian Province were conducted onsite investigation, data were analyzed.ResultsA total of 42 hospitals participated in the investigation, 92.86% were traditional Chinese medicine hospitals, 7.14% were integrated traditional Chinese and Western medicine hospitals; all hospitals set up HAI management committees and HAI management groups of clinical departments, there were 100 HAI management professionals (66 were fulltime, 34 were parttime), nursing staff accounted for 63.00%, junior college and undergraduate personnel accounted for 84.00%, staff with intermediate and senior professional titles accounted for 79.00%. There were significant differences in academic disciplines and education levels among administrators in secondary and tertiary hospitals(P<0.05). All hospitals carried out HAI case surveillance, only 2.38% achieved HAI informational software monitoring, 83.33% carried out comprehensive and targeted monitoring, 42.86%, 71.43%, and 80.95% of hospitals carried out targeted monitoring on multidrugresistant organisms, surgical site infection, and intensive care unit respectively.ConclusionThe environment of majority of Chinese medicine hospitals in Fujian Province improved significantly, organizations of HAI management is rational, staffing and quality of HAI management personnel is imbalanced, HAI monitoring is still at preliminary stage, lack information management, HAI management in key departments is not optimistic.
• WANG Xiuzhen , QIAO Meizhen , JIN Meijuan , QIAN Xuefeng , ZHANG Junji , NI Xiaoyan , ZHAO Naxing , XU Zheng , ZHANG Qinying , YAN Xiangming , LI Xinfang
•2018, 17(4):325-328. DOI: 10.3969/j.issn.1671-9638.2018.04.010
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ObjectiveTo investigate current status of hemodialysis, and qualified status of dialysis water and dialysate in a city. MethodsStatus of hemodialysis in 36 medical institutions in a city which conducted blood purification programme was surveyed, dialysis water and dialysate were collected to perform microbial detection(including conventional and low temperature culture methods) and onsite ATP detection.Results13.89% of equipments for water treatment were used less than 1 year, 5.56% were used for more than 10 years. 77.78% of medical institutions didn’t replace sand filtration which had been used for more than 1 year, the replacement time of 72.22% of filter core was less than 3 months, 2.78% of reverse water supply pipeline was used for more than 10 years. 77.78% of medical institutions used finished A solution, 72.22% used finished B solution, 22.22% used centrally provided A solution, 19.44% used centrally provided B solution, and 8.34% used selfmade B solution. Routine microbial detection in 36 medical institutions were qualified, but 80.56% of detection results were "0" value for long period; ATP detection of onsite collected dialysis water and dialysate were all qualified. One specimen for microbial detection under normal temperature exceeded the standard, 2 reached the intervention value; 4 specimens for microbial detection under low temperature exceeded the standard, 6 reached the intervention value; qualified rates of 3 kinds of detection methods among different levels of medical institutions weren’t significantly different(all P>0.05).ConclusionThe overall quality of hemodialysis water and dialysate in this city is good, the majority of medical institutions pay attention to the routine maintenance of water treatment equipment, detect the quality of hemodialysis water and dialysate regularly, but microbial detection technique needs to be improved, causes for abnormal results or intervention value of routine detection needs to be analyzed and improved continuously.
• HU Yuqing , MA Xinran , MAO Wenjun , ZHAO Rongjia , Reyizha Nuersulitan , SHEN Ning
•2018, 17(4):329-334. DOI: 10.3969/j.issn.1671-9638.2018.04.011
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ObjectiveTo analyze related factors affecting the prognosis of patients with Acinetobacter baumannii(A. baumannii) bloodstream infection(BSI), guide clinical prevention and treatment.MethodsA casecontrol study was conducted to retrospectively analyze patients with A. baumannii BSI in Peking University Third Hospital from January 2012 to December 2016. According to prognosis, patients were divided into poor prognosis group and good prognosis group. Univariate analysis and logistic regression analysis were used to analyze the risk factors of poor prognosis in patients with A. baumannii BSI.ResultsThere were 58 confirmed cases of A. baumannii BSI, including 31 patients with poor prognosis and 27 with good prognosis. Univariate analysis revealed that risk factors for poor prognosis of A . baumannii BSI were antimicrobial use and at least two kinds of antimicrobial agent use three months before admission, at least two kinds of antimicrobial use, and carbapenems use before infection after admission, increase of white blood cell (WBC) count after infection(P<0.05). After 3day antiinfective treatment, examination results of WBC count and Xray chest film in good prognosis group were all better than poor prognosis group(P<0.05). Logistic multivariate regression analysis showed that independent risk factors for poor prognosis of A. baumannii BSI were antimicrobial use three months before admission, at least three kinds of antimicrobial use and carbapenem use before infection after admission, increase of WBC count and WBC count>12×109/L after infection,as well as increase of WBC count and WBC count>15×109/L after 3day antiinfective treatment(P<0.05).ConclusionThe probability of poor prognosis is high in patients with A. baumannii infection. For patients receiving≥2 kinds of antimicrobial agents three months before admission, patients receiving≥3 kinds of antimicrobial agents as well as patients receiving carbapenems before infection after admission, the likelihood of A . baumannii BSI should be paid attention. For patients with WBC count>12×109/L after infection and WBC count>15×109/L after 3day treatment, poor prognosis should be alerted, treatment plan needs to be adjusted in time to reduce the mortality.
• FAN Runping , GONG Qingxia , GONG Wenhua , WANG Yu , WANG Fang
•2018, 17(4):335-340. DOI: 10.3969/j.issn.1671-9638.2018.04.012
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ObjectiveTo evaluate risk factors for central venous catheterrelated bloodstream infection(CRBSI) in intensive care unit(ICU) patients by Meta analysis. MethodsLiteratures about risk factors of CRBSI in ICU patients were retrieved from databases of Cochrane Library, PubMed, Embase, CBM, CNKI, and WanFang Data, RevMan 5.3 software was used for Meta analysis. ResultsThere are 12 literatures in accordance with the inclusion criteria, with a total sample size of 14 422 cases, 5 cohort studies and 7 casecontrol studies, the NewcastleOttawa Scale(NOS) scores were 4-6 points. According to Meta analysis, duration of indwelling catheter(WMD, 12.25 [95%CI, 5.55-18.94]), multicavity catheter(OR, 3.52 [95%CI , 1.46-8.52]), femoral vein catheterization(OR, 2.44 [95%CI, 1.34-4.46]), parenteral nutrition(OR, 2.47 [95%CI, 1.18-5.21]), length of stay in ICU( WMD, 10.01 [95%CI, 4.17-15.85]), APACHE II score(WMD, 4.46 [95%CI, 1.25-7.66]), and diabetes mellitus(OR, 1.83 [95%CI, 1.08-3.09])were significantly different in each group (all P<0.05). ConclusionRisk factors for CRBSI in ICU patients are duration of indwelling catheter, multicavity catheter, femoral vein catheterization, parenteral nutrition, length of stay in ICU, APACHE II score, and diabetes mellitus. However, due to the limitation of methodological quality of included studies, more strictly designed and large sample prospective studies are needed to verify the result.
• HUANG Kelin , OUYANG Yuqi , WU Zhijian , YUAN Hongxia , JIANG Juan
•2018, 17(4):341-346. DOI: 10.3969/j.issn.1671-9638.2018.04.013
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ObjectiveTo explore the retrograde contamination of drainage bag outlets, and provide basis for the formulation of related guideline for healthcareassociated infection(HAI) management. MethodsOn October 14, 2016, with sterile manipulation, urine, 5% glucose solution, glucose normal saline, sterile water, and 0.9% normal saline were injected into antireflux drainage bags (antireflux group) and common drainage bags (common group) respectively, entrances of bags were sealed and bags were hung in two ways: outlets were 10 cm away from the ground (suspended group) and touched the ground (groundtouching group) respectively, specimens were collected from bag outlets to perform bacterial culture every 3 days, a total of 10 times of cultures were performed, retrograde contamination of drainage bag outlets was observed dynamically. ResultsRetrograde contamination rate of drainage bag outlets of antireflux group was significantly lower than common group (7.7% vs 46.0%, P=0.000); suspended group was significantly lower than groundtouching group (17.9% vs 35.8%, P=0.000). Retrograde contamination rates of outlets of drainage bags filled with different properties of liquid were as follows: urine (54.3%)>5% glucose solution (34.5%)>glucose normal saline (24.3%)>0.9% normal saline (10.8%)>sterile water (10.5%), pairwise comparison showed a significant difference(P=0.000). The initial occurrence time of contamination in antireflux group and common group was on the 13th day and 7th day respectively, two group was significantly different on the 7th day(P=0.041). There was a medium intensity correlation between the types of drainage bags and liquid properties(Pearson C=0.5). ConclusionDifferent types of drainage bags, retention time, and liquid property can impact retrograde contamination of drainage bag outlets, regular urine culture during the use of drainage bags should be paid attention in clinical practice, so as to use antimicrobial agents rationally and guide replacement time of drainage bags.
• LENG Ping , LI Jing , LIU Xiaoying , BI Pengfei , QIAO Weili
•2018, 17(4):347-350. DOI: 10.3969/j.issn.1671-9638.2018.04.014
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ObjectiveTo evaluate the application effect of meticulous management mode on prevention and control of infection related to pharmacy intravenous admixture service(PIVAS). MethodsQualified detection results of hygiene status of object surface, air culture quality, hand hygiene of medical staff in PIVAS in a hospital from January 2014 to December 2016 were investigated, meticulous management measures were taken to intervene and analyze the detection results.ResultsThe qualified rates of hand hygiene in 2014-2016 were 68.18%, 81.82%, and 100.00% respectively, hand hygiene qualified rates in different years were statistically different(χ2=2.993,P=0.019). Qualified detection rates of surface of small objects, surface of horizontal laminar flow hoods, surface of biosafety cabinets, and air quality of dressing room I and II in PIVAS all increased to 100% in 2016.ConclusionStrengthening meticulous management of the internal work of PIVAS can effectively improve staff’s standardized operation.
• HU Huifang , GUO Jinfeng , KONG Li , LI Yusen , WANG Juan , LIU Hong
•2018, 17(4):351-354. DOI: 10.3969/j.issn.1671-9638.2018.04.015
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ObjectiveTo improve the cleanliness of object surface frequently touched by doctors and nurses through collaboration of multidisciplinary team(MDT). MethodsIn the fourth quarter of 2015, a baseline survey was performed by healthcareassociated infection(HAI) management professionals in a hospital (baseline survey stage), in the first quarter of 2016, HAI management office combined with medical affairs office and nursing department to carry out collaboration of MDT intervention (intervention stage). The second, third, and fourth quarters of 2016 were evaluation stages for efficacy of implementation of intervention measures, cleanliness of frequently touched object surface at different stages was compared.ResultsIn the baseline survey, the qualified rates of fluorescent labeling in doctor group and nurse group were 44.25% and 61.61% respectively, after MDT joint intervention, the qualified rates of fluorescence labeling in doctor group and nurse group increased to 89.83% and 87.50% respectively, difference was statistically significant(both P<0.05). The incidence of HAI in baseline survey stage was 1.22%, at stage three of postintervention, incidence of HAI was 1.02%, difference was statistically significant (P<0.05). ConclusionMDT can effectively integrate hospital management resources, make medical affairs office and nursing department give full play to their respective function, and effectively enhance the cleanliness of frequently touched object surface during medical care.
• LI Dong,LI Manyu , GUO Yaping,YANG Zhi
•2018, 17(4):355-358. DOI: 10.3969/j.issn.1671-9638.2018.04.016
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ObjectiveTo observe the efficacy of a medical disinfectant ultrasonic coupling agent on the killing of five clinically isolated multidrugresistant organisms(MDROs).MethodsFrom March 2016 to May 2017, a disinfection ultrasonic coupling agent containing active ingredient, including triclosan and propylene glycol, was used to conduct carrier quantitative germicidal test on five clinically isolated MDROs, the killing efficacy to MDROs was observed.ResultsAfter 1.5, 3.0, and 4.5 minute disinfection time,the killing logarithms values of disinfection ultrasonic coupling agent to five MDROs (multidrugresistant Acinetobacter baumannii [MDRAB], methicillinresistant Staphylococcus aureus [MRSA], multidrugresistant Pseudomonas aeruginosa [MDRPA], carbapenemresistant Klebsiella pneumoniae [CRKP], and extendedspectrum βlactamase Escherichia coli [ESBLsEC]) were all>3.0.ConclusionMedical disinfection ultrasonic coupling agent can effectively kill five common MDROs, and can take the place of disinfectant during ultrasonic examination.
• CHEN Suoxian , LV Qingpai , SHEN Yaping , HUANG Min , SUN Hongjuan
•2018, 17(4):359-362. DOI: 10.3969/j.issn.1671-9638.2018.04.017
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ObjectiveTo understand the occurrence of surgical site infection (SSI) following caesarean section, analyze risk factors, implement intervention measures, and evaluate intervention efficacy. MethodsAll puerperas who underwent caesarean section in the obstetric department of a hospital from January to December 2013 were monitored, investigation were performed in two stages: evaluation stage (JanuaryJune, 2013) and intervention stage (JulyDecember, 2013). Targeted intervention and clinical intervention were combined to intervene the risk factors. Occurrence of SSI, length of hospital stay, and hospitalization expense before and after intervention were compared. ResultsA total of 1 593 patients with caesarean section were monitored, 31(1.95%) had SSI, incidence of SSI in evaluation stage and intervention stage were 3.40% and 0.95% respectively;incidence of SSI before and after intervention was significantly different(χ2=12.02,P<0.01). Univariate analysis on evaluation stage showed that risk factors for SSI in patients with caesarean section were duration of operation ≥1 hour, body mass index ≥26 kg/m2, intraoperative blood loss ≥300 mL, underlying diseases, premature rupture of membranes, and without antimicrobial prophylaxis (all P<0.05). In evaluation stage, 648 patients received postoperative antimicrobial prophylaxis for>48 hours (n=395, 60.96%); in intervention stage, 945 patients received postoperative antimicrobial prophylaxis for<24 hours (n=776, 82.12%), different time distribution of postoperative antimicrobial prophylaxis in two stages after intervention was compared, difference was statistically significant(χ2=673.26,P<0.01). The mean length of hospital stay of 31 SSI patients were (13.83±3.26) days, nonSSI patients were (7.06±1.66) days, difference was statistically significant (t=7.86, P<0.01); the average hospitalization expenses for patients with SSI were (9 044.77±2 649.19) yuan, nonSSI patients were (6 254.73±638.52) yuan, difference was statistically significant (t=4.344, P<0.01). ConclusionIntervention measures for risk factors of SSI after caesarean section can effectively reduce the incidence of SSI in caesarean section.
• WEI Nan , WANG Lihong , ZHAO Xia , ZHANG Jingli , ZHAO Huijie , MA Wenhui , HAN Xu
•2018, 17(4):363-366. DOI: 10.3969/j.issn.1671-9638.2018.04.018
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医院感染是导致住院患者死亡的一个重要原因。在美国医院感染已居居民死亡原因的第八位[1]。贾巍等[2]研究结果显示,高龄(≥60岁)是重症监护病房(intensive care unti, ICU)住院患者发生医院感染的危险因素,平均增加感染危险度1.5倍。目前,世界人口老龄化进程正在加速,世界卫生组织(WHO)数据[3]显示,2014年全世界60岁及以上人群有8.41亿,预计到2050年将达到20亿。老年患者作为医院感染的易感人群,医院感染的发生率和病死率均比较高,需引起医疗相关工作人员的高度重视。本综述主要介绍目前老年患者医院感染的现状,针对医院感染的危险因素提出相应的干预策略,从而为降低老年患者医院感染的发生提供支持依据。
•2018, 17(4):368-369. DOI: 10.3969/j.issn.1671-9638.2018.04.019
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