Abstract:After the introduction of revision of "Specification of hand hygiene of health care workers WS/T 313-2019", the requirements of hand disinfection for health care workers are more standardized. Hand disinfectant is an effective tool to improve hand hygiene and reduce hand-borne pathogenic microorganisms, national compulsory standard of "Hygienic requirements for hand antiseptic agents GB 27950-2010" stipulates the hygienic requirements for hand disinfectant, but there is no specific requirement for the inactivated virus markers. At present, the commonly used hand disinfectant in the market is mainly alcohol or alcohol-based hand disinfection product, but effect of alcohol disinfectant on inactivation of enteroviruses with strong disinfection resistance is disputed. In this paper, the domestic and foreign studies on the effect of hand disinfectant on inactivation of enterovirus are reviewed, so as to provide reference for health care workers to select hand disinfectant rationally.

Abstract:Objective To analyze the clinical characteristics, pathogenic species and drug resistance of patients with hospital-acquired candidemia(HAC), and explore risk factors affecting the prognosis of patients with candidemia. Methods HAC cases which were confirmed by blood culture in Nanfang Hospital of Nanfang Medical University between January 1, 2008 and December 31, 2018 were chosen, demographic and clinical data were collected, patients were divided into survival group and death group according to the prognosis, statistical analysis was performed. Results Clinical data of 240 patients with HAC were collected, including 155 males and 85 females, with an average age of (50.4±16.6) years. 90 strains (37.5%) of Candida albicans (C. albicans), 63 strains (26.3%) of C. parapsilosis and 53 strains (22.1%) of C. tropicalis were isolated from blood culture. Susceptibility rates of C. albicans and C. parapsilosis to azoles were more than 90%, susceptibility rates of C. krusei, C. glabrata and C. tropicalis to fluconazole were all low (40.0%, 59.3%, 62.3%, respectively), susceptibility rates of C. tropicalis and C. krusei to itraconazole were also low(62.3%, 60.0%, respectively). Multivariate analysis showed that organ failure (OR=5.872, P<0.001) and septic shock (OR=3.313, P=0.005) were independent risk factors for the death of patients with HAC. Conclusion C. albicans is the most common pathogens causing candidemia, Candida spp. is detected to be resistant to fluconazole, flucytosine and itraconazole, patients with candidemia have multiple underlying diseases, serious illness and high mortality, organ failure and septic shock are independent risk factors for the death of patients with candidemia.

Abstract:Objective To understand clinical distribution and drug resistance characteristics of carbapenem-resis-tant Gram-negative bacillus (CR-GNB), and provide basis for guiding clinical rational use of antimicrobial agents. Methods Clinical isolates of CR-GNB were collected from a hospital between January 2017 and October 2018, statistical analysis was performed by WHONET 5.6 software. Results A total of 9 506 strains of CR-GNB were collected, including 3 879 strains (40.18%) of carbapenem-resistant Acinetobacter baumannii (CRAB), 3 602 strains (37.89%) of carbapenem-resistant Klebsiella pneumoniae (CRKP), 1 322 (13.91%) strains of carbapenem-resis-tant Pseudomonas aeruginosa (CRPA) and 334 strains (3.51%) of carbapenem-resistant Escherichia coli (CREC). CR-GNB mainly distributed in intensive care unit (ICU) (6 340 strains, 66.69%), followed by department of respiratory medicine (751 strains, 7.90%); most strains were isolated from respiratory specimens (6 614 strains, 69.58%), followed by blood specimens (800 strains, 8.42%). Four major CR-GNB were generally resistant to common antimicrobial agents, CRPA was only susceptible to polymyxin B and amikacin, with susceptibility rates of 99.39% and 74.18% respectively; CRAB and CRKP were susceptible to tigecyclin, polymyxin B and minocycline, with susceptibility rates of 60.30%-99.66%; CREC was susceptible to tegacyclin, polymyxin B, amikacin and minocycline, with susceptibility rates of 66.49%-99.13%. Conclusion Antimicrobial resistance of CR-GNB is serious, especially in strains from ICU, clinicians should make more rational anti-infective treatment scheme and strengthen the implementation of infection control measures, reduce the emergence of multidrug-resistant organism and control the spread in hospital.

Abstract:Objective To compare the effect of unrestrictive visiting policy(UVP) and restrictive visiting policy(RVP) on delirium, length of hospital stay, acquired infection, as well as anxiety and depression of patients in intensive care unit (ICU), explore the optimal visiting mode. Methods Relevant researches were retrieved from Cochrane Library, PubMed, Embase, Web of Science,Chinese Biomedical Literature Database, Wanfang Database, China National Knowledge Infrastructure(CNKI) and VIP Database,the deadline was March 31, 2019. Quality of literatures was strictly evaluated and data were extracted by two researchers, literatures which conformed to the inclusion criteria were performed Meta-analysis. Results A total of 18 literatures (13 Chinese and 5 English) were included in this study, 8 were randomized controlled trial (RCT) studies and 10 were quasi-experimental studies, 4 728 patients were included. The included studies were divided into subgroups according to study design and length of visiting, forest plot result showed that compared with RVP, UVP could effectively reduce the incidence of delirium in ICU patients (OR=0.19, 95% CI[0.15, 0.24], P<0.001), reduce ICU patients' anxiety (MD=-1.60, 95% CI[-1.67, -1.54], P<0.001) and depression (MD=-1.63, 95% CI[-2.76, -0.49], P=0.003), as well as effectively improve patients' relatives' satisfaction to health care workers in ICU (OR=3.56, 95% CI[2.32, 5.48], P<0.1); meanwhile, UVP didn't increase the incidence of ICU-acquired infection (OR=0.82, 95% CI[0.55, 1.21], P=0.31), ICU mortality (OR=0.61, 95% CI[0.21, 1.79], P=0.37), and length of hospital stay(MD=-0.40, 95% CI[-1.29, 0.50], P=0.39). In addition, without considering the study design, UVP could reduce the incidence of ICU-acquired infection (OR=0.65, 95% CI[0.51, 0.82], P=0.004), the longer the visiting duration, the lower the incidence of ICU-acquired infection (OR=0.75, 95% CI[0.61, 0.91], P=0.004). Conclusion UVP does not increase the incidence of ICU-acquired infection, length of hospital stay and mortality, but can effectively decrease the incidence of ICU patients' delirium, reduce critically ill patients' anxiety and depression, and improve ICU patients' relatives' satisfaction.

Abstract:Objective To investigate effect of Da Vinci robotic surgery on healthcare-associated infection (HAI) and related factors in surgery patients, and provide evidence for prevention and control for HAI in Da Vinci robotic surgery. Methods Da Vinci robotic surgery cases from May 2016 to October 2018 in a hospital were selected, 839 patients who underwent 7 kinds of surgery were selected as case group, 891 patients who were operated in traditio-nal way and met the inclusion criteria during the same period were as control group, retrospective case-control study was performed. Results Urinary surgery, general surgery, and cardiothoracic surgery accounted for 74.26%, 20.50%, and 5.24% of Da Vinci robotic surgery respectively. HAI case rate, surgical site infection rate, length of hospital stay, duration of antimicrobial use, and duration of indwelling catheterization in the radical resection group of rectal cancer were all lower than control group; length of hospital stay and indwelling catheterization in atrial septal defect repair surgery group were both lower than control group; duration of indwelling catheterization in partial nephrectomy case group was lower than control group, difference were all statistically significant (all P<0.05). Total cost of hospitalization and operation in case group were both higher than control group, difference were both statistically significant (both P<0.01). Conclusion Compared with traditional surgical methods, Da Vinci robotic surgery does not increase the incidence of HAI, some surgeries can reduce the occurrence of HAI.

Abstract:Objective To investigate the pathogenic distribution and clinical characteristics of premature infants with septicemia in intesive care unit(ICU). Methods 155 premature infants with septicemia confirmed by laboratory positive blood culture were retrospectively analyzed, these infants were admitted in ICU of a hospital from January 2016 to December 2018, clinical characteristics of septicemia in premature infants with different pathogens were compared. Results Among 155 premature infants with septicemia, 76 cases (49.03%) were in Gram-negative bacillus group (G^- group), mainly Klebsiella pneumoniae septicemia; 42 cases (27.10%) were in Gram-positive coccus group (G⁺ group), mainly Staphylococcus epidermidis septicemia; 37 cases (23.87%) were in fungus group (fungus group), mainly Candida parapsilosis septicemia and Candida albicans septicemia. The gestational age and birth weight of premature infants in G^- group and fungus group were less than G⁺ group; disease onset age of premature infants in fungus group was older than G^- group and G⁺ group, proportion of deep vein catheterization was higher than G^- group and G⁺ group; platelet count of premature infants in fungus group was lower than G^- group and G⁺ group; C-reactive protein (CRP) of G^- group was higher than G⁺ group and fungus group, difference were all statistically significant (all P<0.05). The recovery rate and mortality of 155 premature infants were 94.84% and 5.16% respectively. Mortality of premature infants in G^- group was higher than G⁺ group and fungus group, treatment days of fungus group were longer than G^- group and G⁺ group,differences were all statistically significant (all P<0.05). Conclusion The main pathogens of septicemia in premature infants are G^- bacteria, clinical manifestations, laboratory markers and prognosis of septicemia children in G^- group, G⁺ group and fungus group are different.

Abstract:Objective To analyze the incidence and risk factors of surgical site infection (SSI) after clean incision craniotomy of neurosurgery, and provide basis for prevention and control of SSI. Methods From July 2017 to December 2018, patients with clean incision craniotomy in department of neurosurgery of a tertiary general hospital were prospectively monitored for SSI, occurrence of SSI was monitored, univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors for SSI in clean incision craniotomy. Results Among 1 154 patients who underwent clean incision craniotomy, 105 (9.10%) had SSI, 11 were superficial incision infection and 94 were organ space infection, there was no deep incision infection. Multivariate logistic regression analysis showed that reoperation, duration of postoperative drainage ≥ 4 days, duration of operation ≥ 4 hours and emergency operation were independent risk factors for SSI in clean incision craniotomy. Postoperative epidural/subdural drai-nage (no more than 72 hours) was a protective factor for SSI in clean incision craniotomy. 87.62% (92/105) of patients developed SSI within 2 weeks after surgery. Conclusion In order to reduce the occurrence of SSI of clean incision craniotomy of neurosurgery, it is necessary to avoid reoperation, shorten operation time, strengthen mana-gement of emergency operation and place epidural/subdural drainage if necessary, but drainage tube should be removed as early as possible.

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Objective To understand the distribution, drug resistance and change trend of Streptococcus pneumo-niae (S. pneumoniae) infection in children in a hospital. Methods Sputum, blood and cerebrospinal fluid specimens of pediatric inpatients from January 2012 to December 2017 were cultured, bacteria were isolated and identified, antimicrobial susceptibility testing and result judgment were conducted according to Clinical and Laboratory Standards Institute (CLSI) M100-S28, data were statistically analyzed. Results A total of 2 384 strains of S. pneumoniae were isolated, 54.32% of which were isolated from male, 45.68% were from female, 63.38% of children were 0.5-3 years old, 21.10% were ≤ 0.5 year old, 15.52% were >3 years old. S. pneumoniae accounted for 18.08% of all isolated bacteria, according to the quarterly statistics, the proportion of bacteria isolated in the fourth quarter (20.62%, 839/4 068) > first quarter (18.77%, 762/4 059) > second quarter (18.42%, 557/3 024) > third quarter (11.11%, 226/2 034), but difference with the change of quarter was gradually narrowing. Resistance rates of S. pneumoniae to erythromycin, compound sulfamethoxazole, clindamycin and tetracycline were high (73.21%-99.62%), while resistance rates to levofloxacin, chloramphenicol, cefuroxime, cefotaxime, amoxicillin and penicillin were low (0.19%-33.92%), no S. pneumoniae was found to be resistant to vancomycin, quinupristin/dalfopristin, linezolid and moxifloxacin. Conclusion S. pneumoniae is mainly isolated from children with respiratory tract infection, most infection occurred in children aged ≤ 3 years. Difference in S. pneumoniae isolation rate with the change of quarter is gradually narrowing, and its time distribution characteristics becomes less and less obvious. Amoxicillin and penicillin can be used as first-line agents for treatment of S. pneumoniae infection in children.

Abstract:Objective To evaluate packing methods of paper-plastic bag for ethylene oxide(EO) sterilization of flexible endoscopes. Methods Two packing methods of paper-plastic bag were adopted (group A:each endoscope was rolled up to the size of 40 cm, then put into a 40 cm×60 cm×10 cm three-dimensional bag; group B:each endoscope from insertion part to manipulation part was vertically put into a 25 cm×185 cm paper-plastic bag), endoscope package was sterilized after disinfected and dried, differences between two packing methods as well as the preference of persons who operated endoscope was compared respectively. Results A total of 720 flexible endoscopes (including gastroscope, enteroscope and duodenoscope) were packed by two persons after cleaned, disinfected, rinsed and dried, methods A and B each packed 360 endoscopes. After sterilization, the indicator strip in two groups all changed color (100%). The average packing time of each endoscope in group A was (82.8±11.4) seconds, and that in group B was (23.6±3.4) seconds, with a significant difference (t=94.28, P<0.001); five bags in group A and two bags in group B were broken, there was no significant difference between two groups (χ²=0.577, P=0.447). Conclusion For the sterilization of flexible endoscope, paper-plastic bag with size of 25 cm×185 cm is convenient, time-saving and labor-saving, which meets the sterilization requirements of central sterile supply department, and is worth to be promoted in practical process.

Abstract:Objective To clarify the drug resistance of patients with pulmonary tuberculosis, explore the risk factors for multidrug-resistant tuberculosis(MDR-TB), and provide basis for the prevention and treatment of MDR-TB. Methods 468 patients with pulmonary tuberculosis were collected, including 365 newly treated patients and 103 retreated patients. Susceptibility of Mycobacterium tuberculosis to antituberculous drugs was detected by proportion method. Univariate analysis and multivariate logistic regression analysis were adopted to analyze the risk factors for MDR-TB. Results The overall drug resistance rate, multidrug resistance rate and extensive drug resis-tance rate of 468 patients were 25.85%, 11.97%, and 3.21%, respectively. The overall drug resistance rate, multi-drug resistance rate and extensive drug resistance rate in retreated patients were all significantly higher than those in newly treated patients (49.51% vs 19.18%; 34.95% vs 5.48%; 10.68% vs 1.10%, respectively, all P<0.05). The overall drug resistance from high to low was as follows:isoniazide(INH)>rifampicin(RFP)> oxfloxacin(OFX)>ethambutol (EMB)> streptomycin (SM)>kanamycin (KM). Univariate and multivariate logistic regression analysis showed that living in rural areas (OR=2.316,95% CI:1.604-5.118), retreatment (OR=6.150,95% CI:4.728-13.824), tuberculosis cavity (OR=3.219, 95% CI:2.405-8.627), treatment interruption (OR=5.826,95% CI:4.610-12.507) and initial treatment without combined medication (OR=2.508,95% CI:1.813-5.646) were risk factors for the occurrence of MDR-TB. Conclusion Drug resistance rate of pulmonary tuberculosis patients is high, and there are multiple risk factors affecting the occurrence of MDR-TB, active intervention mea-sures should be taken to control the occurrence of MDR-TB.

Abstract:Objective To observe the damage of disposable non-woven fabric used for packing device, analyze the causes of damage of packing, and improve the integrity of package by improving the packing method. Methods From October 2017 to December 2018, 5 000 surgical device packages of the same specification in a hospital were selected as the research objects, and divided into groups A-E according to different packing methods (group A:common basket+disposable non-woven fabric; group B:common basket+disposable absorbent liner+disposable non-woven fabric; group C:flat bottom basket+disposable non-woven fabric; group D:flat bottom basket+disposable absorbent liner+disposable non-woven fabric; group E:basket+flat bottom basket+disposable absorbent liner+disposable non-woven fabric), each group has 1 000 pieces. Damage of device packing at 7 steps from the completion of packing to pre-use was observed and recorded (① completing packing; ② loading to sterilization rack; ③ unloading to storage rack after sterilization; ④ loading into transport vehicle; ⑤ unloading to storage rack in operating room; ⑥ placing on manipulating platform before use; ⑦ openning before use). Results Damage rates of packing in group A-E were 21.7%, 13.5%, 8.8%, 5.2%, and 0.1% respectively, the highest was in group A and the lowest in group E, differences were all statistically significant (all P<0.001). In transfer step ①-⑦, damage rates of packing were 0, 0.24% (n=12), 1.04% (n=52), 1.44% (n=72), 3.44% (n=167), 0.30% (n=15) and 0.46% (n=23) respectively, except that the number of packing damage of step ① was 0, packing damage ccurred in other steps, and step ⑤ had the highest damage rate, damage of device package occurred continuously until it was pre-used in departments. Conclusion Compared with common basket, damage rate of device packing with flat bottom basket is lower, the use of disposable absorbent paper can further protect the packing from damaging, transport basket can effectively reduce the damage of packing in the process of transportation.

Abstract:Objective To explore the application and efficacy of plan-do-check-action (PDCA) cycle management method in the special management of antimicrobial agents in a maternity and child healthcare hospital. Methods PDCA cycle method was used to supervise the clinical application of antimicrobial agents in a maternity and child healthcare hospital through multi-department cooperation, efficacy before and after the application of PDCA method was compared (August 2014 to July 2015 was pre-special management, August 2017 to July 2018 was post-special management). Results The proportion of the amount of money in antimicrobial use, antimicrobial use in outpatient and emergency departments, antimicrobial use in hospitalized patients, as well as rate of antimicrobial prophylaxis in class I incision operation decrease from 16.69%, 13.18%, 58.63%, and 45.12% before the special management to 7.69%, 6.75%, 38.21%, and 8.13% respectively after management, the downward trend was statistically significant (all P<0.05), all met the national requirements; other indicators, such as antimicrobial use density, the rate of specimen microbiological detection for patients receiving antimicrobial treatment, all meet the national requirements. Conclusion The effect of using PDCA cycle management method to carry out the special management of antimicrobial agents is obvious, clinical application of antimicrobial agents tends to be more standardized and rational.

Abstract:Objective To understand contamination status of dental water in private dental institutions in one district of Beijing, and provide reference for improving dental water quality. Methods From November 1 to 30, 2019, stratified random sampling method was used to select 30 private dental institutions for on-site dental water collection, detection method was in accordance with GB/T 5750.12-2006 Standard Test Method for Drinking Water, judgment criterion was referred to GB 5479-2006 Standard for Drinking Water Quality. Results A total of 264 dental water specimens were collected from 30 private dental institutions, 76 dental water specimens were qualified, with a qualified rate of 28.79%. The median of the tatal number of colonies in water in dental handpiece and water-storage bottle was about 2 000 CFU/mL, the qualified rate of dental handpiece water specimens was higher than that of water-storage bottle (18.33% vs 9.09%); the median of the total number of colonies in water specimens of imported and domestic dental chair units (DCUs) were 255 and 1 750 CFU/mL respectively; qualified rate of water specimens of imported DCUs was higher than that of domestic DUCs(42.39% vs 21.51%); the median of the total number of colonies in tap water and water in water-storage bottle were 400 and 2 100 CFU/mL respectively, qualified rate of tap water specimens was higher than that of water-storage bottle (35.82% vs 12.16%). Conclusion Dental water in private dental medical institutions in this district of Beijing is seriously contaminated, it is suggested that the relevant standards and specifications of dental medical institutions should be formulated as soon as possible, so as to improve the quality of dental water sanitation.

Abstract:Objective To investigate the staffing of health care workers(HCWs) in blood purification institutions in Suzhou City, and provide baseline data for improving the staffing of HCWs in blood purification institutions in Suzhou. Methods A cross-sectional survey was conducted in 39 non-independent medical institutions that provided medical services of blood purification technology in a city in August 2017, self-designed blood purification questionnaire for HCWs was used. Data were analyzed statistically by Excel 2013 and SPSS 17.0. Results Of the 39 blood purification institutions, the number of doctors in 37 institutions was up to the standard, qualified rate was 94.87%; the number of nurses in 7 blood purification institutions was up to the standard, qualified rate was 17.95%. The number of nursing staff in 10 administrative regions of the city is insufficient, among which county-level city G has the highest proportion (0.47), district F has the lowest proportion (0.33). The proportion of HCWs with intermediate and higher titles was the highest (92.31%) in district F and the lowest (35.42%) in district B(P<0.01), the tertiary medical institutions was higher than that in the secondary, primary and non-graded medical institutions, with a statistically significant difference (P<0.05). Conclusion There is a shortage of nursing staff in the staffing of HCWs in blood purification institutions in this city, and constituent of professional titles of HCWs in some blood purification institutions is irrational.

Abstract:目的 调查北京市某三级甲等医院口腔门诊水路冲洗行为依从性现状。方法 采用直接观察法，于2018年11月—2019年1月对该院11个口腔门诊科室配合护士的水路冲洗行为现状进行现场调查。结果 共观察74名临床配合护士。开诊前水路冲洗指征共110次，实施0次，依从率为0；诊疗之间水路冲洗指征共519次，实施30次，依从率为5.78%，正确率为30.00%，不同器械诊疗之间水路冲洗的依从率依次为牙科高速手机（12.55%，29/231）、超声波洁牙机（1.35%，1/74）、三用枪（0，0/214）。不同科室诊疗之间配合护士水路冲洗行为的依从率不同，其中口腔外科依从率最高（71.43%，20/28），其次为综合科（22.73%，10/44），口腔内科和其他科室均为0。不同科室诊疗之间配合护士水路冲洗牙科高速手机的依从率不同，其中口腔外科依从率最高（100.00%，20/20），其次为综合科（50.00%，9/18），口腔内科和其他科室均为0。结论 该院口腔门诊的水路冲洗行为依从性总体处于低水平，应进一步加强对水路冲洗行为的监督与管理。

Abstract:Glove perforation is very common in surgical operation. Owing to the contamination of pathogenic microorganisms after glove perforation, surgical site infection may occur and occupational exposure risk of surgical staff will increase. The author summarized the research progress in glove perforation event, relevant risk factors and preventive measures at home and abroad in this paper, preliminary suggestions have been put forward to strengthen the management and control of glove perforation during operation.

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