Abstract:In recent years, with the widespread use of broad-spectrum antimicrobial agents, multidrug-resistant organisms (MDROs) have emerged and become more and more common, such as methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Enterobacteriaceae(CRE), which pose severe challenge to clinical anti-infective treatment and prevention and control of healthcare-associated infection. The new antimicrobial agents and bacterial resistance have developed at the same time, development of bacterial resistance seems to have a tendency to overwhelm the development of antimicrobial agents. Antimicrobial resistance(AMR) is now recognized as one of the major threat to human health worldwide. The Center for Disease Control and Prevention (CDC) of America has proposed four core plans to address the challenge of MDROs:surveillance, antimicrobial management, improvement of antimicrobial agents and diagnosis, as well as prevention and control of transmission. In response to the severe threat of MDRO infection, prevention of infection should be focused on, antimicrobial management and HAI management should be grasped at the same time and attached sufficient importance, effective measures should be taken based on the source, route, and susceptible people of infection, multiple details and constant innovation should be paid attention to, the final victory can be achieved.

Abstract:Objective To evaluate the effect of different gargling liquid on colony number in air during oral ultrasound scaling for patients with periodontitis. Methods Patients with mild(n=54), moderate(n=54), and severe chronic periodontitis(n=54) were selected, then patients with same degree of periodontitis were randomly divided into three groups, with 18 in each group. Before scaling, patients in each group of mild, moderate, and severe periodontitis were given honeysuckle liquid (gargle A), 3% hydrogen peroxide (gargle B), and normal saline (gargle C) respectively. Bacterial culture and identification of air specimens were conducted at 0 and 30 minutes after the beginning of ultrasonic scaling as well as 10, 20 minutes after the end of ultrasonic scaling. Results Variance analysis of three-factor factorial design data showed that degree of periodontitis, types of gargling liquid, and sampling time had interaction (F=2.666, P=0.002). Comparisons of air colonies:At the beginning of scaling, there was no significant difference in colony number of air around patients using different gargling liquid in mild, moderate and severe groups (all P>0.05). Among patients using the same gargling liquid at 30 minutes after the beginning of scaling, colony number of air was the lowest around patients with mild periodontitis and the highest around patients with severe periodontitis, colony numbers of air around patients with gargle A and B were lower than that of patients with gargle C. Comparison of each sampling points showed that colony number of air around the right side of patients' head was highest, differences were all statistically significant (all P<0.05). 20 minutes after the end of scaling, there was no significant difference in colony number among groups compared before scaling (all P>0.05). The main isolated strains in the air were Streptococcus viridans(32.53%), coagulase negative staphylococcus(24.56%), and filamentous fungi(18.48%). Conclusion There are variety of opportunistic pathogens in the air during oral ultrasound scaling, and the number of colonies is positively correlated with the degree of periodontitis. honeysuckle liquid has a good effect on reducing the number of air colonies during and after scaling.

Abstract:Objective To understand the changing trend of incidence of surgical site infection (SSI) following oral and maxillofacial surgery, and explore the influence of American Society of Anesthesiologists(ASA) score, type of incision, duration of operation and surgical risk index. Methods Data of patients who were hospitalized and underwent oral and maxillofacial surgery in a tertiary dental hospital from 2007 to 2017 were retrospectively analyzed. Trend Chi-square test was used to analyze the changing trend of incidence of SSI, binary logistic regression was used to analyze the risk of SSI. Results From 2007 to 2017, incidence of SSI in patients with oral and maxillofacial surgery was 0.33%-0.93%, with an average of 0.71%; patients with high indexes of ASA score, type of incision, duration of operation and surgical risk had higher incidence and risk of SSI; incidence of SSI was the lowest in 2009. In patients with ASA score of P1, surgical risk index of grade 1, incidence of SSI declined from 0.72% and 2.79% in 2011 to 0.42% and 1.54% in 2017 respectively, with a decrease of more than 41%. Conclusion Incidence of SSI following oral and maxillofacial surgery decreased and finally remained at a low level during 11 years, with the increase of ASA score, risk indexes score of surgical incision type, duration of surgery and surgical risk, incidence and risk of SSI increased gradually, medical environment may be one of the factors that affected SSI.

Abstract:Objective To screen specific mass peaks(SMP) of carbapenem-resistant Klebsiella pneumoniae (CRKP) by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and perform rapid homology analysis on CRKP based on SMP. Methods 76 strains of CRKP with multilocus sequence typing (MLST) were selected from a microbiology laboratory of a hospital, 52 strains were for establishment of method and 24 strains were for validation of method. Five different criteria for selecting SMP of CRKP were set, SMP of different ST-type were screened according to different criteria, CRKP was typed based on screened SMP, criterion with the highest coincidence rate of MLST results was determined as the best criterion. Twenty-four CRKP strains were typed according to the specific peaks screened through best criteria, accuracy of SMP typing method was verified, and was compared with principal component analysis (PCA) and main spectra profile(MSP) cluster analysis in mass spectrometer software. Results According to standard 2 (1signal-to-noise ratio[S/N] ≥ 4, 2S/N ratio ≥ 1.5, 3coefficient of variability[CV ≤ 40%]), 45 SMP were selected from 52 strains of CRKP strains, 29 strains of CRKP were typed by SMP, with the highest coincidence rate (82.8%) with MLST, which was determined as the best criterion. Another 24 CRKP strains were typed according to SMP screened based on this criterion, and the coincidence rate with MLST was 83.3%. The coincidence rate between PCA cluster analysis and MLST was only 66.7%, consistency between MSP clustering analysis and MLST was poor, and it didn't conform to the grouping trend of ST typing. Conclusion MALDI-TOF MS can select SMP of CRKP of different ST, which can be used for rapid homology analysis on CRKP, provide basis for surveillance and control of outbreak of healthcare-associated infection.

Abstract:Objective To explore the influence of obesity in surgical site infection(SSI) following spine surgery. Methods Literatures on relationship between obesity and spine surgery were collected. Data were extracted, checked, and analyzed with STATA 11.0 software by two researchers independently, fixed-effect model and random-effect model were used to analyze the combined OR value and its 95% confidence interval (95%CI). Results A total of 32 literatures involving 110 877 patients were included in the study. Most studies were thoracic or lumbar surgery. SSI rate in obesity group was higher than control group(OR,2.56[95%CI,1.95-3.36]). Stratified analysis result showed that incidence of infection in obese Caucasians was 2.50 times higher than that in control group(95%CI, 1.77-3.52), obese people in Asia was 2.77 times higher than that of people with normal weight(95%CI,1.81-4.22). Conclusion Among Caucasians and Asians, obese people are more likely to have SSI following spine surgery.

Abstract:Objective To establish a nursing risk assessment index system(NRAIS) for stroke-associated pneumonia (SAP), and provide reference for the prevention and control of SAP. Methods On the basis of literature analysis and semi-structured interviews, the basic framework of NRAIS for SAP was preliminarily drawn up. Indexes were screened by using Delphi method and analytic hierarchy process, the weight of index was calculated. Results The NRAIS for SAP consisting of 6 first-level indexes and 33 second-level indexes was constructed, positive coefficient of expert of two rounds consultation were 88.89% and 100% respectively, authoritative coefficients was 0.8%. Conclusion The constructed assessment index system can effectively help managers identify high-risk factors and high-risk links of SAP, and provide evaluation basis for effective prevention of clinical nursing risks.

Abstract:Objective To establish the risk prediction scoring model of central line-associated bloodstream infection (CLABSI) in elderly patients, provide basis for screening high-risk population, and effectively prevent and control bloodstream infection(BSI) in elderly patients. Methods According to the inclusion and exclusion criteria, data of elderly patients who underwent central catheterization during hospitalization from January 1, 2015 to December 31, 2017 were collected, patients were randomly divided into modeling group and verification group according to the ratio of 7:3 (random seed was 20180708), risk factors of data of modeling group were distinguished, logistic regression model was constructed. The corresponding score of each risk factor was assigned according to β value, infection risk scoring model was established, prediction accuracy of model was evaluated by receiver operating characteristic (ROC) curve; according to the established infection risk scoring model, cases in validation group were scored, prediction accuracy of model was evaluated by ROC curve. Decision curve was constructed using R software. Results Logistic regression analysis showed that the number of operation ≥ 3 times, length of stay in intensive care unit(ICU) ≥ 2 days, duration of indwelling central venous catheterization ≥ 7 days, and use of antimicrobial agents were independent risk factors for CLABSI in elderly patients; the corresponding points in risk prediction scoring model were 3, 4, 4, and 9 respectively, and the score of 13-17 points were high-risk population of CLABSI; the area of ROC curve (AUC) was 0.74 in the modeling group; ROC curve was plotted based on the risk score of patients in validation group, AUC was 0.70. The decision curve showed that the net benefit of the risk scoring model was higher in the high risk thershold of 0.01-0.05. Conclusion The established risk prediction scoring model has good discriminant validity and application value, and can be used in the identification of susceptible high risk population of CLABSI in elderly patients, so as to achieve early prevention and control.

Abstract:Objective To study the effect of relatively closed environment dispensing mode on insoluble particles in pharmaceuticals. Methods The numbers of insoluble particles in conventional manual dispensing mode and relatively closed environment dispensing mode in lass Ⅰ and class Ⅲ environment were detected, effect of different dispensing modes on the number of insoluble particles in pharmaceuticals was compared. Results When adopting manual dispensing, the numbers of 1-10 μm insoluble particulates in different groups in class Ⅰ environment were less than those in class Ⅲ environment respectively, differences were all statistically significant (all P<0.05). When adopting a new mode of dispensing in relatively closed environment, there was no significant difference in the numbers of 1-15 μm insoluble particulates in different groups between class Ⅰ and class Ⅲ environment respectively (all P>0.05). The numbers of 1-20 μm and 1-15 μm insoluble particles in different groups were less than those in manual dispensing when the new mode of dispensing were adopted in class Ⅲ and class Ⅰenvironment respectively, differences were all statistically significant (all P<0.05). The numbers of 1-15 μm insoluble particles in different groups in manual dispensing in class Ⅰ environment were more than those in class Ⅲ environment respectively, difference were all statistically significant (all P<0.05). Conclusion The relatively closed environment dispensing mode can effectively reduce environmental particulates entering intravenous infusion system during dispensing process.

Abstract:Objective To explore the effect of risk assessment method on the incidence of healthcare-associated infection(HAI) in high-risk departments. Methods A hospital was selected as the research object, risk assessment of HAI management at the hospital and department level was carried out, high-risk departments and high-risk links were screened out, targeted intervention was performed. Patients hospitalized in April-June 2017 were as control group and those hospitalized in July-September 2017 were as intervention group, incidence of HAI between two groups was compared. Results Through risk assessment at the hospital level, department of critical care medicine was the department with the highest risk, risk assessment at the department level showed that without wearing isolation clothes when contacting isolated patients during diagnosis and treatment, without using sterile sheeting when catheterization, and low correct rate of hand hygiene were high-risk links in department of critical care medicine. Targeted intervention was performed, isolation clothing allocation rate for contacting isolated patients increased from 0 to 100%, compliance rate to wearing isolation clothing among medical staff increased from 0 to 97.62%, implementation rate of using sterile sheet for deep vein catheterization increased from 72.50% to 100%; hand hygiene correct rate increased from 85.00% to 96.59%. Incidence of HAI decreased from 5.90% to 2.64%, difference was statistically significant (P<0.05). Conclusion Implementing risk assessment management of HAI in medical institutions can effectively guide the prevention and control of HAI in high-risk departments, and improve the level of HAI management.

Abstract:Clinical data of one patient with sepsis-induced myopathy(SIM) who was successfully treated were reviewed retrospectively, analysis was conducted combined with the relevant literatures. Patient was a middle-aged woman without underlying disease, she was admitted to hospital because of fever, cough, chest tightness and shortness of breath, during the treatment period, type Ⅱ respiratory failure occurred repeatedly, and it was difficult in withdrawing respirator, patient was finally diagnosed with SIM. After anti-infective treatment and rehabilitation training, she was successfully withdrawn respirator, muscle strength was recovered. This case suggests that SIM can be completely cured through early identification, neuromuscular nutrition therapy, graded rehabilitation training and lung rehabilitation therapy.

Abstract:A 56-year-old female patient was admitted to a hospital because of repeated fatigue, anorexia, fever for more than one year, recurrence for 2 months and sudden left limb twitch for 10 days. In 2017, patient was diagnosed with infective endocarditis, then underwent aortic valve replacement, valve biopsy showed Candida parapsilosis, she took medicine regularly after operation and withdrew medicine after three consecutive negative blood culture. Fever and multiple organ infarction occurred again in 2018, Candida parapsilosis was isolated again from blood culture, it is suggested that fungal endocarditis may be latent and recurrence in human body for a long time, exfoliation of vegetation may embolize various organs and lead to corresponding clinical manifestations, surgery combined with drug therapy and subsequent maintenance of antifungal therapy are extremely important to improve the prognosis of patients.

Abstract:Objective To evaluate the cleaning quality of different cleaning methods for laparoscopic instruments, ensure the cleaning quality of instruments. Methods The used laparoscopic instruments were classified into two categories:non-lumen instruments and lumen instruments. Three cleaning methods, traditional manual cleaning (A), manual cleaning + ultrasonic cleaning (B), manual cleaning + automatic cleaning disinfector (C), were adopted respectively for treating instruments. Cleaning quality of instruments were detected with ATP bioluminescence assay. Results The qualified rates of laparoscopic non-lumen instruments cleaned by methods A, B, and C were 78.75%, 95.71%, and 96.00% respectively, difference was significant (χ²=16.453,P<0.001);qualified rate of methods B and C for cleaning non-lumen instruments was higher than that of method A (P<0.016), there was no significant difference between methods B and C (P>0.016). Qualified rates of laparoscopic lumen instruments cleaned by methods A, B, and C were 76.47%, 98.75%, and 91.55% respectively, difference was significant(χ²=21.087,P<0.001); qualified rates of methods B and C for cleaning lumen instruments were both higher than that of method A (P<0.016), there was no significant difference between methods B and C (P>0.016). Conclusion Effect of manual cleaning + ultrasonic cleaning and manual cleaning + automatic cleaning disinfector on used laparoscopic instruments are both better than that of traditional manual cleaning method, can effectively guarantee the cleaning quality of instruments and help to ensure the operation safety of patients.

Abstract:Objective To understand pathogenic microorganism contamination status of medical waste sharps containers with different use time, explore the reasonable duration of service time of sharps containers, provide reference for the management of medical waste. Methods Twelve 2L sharps containers on treatment trolleys in a tertiary first-class infectious disease specialty hospital were randomly selected, viral loads of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) as well as bacterial colonies on inner and outer surfaces of sharps containers at different time points were detected, three unused sharps containers were taken as control at the same time. Results Sixty eluent specimens of outer surface and contents of sharps containers in trial group and control group were collected respectively at four time points (48 h, 72 h, 5 d, 7 d), no HIV and HCV were detected, and no HBV was detected in specimens of outer surface of sharps containers, HBV was detected in the eluent of contents in one sharps container 72 hours after the use, concentration of HBV was 2.20E+01 IU/mL. Changes in bacteria in the eluent of used sharps containers:100% of the eluent of contents in sharps containers grew bacteria on the 5th day after use, bacterial load of the eluent of contents in sharps containers on the 7th day after use was incalculable. Bacterial load on the outer surface of sharps containers ranged from 1 to 9 CFU/cm². No significant changes were observed in the inner and outer surfaces of all sharps containers, and no discomfort odor emerged. Conclusion With the storage time prolonged to 7 days, bacterial colonies on the outer surface of sharps containers didn't increase significantly, HIV, HBV and HCV were not detected. It is suggested that service time of sharps containers with small production of contents should not be set compulsorily at 48 hours (even if the contents in sharps container is less than 3/4 of storage capacity after 48 hours of use).

Abstract:Objective To analyze the correlation between antimicrobial use density (AUD) and change in antimicrobial resistance rate of Stenotrophomonas maltophilia(SM), and explore the influencing factors of antimicrobial resistance of SM. Methods Antimicrobial resistance rate of SM and AUD of commonly used antimicrobial agents in patients in a hospital from 2012 to 2017 were summarized, correlation was analyzed with Pearson correlation method. Results A total of 23 994 strains of gram-negative bacteria were isolated, of which 1 331 strains (5.55%) were SM, mainly from sputum (54.02%) and distributed in intensive care unit (21.49%). Resistance rates of SM to ceftazidime, levofloxacin, and compound sulfamethoxazole were 21.79%, 7.66%, and 13.37% respectively, resistance rates to levofloxacin showed an increasing trend year by year (P<0.05). Resistance rate of SM to levofloxacin was positively correlated with the use intensity of β-lactamase inhibitors, carbapenems, fluoroquinolones, and oxazolidinones (all P<0.05); resistance rate to compound sulfamethoxazole was positively correlated with the use intensity of macrolides (P<0.05). Conclusion Change in resistance rates of SM to levofloxacin and compound sulfamethoxazole are positively correlated with the use intensity of some commonly used antimicrobial agents, reducing AUD is beneficial to the control and reducing of the resistance of SM.

Abstract:Objective To understand the present status of special reports relating to microbiology at China provincial-level annual academic conference of healthcare-associated infection(HAI), and provide basis for the training and capacity-building of HAI management staff. Methods The conference arrangements for annual academic conference of provincial HAI quality control centers and HAI management societies from January 2015 to May 2017 were collected, and the special reports on microbiology were summarized and analyzed. Results A total of 35 annual academic conferences held by 17 provinces/municipalities directly under the central government/autonomous regions were included in the study, most conferences(42.31%) were concentrated on the fourth quarter. 15 annual academic conferences were related to microbiology report, accounting for 5.91% of the total reports, reporting time accounted for 4.81% of total time. There were various forms of microbiological thematic reports, subject reports, literature exchange, and interactive exchange accounted for 68.96%, 24.14%, and 6.90% respectively. The proportion of topics related to microbiology reports increased to a certain extent, but the proportion of reporting time decreased. Conclusion At present, the proportion and reporting time of microbiology reports in China provincial-level annual academic conference of HAI is relatively low, it is necessary to increase the number of microbiology reports in the future annual conference of HAI.

Abstract:Platelet activation plays an important role in the occurrence and development of sepsis. During sepsis stage, platelet activation can cause endothelial cell damage, promote the formation of neutrophil extracellular traps (NETs) and microthrombosis, aggravate coagulation dysfunction and inflammatory response disorder, and ultimately lead to multiple organ dysfunction syndrome(MODS) in septic patients. During the infection, platelets also participate in the process of congenital immune response and acquired immune response, through the interaction with immune mediators, platelets can actively defend the invasion and spread of pathogens, but also may aggravate the disease and even cause septic shock due to overactive immune response. This paper mainly introduces the role of platelet activation in the occurrence and development of sepsis, and highlights the role of platelet-mediated immune response in anti-infection of human body.