Abstract:

During the epidemic period of coronavirus disease 2019(COVID-19) outbreak, how to carry out the prevention and control work quickly, orderly, systematically and with high-quality is a huge challenge facing the general hospital. In accordance with relevant national guidelines and specifications, combined with the actual situation and previous experience of the hospital, Xiangya Hospital of Central South University has formulated a scientific prevention and control plan, issued strong prevention and control measures, and achieved the goal of zero infection of front-line health care workers, zero spread of hospital epidemic situation, and zero death of confirmed patients in the hospital. This paper introduces the practice and experience of Xiangya Hospital of Central South University in the prevention and control COVID-19.

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Objective To understand results of nucleic acid test of 2019-nCoV(SARS-CoV-2) and blood routine examination of persons who had close contact with coronavirus disease 2019 (COVID-19) cases. Methods 738 persons who were under medical observation in a designated isolation hotel from February 11 to 23, 2020 due to close contact with COVID-19 cases but without symptoms were selected, nasopharyngeal swabs were taken for 2019-nCoV nucleic acid test, and blood specimens were taken for blood routine detection, these persons were observed untill the end of isolation period. Results Among 738 persons who were under medical observation, 70 (9.49%) were positive for nucleic acid test of 2019-nCoV, 664 (89.97%) were negative, and 4 (0.54%) were suspected; in the initial nucleic acid test of 2019-nCoV, 52 persons were positive, 28 were suspected, and 658 were negative; 28 cases with suspected results were resampled the next day, 18 were positive, 6 were negative, and 4 were still suspected (After the second sampling, the observation period ended and these persons were transferred to the designated isolation observation place). Among all persons with positive nucleic acid test of 2019-nCoV and suspected persons under observation, white blood cell (WBC) count were all normal in blood routine, only 2 cases showed decreased lymphocyte count. During the first 14-day observation, among 738 medical observed persons, 40(5.42%) had COVID-19, 70 of whom were positive in nucleic acid test for 2019-nCoV, 42.86% (n=30) had fever, cough, shortness of breath and other clinical symptoms; among 644 persons with negative nucleic acid test, 1.51% (n=10) developed symptoms. All confirmed cases were transferred to designated hospitals for further treatment; at the end of the first observation period, those who did not turn negative for nucleic acid test of 2019-nCoV and those who still had suspected results were sent to the designated isolation place for continuous observation. During continuous observation period, 4.54% (2/44) developed symptoms and were confirmed with COVID-19, and were send to a designated hospital for treatment; the rest of the observed persons all turned negative in nucleic acid for 2019-nCoV detection. Incidence was 5.69% (42/738) during the whole isolation period. Conclusion Among persons with positive nucleic acid test of 2019-nCoV due to close contact with COVID-19 cases, proportion of latent infection is high, and there is a certain proportion of asymptomatic infected persons, which should be identified and diagnosed as early as possible.

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At the end of 2019, outbreak of coronavirus disease 2019(COVID-19) occurred in Wuhan, Hubei Province, and spread rapidly all over the country. The sixth edition of Diagnosis and treatment plan of COVID-19 issued by National Health Commission of the People's Republic of China pointed out that 2019-nCoV may be spread due to the exposure to high concentration of aerosol in a relatively closed environment for a long time, which trigger the public to fear that air conditioning system may cause virus cross diffusion. There are many kinds of air conditioning systems on the market, with different brands and different air treatment methods. This paper sorts out the main types and applicable characteristics of air conditioners used in indoor places, and reclassifies them according to the location and burden range of air conditioning terminal equipment, so as to guide clients and the general public to use air conditioner correctly, eliminate their panic.

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Since December 2019, the epidemic of coronavirus disease 2019(COVID-19) in Wuhan has escalated into a national public health emergency, in order to focus on treatment of patients with COVID-19, the government of Wuhan urgently built a Huoshenshan Hospital. The importance of imaging examination determines the important role of radiology department in relevant treatment. By the end of February 20, through summary on relevant experience of prevention and control in radiology department in Wuhan Huoshenshan Hospital since its smooth and efficient operation for 18 days, prevention and control as well as workflow during COVID-19 epidemic period is explored, so as to provide experience and reference for peers in radiology department.

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Objective To understand status of protection behavior and protection knowledge level of accompanying visitors of hospitalized patients during the epidemic period of coronavirus disease 2019 (COVID-19). Methods Convenient sampling method was adopted to select accompanying visitors of non-confirmed or suspected COVID-19 patients in departments of oncology, respiratory, hematology, and orthopedics of a tertiary first-class hospital from February 3 to February 6, 2020 as studied subjects. Phenomenological research method and self-designed questionnaire about prevention and control knowledge were used for survey. Results A total of 208 questionnaires were sent out, and effective respond rate was 100%. Direct observation of researchers showed that implementation rate and correct rate of wearing masks were 84.62% (176/208) and 50.57% (89/176) respectively. Implementation rate and correct rate of hand hygiene were 75.00% (156/208) and 22.44% (35/156) respectively. Implementation rate of ward ventilation was 100%, 90.38% of the accompanying visitors ventilated wards twice a day. Questionnaire of protection knowledge level showed that accompanying visitors had the highest correct rate in knowing clinical manifestations of COVID-19, which was 98.08%; only 50.48% of accompanying visitors thought that novel coronavirus (2019-nCoV) could be killed by 75% alcohol; 46.15% of accompanying visitors thought it was necessary to inform medical staff of their temperature rise; 8 accompanying visitors thought they could get together to chat with friends and relatives. Conclusion The correct implementation rate of protection behavior of accompanying visitors is low, education on COVID-19 prevention and control knowledge and behavior among accompanying visitors should be emphasized in ward area, so as to improve correct implementation rate of protection behavior, and avoid the occurrence of hospital clustering epidemic.

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Objective To understand the contamination status of novel coronavirus (SARS-CoV-2, 2019-nCoV) in wards of patients with coronavirus disease 2019 (COVID-19). Methods Smear sampling was performed on object surface of COVID-19 patients' wards, surface of patients' hands and outer surface of nurses' gloves, reverse transcriptase-polymerase chain reaction (RT-PCR) was conducted to test SARS-CoV-2 nucleic acid of swab specimens. Results Among 47 specimens, 1 was positive for SARS-CoV-2, positive rate was 2.13%. Positive specimen was smearing swab of the inner surface of warm shirt cuff of a patient with positive result of SARS-CoV-2 nucleic acid test on the day of sampling, warm shirt has not been changed since patient was admitted to hospital; SARS-CoV-2 nucleic acid test of smearing swabs of high-frequency touched object surfaces of patients' wards, such as door handle, bed rails, bedside table, electrocardiogram monitor, infusion pump and so on, as well as surface of patients' hands and outer surface of nurses' gloves before disinfection were all negative. Conclusion Contamination degree of SARS-CoV-2 in wards of COVID-19 patients is relatively low, which is related to the daily cleaning and disinfection of object surface and emphasis on hand hygiene. Patients' clothes should be changed after admission, regularly during hospital stay, and at any time in case of contamination.

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Coronavirus disease 2019(COVID-19) has been developing rapidly since December 2019, the number of isolation wards for observation and isolation wards for patients with COVID-19 in some medical institutions is far from satisfying the requirement of receiving and treating patients as much as possible. According to the original building layout, it is necessary to reconstruct existing common wards into isolation wards, so as to relieve rapidly the contradiction between supply and demand. This paper discusses the site choice, scheme design and key issues that need to be paid attention during the reconstruction of existing common wards into isolation wards, so as to provide reference for similar reconstruction.

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Coronavirus disease 2019(COVID-19) is a emerging infectious disease, as a treatment place for suspected and confirmed cases of COVID-19, in order to ensure the safety of health care workers(HCWs), it is very important to use personal protective equipment(PPE) correctly. In clinical practice, HCWs are faced with a lot of confusion in the use of PPE, this paper explores the problems and confusion in the process of HCWs' putting on and taking off PPE, and summarizes the corresponding measures taken by the hospital.

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Objective To evaluate the methodology and report quality of Chinese literatures on the influencing factors of healthcare-associated infection(HAI) in renal transplant recipients. Methods Literatures about risk factors for HAI in renal transplant recipients after renal transplant surgery were searched from China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Database from the establishment of database to July 31, 2019, The Newcastle-Ottawa Scale (NOS) and STROBE statement were used to assess methodology and reporting quality. Results 32 literatures were included in this study, 10 literatures reported risk factors of donors and 32 reported risk factors of receptors. Methodological quality evaluation results showed that there was no bias analysis and follow-up information, reporting quality evaluation results revealed that the information of participants, bias analysis and funding sources were not fully reported. Conclusion The quality of Chinese literatures on risk factors for HAI in renal transplant patients published in China is acceptable, and there is room for improvement in methodology and reporting standards.

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Objective To explore the diagnostic value of metagenomic next-generation sequencing (mNGS) in severe community-acquired pneumonia (CAP), and provide basis for the rational application of this technology. Methods Clinical data of 3 cases of severe CAP successfully treated in a hospital were reviewed, the role of mNGS in etiological diagnosis was analyzed, experience and procedures of rational application of mNGS were summarized based on previous literatures and self-experience. Results Bronchoalveolar lavage fluid was taken from 3 patients with severe CAP who failed in initial treatment, specimens were performed mNGS, results indicated that 3 patients were infected with Streptococcus, adenovirus type 7 and Chlamydia psittaci respectively. According to the results of mNGS, therapeutic plan was subsequently adjusted, patients' symptoms quickly relieved, and their clinical outcomes were good. Conclusion mNGS plays an important role in the rapid etiological diagnosis of severe CAP, but it is also necessary to recognize its limitation and make rational application.

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Objective To analyze the distribution and antimicrobial resistance of pathogens in patients with pemphigus and infection, and guide rational clinical use of antimicrobial agents. Methods Patients with pemphigus and infection in a hospital from January 2014 to September 2019 were chosen retrospectively, distribution and antimicrobial resistance of pathogens, as well as influencing factors for multidrug-resistant organism(MDRO) infection was analyzed. Results A total of 114 patients with pemphigus and infection were chosen, and 121 strains of pathogens were isolated, including 73 (60.33%) strains of Gram-positive (G⁺) bacteria, 26 (21.49%) Gram-negative (G^-) bacteria and 22 (18.18%) fungi. G⁺ bacteria were mainly isolated from skin (n=70, 95.89%), including 53 strains of Staphylococcus aureus (S. aureus) and 10 strains of Staphylococcus epidermidis (S. epidermidis). G^- bacteria were also mainly isolated from skin (n=14, 53.85%), followed by urine (n=6, 23.08%) and sputum (n=5, 19.23%). Fungi were mainly isolated from oral mucosa (n=16, 72.72%). A total of 37(30.58%) MDRO strains were isolated. Resistance rates of S. aureus and S. epidermidis to penicillin were both 100%; resistance rates of S. aureus to fluoroquinolones, ceftriaxone, ampicillin/sulbactam, and tetracycline were all <50%, resis-tance rates to clindamycin and erythromycin were both >90%. Resistance rates of S. epidermidis to ampicillin/sulbactam, gentamycin, tetracyclines and moxifloxacin were all <50%. Isolation rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant S. epidermidis (MRSE) were 43.40% and 60.00% respectively. Vancomycin-, linezolid-, and quinupristin/dalfopristin-resistant G⁺ bacteria were not found. Resistance rates of Escherichia coli to most commonly used antimicrobial agents, such as the third generation cephalosporins, fluoroquinolones, and tetracyclines were all ≤ 50%, to aztreonam was 30%, Escherichia coli were sensitive to both cefoperazone/sulbactam and imipenem. Patients with moderate/severe disease and hypoproteinemia had a higher incidence of MDRO infection, differences were all statistically significant (all P<0.05). There was no significant difference in the incidence of MDRO infection among patients of different age, gender, oral involvement, and diabetes history (all P>0.05). Conclusion Patients with pemphigus are susceptible to all kinds of infection, mainly skin bacterial infection, MDRO infection rate is high, pathogenic bacteria and antimicrobial resistance have certain characteristics.

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Objective To analyze the effect of risk assessment on healthcare-associated infection (HAI) management. Methods Risk assessment on 36 departments in a hospital in 2016 and 2019 was carried out respectively, results of two assessment was compared (including change in risk assessment factors, change in high-risk departments, change in the integrity of current management system and so on). In addition, influence of risk assessment on HAI management was evaluated, that is, the change in HAI-related indicators, such as incidence of HAI, incidence of multidrug-resistant organism (MDRO) HAI, hand hygiene compliance, hand hygiene accuracy rate, ventilator utilization rate, central line catheterization rate, urinary catheterization rate, incidence of ventilator-associated pneumonia (VAP), incidence of central line-associated bloodstream infection(CLABSI) and incidence of catheter-associated urinary tract infection (CAUTI). Results Risk assessment in 2019 showed that cardiac surgery intensive care unit (ICU), respiratory ICU, cardiology ICU, surgery ICU, department of nephrology, pediatric surgery, geriatric ICU, neonatal ICU and pediatric ICU were high-risk departments, among which pediatric ICU, neonatal ICU, pediatric surgery and nephrology were the newly increased risk departments in 2019. Risk levels in four high-risk departments (neurology, rheumatology and immunology, hematology, and urology) in 2016 decrased significantly. Compared with surveyed data of 2016, the integrity of current management system in 2019 was improved, incidence of HAI, incidence of MDRO HAI, incidence of CAUTI and urinary catheterization rate decreased significantly, hand hygiene compliance and accuracy rate improved significantly, difference were all statistically significant (all P<0.05). Conclusion Through the risk assessment, the key departments and risk factors that should be paid attention can be pointed out and intervention can be implemented, which can effectively promote the management of HAI and reduce the incidence of HAI.

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Objective To understand the current situation of endoscope cleaning and disinfection in medical institutions(MIs) in a province, and provide theoretical and technical support for the implementation of Regulation for cleaning and disinfection technique of flexible endoscope WS 507-2016 as well as next work focus and research direction of endoscopy quality control center. Methods 130 MIs which performed endoscopic diagnosis and treatment were selected by convenient sampling method, endoscopic cleaning and disinfection status and the effect evaluation of quality control management were surveyed by questionnaire. Results A total of 1 318 nurses in endoscopy centers (rooms) in 120 MIs (including 36 tertiary MIs and 84 secondary MIs) were surveyed, including 149 full-time endoscope cleaning and disinfection personnel, and the pre-job training rate of them was 28.19% (n=42). The allocation rate of automatic washing and disinfection machine was 35.00% (42 MIs), 27.50% (33 MIs) had complete protective equipment, tertiary MIs were superior to secondary MIs in the design and layout of endoscopy centers/rooms (except cleaning the ventilation equipment in the disinfection rooms) (both P<0.01); 60.00% (72 MIs) of MIs changed endoscope cleaning solution after each cleaning, tertiary MIs were superior to secondary MIs(P<0.01);19.17% (23 MIs) used information tracing system for endoscope cleaning and disinfection, 37.50% (45 MIs) performed cleaning quality monitoring, 92.50% (111 MIs) performed disinfection quality monitoring. Conclusion All levels of MIs do not pay enough attention to the cleaning and disinfection of endoscope, cleaning and disinfection technique of endoscope is not standardized. It is necessary to strengthen the supervision of cleaning and disinfection of endoscope, and solve the key and difficult points in the supervision of quality control.

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Objective To explore the effect of multi-sector cooperation management mode on standardizing submission of specimens for blood culture and application of antimicrobial agents. Methods Blood culture specimens from hospitalized patients in a tertiary first-class hospital from 2017 to 2018 were selected as research data. January-December 2017 was as pre-intervention group and January-December 2018 was as post-intervention group. From December 2017, a multi-sector cooperation management team was established, and other intervention measures were gradually implemented. Submission rate, submission mode, contamination rate, and positive rate of blood culture specimens, as well as antimicrobial use rate in hospitalized patients before and after the implementation of intervention of multi-sector cooperation management mode were compared. Results After intervention, submission rate of blood specimens of the whole hospital before therapeutic, restrictive and special-class antimicrobial use were 22.29%, 30.16% and 60.30% respectively, which were higher than 14.91%, 18.55% and 47.05% before intervention, difference were all significant (all P<0.001). The proportion of double and above sets blood culture increased from 15.48% before intervention to 26.97% after intervention. Contamination rate of blood culture after intervention was lower than before intervention (1.02% vs 2.98%), and positive rate of blood culture was higher than before intervention(11.67% vs 9.52%). Antimicrobial use rate after intervention was lower than that before intervention (34.11% vs 37.88%); use rates of restrictive antimicrobial agents and special-class antimicrobial agents after intervention were 14.67% and 2.56% respectively, which were lower than 15.60% and 3.73% respectively before intervention, differences were both significant(both P<0.001). There was significant difference in the constituent of combined use of therapeutic antimicrobial agents (P<0.001). Conclusion Through multi-sector cooperation management mode combining quality control and administrative management, submission quality of blood culture is effectively improved.

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Objective To investigate effect of sterile therapeutic towel wrapping connector and three-way tube of central venous catheter(CVC) on reducing incidence of central line-associated bloodstream infection (CLABSI) in intensive care unit (ICU) patients. Methods Patients with central vein catheterization in surgical ICU of a tertiary first-class hospital in Sichuan Province were selected as the study objects, patients who were admitted to ICU from May to October 2017 were as control group, those from May to October 2018 were as trial group. In control group, routine nursing measures of deep vein catheterization were carried out, in trial group, on the basis of routine nursing measures, CVC and three-way tube were wrapped with sterile therapeutic towel and replaced every 8 hours. Incidence of CLABSI was compared between two groups of patients, self-designed questionnaire was used to investigate the feeling of clinical nurses half a year after the implementation of measures. Results 188 patients in control group and 166 patients in trial group were included in study. In control group, 7 patients developed CLABSI, incidence of CLABSI was 3.72%, central vein catheterization days was 1 233 days, incidence was 5.68 per 1 000 catheter days; in trial group, 5 patients developed CLABSI, incidence of CLABSI was 3.01%, central vein catheterization days was 1 098 days, incidence was 4.55 per 1 000 catheter days; there was no significant difference in the incidence of CLABSI between two groups of patients(χ²=0.136,P=0.712). A total of 65 nurses were investigated about their feelings of clinical use of sterile therapeutic towel wrapping connector and three-way tube of CVC, 98.46% of nurses thought it was inconvenient to open and bandage the sterile therapeutic towel when adding medicine, 93.85% thought it was not conducive to observing the connection of catheter, 66.15% encountered the problems of untimely observation when catheter connection was loose and liquid was oozing out due to the wrapping of sterile therapeutic towel, 53.85% thought that it took about 2-3 minutes to wrap the sterile therapeutic towel for each patient. Conclusion It can not be proved that sterile therapeutic towel wrapping collector and three-way tube can reduce the incidence of CLABSI, while greatly increase the clinical nursing workload, reduce the time of nurses to directly care for patients, and increase the risk of clinical nursing.

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Objective To explore the methods of prevention and control of pertussis in neonates. Methods Clinical data of 8 neonates with pertussis in a hospital were collected, general condition, clinical manifestations, auxiliary examination and treatment were analyzed. Results Only 4 of 8 neonates with pertussis had a definite history of contact with patients with respiratory tract infection, the average time from mild cough to spasmodic cough was(6.25±1.91) days, 3 cases (37.50%) had dyspnea during spasmodic cough period, 4 (50.00%) had carbon dioxide retention, 2 (25.00%) had apnea, 6 (75.00%) were with decrease transcutaneous oxygen; 7 neonates with pertussis for the first times showed leukocytes>20×10⁹/L, lymphocytes>60%, procalcitonin<0.5 ng/mL, polymerase chain reaction of Bordetella pertussis were all positive, and pertussis IgM antibody were all negative. Bordetella pertussis isolated from 8 neonates with pertussis were sensitive to azithromycin, 7 neonates was improved and cured, 1 neonate gave up treatment. Conclusion In the epidemic season of pertussis, it is forbidden to visit the neonate. Neonatal pertussis should be diagnosed as early as possible, treated actively and controlled epidemic according to the clinical manifestations and auxiliary examination.

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Cryptococcus neoformans (C. neoformans) is a yeast-like fungus, which can not only cause lung tissue infection, but also cause life-threatening meningoencephalitis. When humans are infected with C. neoformans, macrophages act as the first line of immune defense to quickly identify, phagocytose and destroy pathogens. The diffe-rent results of interactions between C. neoformans and macrophages will lead to different outcomes, understanding these mechanisms plays a key role in the prevention and treatment of cryptococcosis. This article reviews the intera-ction between C. neoformans and macrophages and the intrinsic molecular mechanism during infection, and provides theoretical basis and direction for vaccine development and immunotherapy of cryptococcosis.