Abstract:Objective To observe the effect of artificially designed and chemically synthesized polypeptides on HBV-DNA replication and expression of viral markers, as well as their cytotoxicity, screen polypeptide of high inhibition and low cytotoxicity HBV, and explore the potential of polypeptides as novel antiviral molecules for HBV. Methods Seven polypeptides (KBDT-1, 2, 3...7 based on hydrophobicity and cationic electroaffinity) were designed and synthesized using traditional methacrylic acid polymer platform, seven chemically synthesized polypeptides (10 mg/mL), lamivudine (1 mg/mL, positive control) and blank solvent (negative control) were applied to HepG 2.2.15 cell line, the inhibition effect of chemically synthesized polypeptides on HBV was detected, cell viabi-lity rate was detected by crystal violet staining, cytotoxicity of each group was compared. Polypeptide with the strongest inhibition effect on HBV was selected, concentration gradients of 10, 1 and 0.1 mg/mL were set, after 3, 6 and 9 days of treatment on HepG 2.2.15 cells, the supernatant of cells was collected, copies of viral DNA were detected by real-time fluorescence quantitative polymerase chain reaction (RT-PCR), changes in HBsAg and HBeAg were detected by chemiluminescent microparticle immunoassay. Results Peptide KBDT-2 was screened from seven chemically synthesized polypeptides, RT-PCR result showed that KBDT-2 had anti-HBV replication effect in vitro, and the higher the concentration of KBDT-2, the better the inhibition effect; chemiluminescence microparticle immunoassay showed that KBDT-2 could inhibit HBsAg and HBeAg, the biological markers of hepatitis B virus; crystal violet staining result showed that KBDT-2 had no obvious toxicity to HepG 2.2.15. Conclusion KBDT-2 can inhibit the replication of HBV without obvious cytotoxicity, and can effectively reduce the expression of HBsAg and HBeAg, which provides experimental data support for exploring new anti-HBV drugs.

Abstract:Objective To explore the effect of asthma on disease characteristics and prognosis of hospitalized patients with community-acquired pneumonia (CAP). Methods Data of all CAP patients hospitalized in 4 hospitals in Beijing, Shandong and Yunnan from January 1, 2013 to December 31, 2015 were retrospectively collected, demographic, clinical and imaging characteristics, as well as etiology and clinical outcomes of patients with and without asthma (AS-CAP and non-AS-CAP) were compared, independent risk factors affecting the 30-day mortality of AS-CAP patients were analyzed by univariate analysis. Results 3 901 CAP patients were included in the analysis, AS-CAP accounted for 5.9% (231/3 901). Compared with non-AS-CAP patients, AS-CAP patients were mostly female and younger age, inhalation factors, one-year history of CAP and use of inhaled glucocorticoid were more common, pleural effusion was rare, but pneumonia severity index (PSI) grading/CURB-65 score, etiological distribution, ICU admission ratio, 30-day mortality and length of hospital stay were similar between two groups. The 30-day mortality of AS-CAP patients was 2.2% (5/231). Compared with survival group, the proportion of male, cerebrovascular disease, chronic liver disease, inhalation factor and imaging hollow in death group were all higher, and PSI grade was also higher, differences were all statistically significant (all P<0.05). Conclusion Clinical characteristics and outcomes of AS-CAP and non-AS-CAP patients are similar, and combination of AS does not increase the severity and 30-day mortality of CAP patients. In addition to PSI grading, clinicians should also pay attention to inhalation factor.

Abstract:Objective To explore the distribution and difference in antimicrobial resistance of pathogens in diabetic patients complicated with pulmonary infection during different disease courses, so as to provide reference for rational choice of antimicrobial agents in clinic. Methods Patients with type 2 diabetes mellitus complicated with pulmonary infection in a hospital between January 2015 and October 2018 were selected, they were divided into long-term disease course group (LC group, disease course ≥ 10 years) and short-term disease course group (SC group, disease course<10 years), qualified sputum specimens were collected for bacterial culture and antimicrobial susceptibility testing, and the monitoring data were analyzed statistically. Results A total of 132 cases in LC group and 127 in SC group were included. 385 strains of pathogens were isolated, 201 of which were isolated from LC group and 184 were from SC group. Proportion of gram-negative bacteria and fungi isolated from LC group was higher than that of SC group, and gram-positive bacteria was lower than that SC group; proportion of Acinetobacter baumannii from LC group was higher than that of SC group, Staphylococcus aureus in LC group was lower than that of SC group; differences were all statistically significant (all P<0.05). Isolation rates of extended-spectrum beta-lactamases (ESBLs) and methicillin-resistant (MR) strains in LC group were both higher than those in SC group (40.87% vs 22.03%; 37.50% vs 19.61%, respectively), with statistical significance (both P<0.05). Antimicrobial susceptibility testing results showed that resistance rates of Klebsiella pneumoniae and Escherichia coli to cefuroxime and levofloxacin were both>50%; resistance rates of Acinetobacter baumannii to ampicillin/sulbactam, piperacillin/tazobactam, ceftazidime, levofloxacin and tobramycin were all ≥ 50%;resistance rates of Pseudomonas aeruginosa to levofloxacin, ciprofloxacin and tobramycin were all >50%; resistance rate of Staphylococcus aureus to cefazolin, ceftriaxone, clindamycin, azithromycin and gentamicin were all ≥ 50%. Resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam, ceftazidime, imipenem and amikacin in LC group were all higher than those in SC group (all P<0.05). Conclusion Distribution of pathogens and antimicrobial resistance of partial bacteria in diabetic patients complicated with pulmonary infection during different disease courses are different, which should be treated differently in clinic.

Abstract:Objective To understand drug resistance mechanism and clinical characteristics of linezolid-resistant Staphylococcus capitis(LRSC). Methods LRSC isolated from a hospital was collected, homology of the strains was analyzed by pulsed-field gel electrophoresis(PFGE), 23S rRNA gene, rplC and rplD genes which encode ribosomal protein L3 and L4, as well as drug-resistant gene CFR were amplified by polymerase chain reaction(PCR), then sequenced. Results Seven strains of LRSC were isolated from specimens of 5 patients, strains were resistant to oxacillin, levofloxacin, gentamicin and other commonly used antimicrobial agents, only susceptible to glycopeptides, rifampicin, tetracycline and quinupristin/dalfopristin. 23S rRNA mutation were found in all 7 drug-resistant strains, all strains didn't carry CFR gene. PFGE showed that 7 clinical strains belonged to the same genotype. All 5 patients had serious underlying diseases, length of hospital stay of patients who isolated drug-resistant bacteria was 92 days to 10 months, 3 of whom indwelled deep venous catheters, 1 patient indwelled both deep venous catheter and dialysis catheter, and 3 patients received linezolid treatment. Conclusion Resistance of 7 strains of S. capitis to linezolid is due to G2576T and C2104T mutations in V region of 23S rRNA; LRSC showed multidrug-resistant phenotype, factors for drug-resistant bacterial infection may be patients with underlying diseases, prolonged length of hospital stay, long course of treatment with linezolid and indwelling deep vein catheter.

Abstract:Objective To explore the application effect of different scales of stroke-associated pneumonia (SAP) on predicting hospital-acquired pneumonia (HAP) in patients with ischemic stroke. Methods Data of patients with ischemic stroke admitted to department of neurology in a secondary general hospital from 2015 to 2018 were collected, the application of 6 SAP predictive scales in predicting HAP in patients with ischemic stroke was analyzed by recei-ver operating characteristic(ROC) curve, and performance of each predictive scale was evaluated. Results Data of 628 patients were collected, there were 44 cases of HAP (7.01%) and 46 cases of SAP (7.32%). C statistics of Kwon, Chumbler,A²DS²,PANTHERIS,ASI-APS,and ISAN were 0.731, 0.764, 0.729, 0.728, 0.66, and 0.778 respectively, except for ASI-APS sale, there were significant differences among the other 5 scales (all P<0.05), but there was no significant difference in the area under the curve of each score (all P>0.05). Comparison of predictive performance of HAP and reported SAP showed that Chumbler and ISAN had little difference in predicting HAP and SAP. Conclusion Except ASI-APS, other SAP predictive scales can be used to predict HAP in patients with ischemic stroke.

Abstract:Objective To understand the colonization of Staphylococcus aureus (SA) and other cultivable symbiotic bacteria in nasal cavity, and provide reference for the formulation of prevention and control measures of infection and healthcare-associated infection (HAI) caused by opportunistic pathogenic bacteria (especially SA) colonized in nasal cavity. Methods Nasal vestibule specimens from military medical university healthy students who studied clinical medicine course in a hospital were collected and inoculated on various kinds of bacterial culture media by microbial automation system for bacterial culture and colony observation, the isolated strains were identified by mass spectrometry, SA was performed antimicrobial susceptibility testing. Results A total of 161 nasal vestibular specimens were collected, 549 bacterial strains of nasal colonization were isolated, including 493 strains of gram-positive and 56 strains of gram-negative bacteria, the top three bacteria were Corynebacterium accolens (151 strains), Staphylococcus epidermidis (150 strains) and Corynebacterium pseudodiphtheriticum (54 strains).There were 72 kinds of bacteria carrying patterns, 21 (13.04%) students were detected Staphylococcus aureus, Staphylococcus epidermidis and Corynebacterium accolens simultaneously, which was the most common patterns. Colonization rates of nasal SA and methicillin-resistant Staphylococcus aureus were 25.46% (41/161) and 4.35% (7/161) respectively, resistance rates of SA to penicillin, erythromycin and clindamycin were 39.02%-78.05%. Conclusion Nasal colonized bacteria in these university students are mainly normal flora, it is necessary to pay attention to the possibility of self-infection and HAI caused by colonized SA and other opportunistic pathogens.

Abstract:Objective To identify species of rapidly growing mycobacteria (RGM) and analyze clinical characteristics of 5 patients with mycobacteria bacteremia, and improve diagnosis and treatment level of the disease. Methods Five strains of RGM collected from Hainan General Hospital between 2016 and 2017 were preliminarily identified by MALDI-TOF MS technique and confirmed by 16s rRNA, clinical characteristics were analyzed combined with 15 cases of RGM bacteremia reported in the literatures. Results MALDI-TOF MS identification results were Mycobacterium mageritense, Mycobacterium abscessus,and Mycobacterium mucogenicum, each had 1 strain, Mycobacterium fortuitum had 2 strains. 16s rRNA identification results were Mycobacterium mageritense,Mycobacterium abscessus,Mycobacterium mucogenicum, Mycobacterium fortuitum and Mycobacterium porcinum, each had 1 strain. The main clinical symptom was fever, 2 patients died and 3 patients got better after treatment. Conclusion MALDI-TOF MS is a simple, convenient, and rapid method for the identification of RGM, identification results were highly conformed to 16s rRNA sequencing analysis. RGM bacteremia mostly occurrs in patients who receives artificial material and catheterization, laboratory and clinical diagnosis of the disease should be paid attention.

Abstract:Objective To investigate the knowledge, attitude and behavior(KAB)of hand hygiene(HH) among caregivers in a tertiary first-class children's hospital, and analyze the changing trend of KAB and its risk factors. Methods From January 2016 to December 2018, the implementation of HH among caregivers in a children's hospital was investigated by concealed on-site observation, bacteriological surveillance on HH was conducted, KAB of HH and its influencing factors were performed questionnaire survey. Results Caregivers' HH compliance rate was 71.10%, qualified rate of bacteriological surveillance on HH was 72.92%, there were no significant differences in the compliance rate and qualified rate of HH among caregivers in three years (all P>0.05). In 2016, caregivers' HH knowledge score and attitude score was correlated (P<0.05), but knowledge score and attitude score were not correlated to behavior score (both P>0.05); in 2017-2018, caregivers' HH knowledge score and attitude score were both correlated to behavior score (both P<0.05). Insufficient supervision of hospital, considering the irritation of skin by alcohol-based hand rub and caregivers' weak consciousness of hand-washing were main factors for lower scores of HH behavior. Conclusion The overall HH compliance rate in this children's hospital is relatively high, but there is still room for improvement, competent department should formulate feasible HH system and standards, and carry out the supervision on implementation, further improve HH compliance rate of caregivers and qualified rate of bacteriological surveillance.

Abstract:Objective To understand the current situation of medical waste management in primary medical institutions in Wuhan, find out the problems and put forward improvement countermeasures. Methods In July 2018, a stratified sampling method was used to investigate the medical waste management of 45 medical institutions in 13 districts of Wuhan. Results In 2017, the median of production of medical waste generated by 45 medical institutions was 0.32 kg/bed-day, the median of medical waste disposal fee was 0.67 yuan/bed-day, the rational disposal rate of uncontaminated disposable infusion bottles after use was 64.44%. 93.33% of medical institutions had leading groups for medical waste management, only 57.78% of medical institutions identified administrative department of medical waste management, the correct rate of medical waste classification was 60.00%. 97.78% of medical institutions established the temporary storage facilities and equipment for medical waste, and equipping rate of complete protective equipment was 73.33%, equipping rate of complete hand washing facilities and hand hygiene products was 64.44%. All medical institutions put medical waste to centralized medical waste disposal center, only 35.56% of medical institutions could transfer medical waste within 2 days. The qualified rates of medical waste temporary storage time and administrative department defining for medical waste management in secondary medical institutions is higher than primary medical institutions(both P<0.05), there were no significant difference in the other indexes. Conclusion Medical waste management in primary medical institutions of Wuhan has been gradually standardized, but there are still problems, especially the temporary storage time of medical waste in primary medical institutions >2 days. It is necessary to increase communication and cooperation in multiple departments, strengthen training and supervision, and explore an appropriate management mode.

Abstract:Objective To innovate the management of medical waste in medical institutions by means of information technology, and explore the effective management mode of medical waste. Methods A tertiary first-class hospital was selected, by means of information technology supporting management mode, the collection, transportation and temporary storage of medical waste were real-time monitored, plan-do-check-act(PDCA) management tool was used for continuous quality improvement in view of the problems found in the management. Change in awareness rate of medical waste-related knowledge, correct rate of medical waste disposal and occupational exposure rate rela-ted to medical waste before and after application of information management were statistically analyzed. Results Awareness on medical waste-related knowledge was surveyed, except the requirement of medical waste management system, the correct rates of other surveys after information management were all higher than before management, differences were all statistically significant (all P<0.01). In the daily inspection of medical waste disposal by ma-nagement department, except the standard temporary storage location of medical waste and protection measures for cleaners, the other inspection indicators after information management were all higher than before management, differences were all statistically significant (all P<0.01). After the implementation of information management, occupational exposure rate related to medical waste disposal was 0.005 case/person-year, which was lower than 0.011 case/person-year before the implementation, difference was statistically significant (P<0.05). Conclusion The effect of management mode of medical waste based on information technology is significant, which can reflect the effect of continuous improvement.

Abstract:Objective To observe the effect of quality control circle (QCC) activity on reducing exceeding standard rate of microbial carrying on mobile phone surface of health care workers(HCWs). Methods QCC activity group was set up by department of healthcare-associated infection management and department of surgery, the theme of activity was "Reducing exceeding standard rate of microbial carrying on HCWs' mobile phone surface", causes of the problems were found and countermeasures were put forward, exceeding standard rate of microbial carrying on HCWs' mobile phone surface before and after implementing QCC activity was compared. Results The exceeding standard rate of microbial carrying on HCWs' mobile phone surface before and after implementing QCC activity were 36.82% and 13.15% respectively, exceeding standard rate of microbial carrying after QCC activity was lower than before QCC activity, difference was statistically significant (χ²=35.81,P<0.001). The goal achievement rate and the progress rate of exceeding standard rate of microbial carrying on mobile phone surface were 144.68% and 64.29% respectively. The circle ability increased from 60% before QCC activity to 85% after QCC activity. Conclusion QCC activity can reduce exceeding standard rate of microbial carrying on HCWs' mobile phone surface.

Abstract:Objective To investigate the incidence and risk factors for healthcare-associated infection(HAI) in hospitalized patients in rehabilitation center. Methods Clinical data of hospitalized patients in a rehabilitation center from January to December 2018 were retrospectively analyzed, incidence of HAI, infection sites and pathogens were analyzed, risk factors for HAI were analyzed by univariate and multivariate logistic regression analysis. Results A total of 4 118 patients were hospitalized, 88 patients had 95 cases of HAI, HAI incidence and HAI case incidence were 2.14% and 2.31% respectively. The highest incidence of HAI was in patients with cerebral hemorrhage, incidence and case incidence were 5.41% and 6.21% respectively. The top three sites of HAI were urinary tract, lower respiratory tract and upper respiratory tract, accounting for 49.47%, 27.37% and 15.79% respectively. A total of 76 strains of pathogens were isolated from 95 cases of HAI, 56 of which (73.68%) were gram-negative bacteria and 15 (19.74%) were gram-positive bacteria. Multivariate logistic retrospective analysis showed that male, invasive operation, disturbance of consciousness and hypoproteinemia were independent risk factors for HAI in hospitalized patients in rehabilitation department (all P<0.05). Conclusion Male patients, disturbance of consciousness, invasive manipulation and hypoproteinemia are risk factors for HAI in patients in rehabilitation center, targeted prevention and control measures should be taken to reduce the occurrence of HAI.

Abstract:Objective To compare the effect of automatic cleaning and disinfection machine as well as traditional manual cleaning and disinfection method on the cleaning and disinfection of digestive endoscopes. Methods 109 digestive endoscopes in a digestive endoscopy center of a hospital were collected and divided into trial group and control group according to their numbers, trial group was cleaned and disinfected by automatic cleaning and disinfection machine, control group was cleaned and disinfected by traditional manual cleaning and disinfection method. Samples were taken from different parts of endoscopes in two groups. Cleaning quality of endoscopes was detected by visual method and ATP biofluorescence detection method, and bacterial contamination of endoscopes was detected by poured-plate culture method. Qualified rate of cleaning and disinfection of endoscopes between two groups was compared. Results There were 55 endoscopes in trial group and 54 in control group. The total qualified rates of endoscope cleaning in trial group and control group were 94.55% and 83.33% respectively, there was no significant difference between two groups (P>0.05). Qualified rate of endoscopic valve cleaning in trial group was higher than control group (96.36% vs 85.19%, P<0.05), but there was no significant difference in qualified rates of endoscopic surface cleaning and endoscopic lumen cleaning between two groups(both P>0.05). The total qualified rates of endoscope disinfection in trial group and control group were 96.36% and 85.19% respectively, there was significant difference between two groups (P<0.05). Qualified rate of endoscopic lumen disinfection in trial group was higher than control group (96.36% vs 85.19%, P<0.05), but there was no significant difference in the qualified rates of endoscopic surface and valve between two groups (both P>0.05). Conclusion Effect of automatic cleaning and disinfection machine on cleaning and disinfection of digestive endoscopes is superior to traditional manual clea-ning and disinfection. If traditional manual cleaning and disinfection of endoscopes is adopted, cleaning and disinfection criteria of soft endoscopes should be strictly enforced to minimize the risk of cross-infection during endoscopy diagnosis and treatment.

Abstract:Objective To study the disinfection efficacy of hypochlorite disinfectant on fiberoptic bronchoscope by automatic soft endoscope cleaning-disinfection machine. Methods Seven fiberoptic bronchoscopes used in a hospital in June-July 2018 (total 48 days) were monitored. Fiberoptic bronchoscopes were cleaned and disinfected with hypochlorite disinfectant by machine for 5 minutes, ATP fluorescence detection method, filter membrane method and pouring method were used to monitor and evaluate the disinfection efficacy on the outer surface and inner surface of fiberoptic bronchoscopes. Results Seven fiberoptic bronchoscopes were sent to central sterile supply room for 159 times of cleaning and disinfection. Specimens were taken 30 times in different dates, surface cleanliness was detected by ATP fluorescence method with RLU range of 10-64 (median was 22), and qualified rate was 100%. A total of 159 times of detection were performed on the inner surface, colony counts were both 0-6 CFU/piece detected by filter membrane method and pouring method, and qualified rates were both 100%. The results of seven cycles of stability test showed that the initial concentration of available chlorine was 210 mg/L when hypochlorite disinfectant was used in automatic endoscope cleaning-disinfection machine, after one-week disinfection, endoscopes were treated 20-32 times, and concentration of available chlorine was 74-106 mg/L. Conclusion Hypochlorite disinfectant can meet the prescribed disinfection requirements when it is used for disinfection of fiberoptic bronchoscope by automatic soft endoscopy cleaning-disinfection machine, the effective concentration of hypochlorite disinfectant can still be maintained when it is used in machine for 7 days.

Abstract:Objective To investigate the management status of central sterile supply departments (CSSDs) in secondary and tertiary hospitals in Shanghai, put forward scientific basis and reference for promoting further implementation of WS 310.1-2016 Hospital Central Sterile Supply Department- Part 1:Management Standard. Methods According to the requirement of WS 310.1-2016, self-designed questionnaires were used to investigate the management of CSSDs of 58 hospitals in 16 districts and counties of Shanghai. Results 94.83% of hospital CSSDs implemented centralized management, 85.19% of hospital CSSDs undertook cleaning and disinfection management of loaner medical devices and implants, there was no significant difference in the implementation rate between secondary and tertiary hospitals (all P>0.05). 70.37% of hospital CSSDs completed monitoring management on the initial sterilization of loaner medical devices and implants, tertiary hospitals performed better than secondary hospitals(χ²=5.684,P<0.05). 48.28% of hospital CSSDs equipped with insulation detector, equipping rate in tertiary hospitals was higher than secondary hospitals(χ²=5.557,P<0.05). Conclusion The overall situation of implementing WS310.1-2016 in secondary and tertiary hospitals in Shanghai is good, but disposal and management of loaner medical devices and implants by CSSDs need to be improved urgently, and equipping of insulation detector should be paid attention.

Abstract:

Abstract:Candida auris(C. auris) is a multidrug-resistant yeast which can cause invasive infection, it was first detected and reported in 2009. It is difficult to be identified through the laboratory traditional morphological and biochemical detection methods, clinical isolates of C. auris are usually multidrug-resistant and cause infection with high mortality rates, it can exist for a long time on environmental surface and colonized population. To date, transmission mechanisms and disinfection measures of C. auris remained unclear, more than 30 countries have successively reported cases of infection and healthcare-associated infection(HAI) due to C. auris, which is gradually becomes a new global threat. Eighteen cases of C. auris infection have been reported in China. In order to reveal the risk of C. auris HAI transmission and help medical institutions improve the prevention and control program for HAI, this paper reviews the current situation of prevention and control of infection and HAI due to C. auris.