Abstract:Hepatitis C is a serious public health issue threatening people's health. At present, there is no vaccine to prevent hepatitis C virus (HCV), but combination treatment of direct antiviral drug can cure more than 95% of chronic hepatitis C. Strengthening the screening of HCV-infected person and conducting effective treatment as early as possible is an effective measure to eliminate the source of infection and block the transmission of HCV. This guideline is revised and updated on the basis of 2012 edition of Chinese guideline for the prevention and control of healthcare-associated infection of hepatitis C, which mainly includes the epidemiology and current situation of healthcare-associated infection of hepatitis C, laboratory detection methods and clinical significance of HCV infection, as well as prevention and control measures of healthcare-associated infection, so as to provide help for the prevention of hepatitis C healthcare-associated infection.

Abstract:Objective To screen out high-risk events of healthcare-associated infection(HAI)and catheter-related infection in intensive care unit (ICU) by failure mode and effect analysis (FMEA), and provide basis for the formulation of prevention and control measures of HAI in ICU. Methods Twenty risk factors were determined by risk identification, FMEA risk assessment was used to screen out high and medium-high risk factors, corresponding infection prevention and control measures were formulated and supervised, ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) before and after the implementation of intervention measures were compared. Results Four high-risk factors were screened out, including patients infected with multidrug-resistant organisms didn't follow effective isolation mea-sures, high-dose use of antimicrobial agents, unqualified cleaning and disinfection of bed units, and cross use of diagnosis and treatment articles; four medium-high risk factors were screened out, which were neglect of secretion clearance on the airbag before extubation or air bag deflation, poor hand hygiene compliance, excessive non-staff of department, as well as poor implementation of accompanying and visiting system. In view of the high and medium-high risk factors, corresponding prevention and control measures were implemented, incidences of VAP, CLABSI and CAUTI per 1 000 catheter day decreased from 7.62 ‰, 2.99 ‰ and 1.90 ‰ in 2018 to 3.93 ‰, 1.01 ‰ and 0.62 ‰ in 2019 respectively; incidences and case incidences of HAI decreased from 4.98% and 6.89% to 2.37% and 3.14% respectively. Conclusion The risk assessment based on FMEA method can find out the weak links in the prevention and control of HAI in ICU, provide scientific and powerful evidence for the prevention and control of HAI in ICU.

Abstract:Objective To evaluate the effect of environmental screening of multidrug-resistant organisms (MDROs) on reducing methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) on object surface in intensive care unit (ICU). Methods Baseline survey period was from September to November in 2018, intervention period was from December 2018 to August 2019, during intervention period, routine screening was conducted every quarter, timely feedback was given, environmental cleaning and disinfection as well as related knowledge training was strengthened; isolation of MRSA and CRAB on surface of environmental objects before and after intervention were compared. Results 896 specimens were collected during baseline survey period, 2 880 specimens were collected after intervention, MRSA isolation rate decreased from 18.08% to 0, CRAB isolation rate decreased from 4.46% to 0.83%; isolation rates of MRSA and CRAB in hospitalized patients were 48.86% and 36.08% respectively at baseline survey period, isolation rates of MRSA and CRAB were 37.42% and 27.27% respectively after intervention; isolation rates of MRSA and CRAB isolated from environmental object surface and hospitalized patients before and after intervention were both significantly different (both P < 0.05), there was a trend of gradual decline every quarter. The most common isolation sites of MRSA and CRAB from environment were: bedside floor (34/168, 20.24%), head pad (19/168, 11.31%), ventilator panel (13/168, 7.74%), bedside table (12/168, 7.14%), and medical hanging tower (12/168, 7.14%). At baseline survey period, isolation rates of MRSA and CRAB in respiratory ICU were the highest, which were 75.00% (24/32) and 25.00% (8/32) respectively, after intervention, MRSA was not isolated in respiratory ICU, isolation rate of CRAB was 3.13% (3/96). Conclusion Routine environmental screening for MDROs in key departments can effectively reduce the colonization of MDROs on the surface of ICU objects and reduce the risk of infection in patients.

Abstract:Objective To investigate the efficacy and influencing factors of tigecycline in the treatment of hematological malignancies complicated with infection, so as to provide reference for clinical rational antimicrobial use. Methods Clinical data of patients with hematological malignancies complicated with infection and treated with tigecycline in a hospital were analyzed retrospectively, clinical efficacy of tigecycline treatment was evaluated, influencing factors of therapeutic efficacy of patients was analyzed by univariate analysis and multivariate logistic regression analysis. Results A total of 182 patients were included in analysis, 85 (46.7%) patients had acute myeloid leukemia, 116 (63.7%) had agranulocytosis, the main infection site was lung (72.0%). 62 strains of pathogens were isolated, 8 of which were carbapenem-resistant Enterobacterales. 113 patients (62.1%) were treated with high-dose tigecycline for a course of (11.6±6.5)days, the total effective rate was 55.5%. Multivariate analysis showed that community-acquired pneumonia, agranulocytosis time >14 days and tigecycline treatment course < 7 days were independent risk factors for treatment failure, therapeutic efficacy was not related to gender, age, primary disease, tigecycline dose, combination antimicrobial use and pathogenic bacteria. Conclusion Tigecycline is effective for the treatment of patients with hematological malignancies complicated with infection, but community-acquired pneumonia, agranulocytosis time >14 days and tigecycline treatment course < 7 days will significantly affect the efficacy.

Abstract:Objective To analyze risk factors for severe and critically severe (hereinafter referred to as critical) coronavirus disease 2019 (COVID-19) combined with multidrug-resistant organism(MDRO) infection. Methods Clinical data of critical COVID-19 patients in the intensive isolation wards of a designated hospital of a province from January to April 2020 were analyzed retrospectively, patients complicated with MDRO infection were selected as case group and those without MDR infection were as control group. Clinical data of two groups of patients were compared, risk factors for critical COVID-19 complicated with MDRO infection were conducted multivariate logistic regression analysis. Results There were 62 cases of critical patients with COVID-19. 10 of whom were complicated with MDRO infection, and 52 cases were not complicated with MDRO infection, 14 patients (22.6%) were complicated with bacterial or fungal infection; 10 patients (16.1%) were complicated with MDRO infection, including 4 cases of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and 6 cases of carbapenem-resistant Acine-tobacter baumannii (CRAB) infection; 9 cases (11 strains) were complicated with non-MDRO or fungal infection. Univariate analysis showed that the proportion of central venous catheterization, the types of used antimicrobial agents, and proportion of antimicrobial use ≥ 4 types in case group were all higher than those in control group; albumin level in case group was lower than control group; differences were all statistically significant (all P < 0.05). Multivariate analysis showed that independent risk factors for critical COVID-19 patients complicated with MDRO infection were the use of ≥ 4 types of antimicrobial agents (OR=17.104, 95%CI: 1.805-162.033), while albumin was the protective factor (OR=0.834, 95%CI: 0.709-0.982). Conclusion Critical COVID-19 patients should use antimicrobial agents rationally and elevate the level of albumin, which is conducive to the prevention and control of critical COVID-19 complicated with MDRO infection.

Abstract:Objective To understand the occurrence of healthcare-associated infection (HAI) in patients with coronavirus disease 2019 (COVID-19), and provide basis for formulating prevention and control measures during the epidemic period. Methods By using point prevalence survey and combining bedside survey with medical record survey, occurrence of HAI, antimicrobial use and invasive manipulation of all hospitalized patients with COVID-19 in a hospital on March 24, 2020 were investigated. Results A total of 323 patients with COVID-19 were investigated, with an average age of (58.33±14.30) years old; the average length of hospitalization stay was (13.13±7.23) days. Prevalence rate of HAI was 3.10%, and that of critically ill patients was the highest (33.33%); the main infection site was lower respiratory tract (30.00%); incidence of catheter-associated urinary tract infection, central line-associated bloodstream infection and ventilator-associated pneumonia were 5.88%, 7.69% and 0 respectively; antimicrobial use rate was 33.44%, 82.41% of which were prophylactic antimicrobial use; 84.26% of which were monotherapy and 68.52% of which were oral administration; the most frequently used antimicrobial agents was moxifloxacin (23.84%). Conclusion The prevalence rate of HAI in patients with COVID-19 is slightly higher than the national average level in 2014, special attention should be paid to the prevention and control of secondary pulmonary bacterial infection in critically ill patients, and routine use of antimicrobial agents is not recommended to prevent bacterial infection.

Abstract:Objective To investigate the distribution characteristics and antimicrobial resistance of common Enterobacterales in a hospital, and provide reference for clinical rational use of antimicrobial agents. Methods All non-repetitive strains of Enterobacterales isolated from clinical specimens in a hospital from 2010 to 2019 were collected. Detection, clinical distribution, specimen distribution and antimicrobial resistance of different kinds of bacteria were analyzed. Results A total of 19 384 strains of Enterobacterales were collected, 45.32% (8 784 strains) were Escherichia coli, 25.11% (4 867 strains) were Klebsiella pneumoniae, 5.67% (1 099 strains) were Enterobacter cloacae, 3.67% (711 strains) were Serratia marcescens, 3.29% (638 strains) were Klebsiella oxytoca, and 16.95% (3 285 strains) were other Enterobacterales. Most strains of Escherichia coli were isolated from urine (42.53%), followed by respiratory tract (21.63%) and blood (16.33%); Klebsiella pneumoniae was mainly isolated from respiratory tract (69.37%), followed by urine (9.33%) and blood (8.73%). Escherichia coli was mainly isolated from department of urology surgery (29.16%), followed by pediatrics (8.86%); Klebsiella pneumoniae was mainly isolated from department of neurosurgery (22.52%), followed by pediatrics (13.71%). Resistance rates of Enterobacterales to ampicillin, piperacillin and cefazolin were higher in 2018-2019, and resistance rates to imipenem and meropenem increased significantly, isolation rate of carbapenem-resistant Enterobacterales (CRE) increased year by year, with statistical significance (P < 0.05). Conclusion Antimicrobial resistance of Enterobacterales is not optimistic, clinicians should take effective measures to prevent the emergence of CRE, and it is also very important to prevent and control cross infection in hospital.

Abstract:Objective To explore whether voriconazole combined with caspofungin can improve the prognosis of critically ill patients with invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU). Methods Clinical data of patients clinically diagnosed and confirmed with IPA in ICU from June 2014 to June 2019 were retrospectively collected, difference in clinical efficacy, acute kidney damage and 42-day survival status after antifungal therapy between voriconazole monotherapy group (monotherapy group) and voriconazole combined with caspofung group (combination group) were compared, risk factors for death in critically ill patients with IPA were analyzed. Results A total of 35 critically ill patients with IPA were included, 25 cases (71.4%) in monotherapy group and 10 cases (28.6%) in combination group. There were no significant differences in overall clinical effective rate, impact on renal function and 42-day survival status between combination group and monotherapy group (all P>0.05). Multivariate Cox regression analysis showed that combination therapy (HR=0.664, 95%CI: 0.222-1.984, P=0.464) was not an independent influencing factor for death in critically ill patients with IPA. Conclusion Voriconazole combined with caspofungin can't improve the prognosis of critically ill ICU patients with IPA.

Abstract:Objective To systematically evaluate the risk factors for urinary tract infection (UTI) in patients after transurethral prostate resection. Methods Prospective and retrospective studies on UTI in patients after transurethral prostate resection published from the establishment of the database to January 31, 2020 were searched from PubMed, Embase, the Cochrane Library, Web of Science, China Biology Medicine (CBM), China National Know-ledge Infrastructure (CNKI), VIP and Wanfang database. Two reviewers independently screened the literatures and extracted the data according to the inclusion and exclusion criteria, quality of literatures was evaluated by Newcastle-Ottawa scale (NOS), Meta-analysis was performed by Stata14.0 software. Results A total of 15 studies with 2 707 cases were included in analysis. Meta-analysis results showed that age (OR=1.93, 95%CI[1.24-3.00], P=0.003), diabetes (OR=2.83, 95%CI[2.34-3.44], P < 0.001), operation time (OR=3.22, 95%CI[1.39-7.44], P=0.006), pre-operative antimicrobial use (OR=2.14, 95%CI[1.12-4.12], P=0.022), pre-operative urinary catheterization (OR=4.06, 95%CI[2.81-5.85], P < 0.001), post-operative indwelling urinary cathe-terization time (OR=4.08, 95%CI[3.34-4.99], P < 0.001), the initial experience of surgeons (OR=2.17, 95%CI[1.69-2.77], P < 0.001), general routine nursing intervention (OR=2.66, 95%CI[1.31-5.42], P=0.007), disconnection of closed urinary drainage system (OR=24.17, 95%CI[8.28-70.62], P < 0.001) were risk factors for UTI after transurethral prostate resection. Conclusion There are multiple risk factors for UTI after transurethral prostate resection, health care workers should pay attention to the pre-operative evaluation of patients, strengthen the management of high-risk population; doctors should improve the technical level, pay attention to the control of operation time; post-operative nursing staff should pay attention to the indications of urinary catheter indwelling, and conduct effective nursing intervention to prevent and control the occurrence of UTI.

Abstract:Objective To construct a nomogram model to predict the risk of occurrence of puerperal infection after cesarean section based on single-center data. Methods Clinical data of pregnant women undergoing cesarean section in a hospital from January 2018 to January 2020 were analyzed retrospectively, univariate and logistic regression multivariate analysis were adopted to analyze independent risk factors for puerperal infection after cesarean section, relevant nomogram prediction model was constructed. Results Inflammatory infection of genital tract during pregnancy (OR=3.457, 95%CI: 1.205-9.917), gestational diabetes (OR=4.901, 95%CI: 1.247-19.259), premature rupture of membrane (OR=8.513, 95%CI: 3.041-23.830), postpartum recurrent vaginal bleeding (OR=10.000, 95%CI: 3.404-29.373), hemoglobin < 90 g/L (OR=4.657, 95%CI: 1.689-12.840) and albumin < 40 g/L (OR=5.163, 95%CI: 2.062-12.926) were all independent risk factors for puerperal infection in pregnant women after cesarean section (all P < 0.05). Based on the above 6 independent risk factors, a nomogram model for predicting puerperal infection after cesarean section for pregnant women was constructed, internal and external verification of the model showed that calibration curve of training set and verification set were well fitted to the ideal curve, predicted value was basically consistent with the measured value. C-index were 0.774 (95%CI: 0.739-0.809) and 0.765 (95%CI: 0.734-0.796) respectively, indicating that the nomogram model has good predictive ability. Conclusion There are multiple independent risk factors for occurrence of puerperal infection in pregnant women after cesarean section, nomogram model constructed in this study has good predictive ability and differentiation, which can be used for clinical screening of high-risk pregnant women and adopting effective nursing care.

Abstract:Objective To explore the effect of multi-disciplinary team (MDT) management in the prevention and control of healthcare-aasociated infection(HAI)caused by multidrug-resistant organisms (MDROs) in children. Methods Children who were isolated MDROs in a tertiary first-class children's hospital between January 1, 2017 and December 31, 2018 were selected as research objects. Routine MDRO HAI prevention and control measures were adopted from January 1 to December 31, 2017 before intervention, and MDT management mode was implemented from January 1 to December 31, 2018. The compliance rate of prevention and control measures, MDRO isolation rate, case incidence of HAI, department distribution and constituent ratio of MDRO infection were compared between two groups of children before and after implementation. Results After the implementation of MDT ma-nagement, compliance rates of various prevention and control measures increased significantly, including clinicians' compliance to give isolation order, medical record folder and patient list pasted with contact isolation sign, isolation sign hanging at the head of bed, alcohol-based hand rub placed at beside, compliance rate and accuracy rate of hand hygiene, proper disposal of medical waste, exclusive use of reusable medical devices, medical staff awareness of MDRO-infected children, correct formulation of disinfectant, inform relevant departments of transferred patient, as well as cleaning and disinfection of environmental object surface, differences were all statistically significant (all P < 0.05). The total isolation rate of MDROs decreased from 22.09% to 16.50%, isolation rates of carbapenem-resis-tant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CREC), methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA) decreased from 19.25%, 10.38%, 27.42%, 36.39% and 15.37% to 15. 29%, 6.01%, 23.64%, 21.99% and 11.39% respectively, differences were all statistically significant (all P < 0.05). Vancomycin-resistant Enterococcus (VRE) were not found before and after the implementation of MDT management; case incidence of MDRO HAI decreased from 0.19% before implementation to 0.14% after implementation of MDT management, difference was statistically significant (χ²=4.800, P=0.028). Conclusion The implementation of MDT management can effectively improve the implementation rate of MDRO HAI prevention and control measures, and effectively reduce the occurrence of MDRO HAI in children.

Abstract:Objective To investigate the risk factors for ventilator-associated pneumonia (VAP) after Stanford type A aortic dissection surgery. Methods Data of patients undergoing Stanford type A aortic dissection surgery from January to December in 2019 were collected retrospectively. Patients with VAP were in VAP group, non-VAP group were 1:3 matched to analyze the risk factors of VAP. Results From January to December in 2019, there were 161 patients with Stanford type A aortic dissection were admitted in hospital and 112 patients were included in study. There were 28 cases of VAP, case infection rate was 17.39%. The total ventilator utilization days was 734 days, infection rate of VAP per 1 000 ventilator-day was 38.14‰. Univariate analysis showed that duration of deep hypothermic circulatory arrest, post-operative ventilator utilization and omeprazole use as well as blood creatinine level in VAP group were all higher than in non-VAP group (all P < 0.05); proportion of post-operative severe hypoxemia and renal failure in VAP group were all higher than in non-VAP group (all P < 0.05). Logistic multivariate regression analysis showed that duration of post-operative ventilator utilization, post-operative severe hypoxemia, blood creatinine level, and continuous renal replacement therapy were independent risk factors for VAP. The area under receiver operating characteristic (ROC) curve of blood neutrophil, white blood cell count, procalcitonin and body temperature were 0.60, 0.73, 0.77 and 0.70 respectively. Elevated white blood cell count, procalcitonin and body temperature could assist in the diagnosis of VAP. The main pathogen of VAP was Klebsiella pneumoniae (23 strains), 22 of which were carbapenem-resistant Klebsiella pneumoniae. Conclusion Shortening the duration of ventilator utilization, reducing post-operative severe hypoxemia and decreasing post-operative renal failure can reduce the incidence of post-operative VAP in patients with Stanford type A aortic dissection. White blood cell count, procalcitonin and body temperature can be used for early auxiliary diagnosis of VAP.

Abstract:Objective To explore the establishment and effect of healthcare-associated infection (HAI) monitoring team of clinicians and nurses based on bottom management model of three-level network in HAI management. Methods The combination of department recommendation and self-recommendation was adopted to select clinicians and nurses as monitoring staff, through defining responsibility, building systematic training, quantifying perfor-mance evaluation standards, monthly special allowance of 200 Yuan, title promotion priority and other incentive treatment, management of monitoring staff team was strengthened, HAI management monitoring indexes before and after the establishment of HAI monitoring team from 2014 to 2018 was compared, effectiveness was assessed. Results A total of 54 HAI control clinicians and 64 nurses were set up in the whole hospital. With the deepening and refinement of management, the scores of monitoring medical staff has improved significantly, incidence of HAI decreased from 2.41% before setting up to 1.17% after setting up, missing reporting rate of HAI decreased from 20.67% to 8.40%, isolation rate of multidrug-resistant organisms decreased from 0.27% to 0.12%, hand hygiene compliance increased from 38.70% to 58.25%, specimen detection rate prior to antimicrobial use increased from 41.18% to 74.08%, incidence of ventilator-associated pneumonia and catheter-related urinary tract infection decreased from 10.47‰ and 3.11‰ to 2.42‰ and 1.13‰ respectively, differences were all significant (all P < 0.05). Conclusion Based on bottom management model of three-level network in HAI management, implementation of innovative management mode can effectively improve the enthusiasm of clinicians and nurses in HAI monitoring, which play a positive role in promoting HAI management and improving the quality of HAI management in the whole hospital.

Abstract:Objective To evaluate the accuracy of fluorescent labeling method and microbiological method in monitoring the quality of clean and hygiene of high frequency touched object surface environment in intensive care unit (ICU). Methods In the last month of each quarter from the third quarter of 2017 to the second quarter of 2019, fluorescence labeling and microbiological method was used to monitor and sample surface of high frequency touched object surface in general ICU (GICU) and respiratory ICU (RICU), qualified rate of surveillance of two methods in the same period was compared. Results From the third quarter of 2017 to the second quarter of 2019, a total of 8 times of surveillance were carried out, results showed that qualified rates of fluorescence labeling clearance in RICU and GICU were 41.62% and 71.45% respectively. Qualified rates of microbiological method in RICU and GICU were 45.58% and 45.18% respectively. Qualified rate of fluorescence labeling method in RICU increased gradually, the lowest was in the third quarter of 2017, which was 28.42% lower than that of microbiological method, and the highest was in the first quarter of 2019, which was 24.90% higher than that of microbiological method; qualified rates of fluorescence labeling method in GICU were all higher than microbiological monitoring method, difference of qualified rates of two methods were 2.86%-44.66%. Conclusion Fluorescence labeling method can be used as the evaluation standard of environmental hygiene and cleaning quality, but it needs to be combined with microbiological monitoring method to achieve more accurate and meaningful result.

Abstract:Arterial indwelling catheter is often used in the department of critical care medicine and cardiothoracic surgery as a channel for monitoring patients' invasive blood pressure and collecting arterial blood gas. Although arterial indwelling catheter has the characteristics of simple operation and low cost, poor manipulation or improper maintenance can easily lead to associated complications, including temporary arterial occlusion, pseudoaneurysm, catheter-related bloodstream infection and so on. This paper summarizes the influence of different factors on the incidence of catheter-related bloodstream infection from evidence-based point, in order to provide a theoretical basis for implementing intervention strategies.

Abstract:Emerging and re-emerging infectious diseases constantly occur and appear, severely threaten the health of human beings, respiratory infectious diseases (RIDs) such as coronavirus disease 2019 (COVID-2019), severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and influenza are mainly transmitted through respiratory droplets and contact, and there is also the possibility of aerosol transmission. Air disinfection is very important to prevent and control the transmission of RIDs, especially during the outbreak of RIDs. This paper elaborates the necessity of air disinfection during prevention and control of RIDs as well as commonly used disinfection methods and their efficacy, so as to provide reference for medical institutions to prevent the transmission of RIDs due to improper air disinfection.