Abstract:In order to guide clinical nursing practice, improve the quality of venous blood sampling, prevent the occurrence of adverse events related to blood sampling, ensure the safety of health care workers(HCWs), patients/blood donors and social security, Infectious Diseases Nursing Branch of Chinese Nursing Association organized domestic experts to jointly formulate this consensus based on the World Health Organization (WHO) specification, relevant national laws, regulations, diagnosis and treatment guidelines, as well as best practices for evidence for healthcare-associated infection prevention and control. This consensus is mainly applicable to domestic medical and health settings to guide the safe sampling of adult venous blood. The consensus evaluates the risk of venous blood sampling to HCWs, patients/blood donors and society, and determines the safe operation process to avoid risks according to the high-risk links. The consensus mainly elaborates personal protective equipment, detailed steps of blood sampling, handling of accident, monitoring of quality index and so on, so as to provide clinical guidance for safe sampling of adult venous blood.

Abstract:Objective To understand the current status of classification and disposal of partial medical waste in medical institutions (MIs) in China, provide scientific evidence for improving the operability of classified disposal of medical waste and realizing the reduction, harmlessness and recycling of medical waste. Methods By stratified sampling method, questionnaires were used to investigate the status of classification and disposal of medical waste in 1 574 MIs, investigation results were checked and statistically analyzed. Results A total of 1 345 qualified questionnaires were collected, with the effective recovery rate of 85.45%. The qualified disposal rates of pathogen culture, specimen, strain, virus preservation solution and household garbage produced by patients with infectious di-seases or suspected infectious diseases were 93.75%(1 261/1 345) and 98.66% (1 327/1 345) respectively; 68.21% (826/1 211) of MIs send human tissues and organs to medical waste disposal centers, 97.45% (916/940) of MIs disposed non-infected placentas or non-infected placentas were taken away by puerpera after signing consent, and 72.13% (678/940) of MIs handed over dead fetus to the funeral home for disposal, only 55.74% (510/915) of MIs handed over batches of expired chemotherapeutic drugs or cytotoxic drugs to qualified institutions for disposal, and a small amount of residual vaccines were mainly disposed of as common infectious waste (88.34%, 932/1 055); 30.38% (322/1 060), 25.42% (257/1 011) and 35.57% (350/984) of MIs respectively disposed the pathological waste liquid, disinfectant and discarded batches of chemical reagent by professional hazardous waste disposal centers. Disposal modes of human tissues and organs, dead fetus, batches of expired chemotherapeutic drugs or cytotoxic drugs and batches of discarded chemical reagents were different in all levels of MIs(all P < 0.05). Oxygen humidification bottles, disposable tourniquets, empty bottles of chemical reagent and disinfectant, disposable shoe co-vers, fixed gypsum, disposable quilt covers, bed sheets and pillowcases of non-infectious patients were mainly disposed as medical waste; outer packaging of paper and plastic, diapers and sanitary napkins of non-infectious patients were mainly disposed as household waste; infusion bottles (bags) and glass medicine bottles such as penicillin bottles were as recyclable waste in 77.18% and 45.21% of MIs respectively. Conclusion The problem of classified disposal of pathological, pharmaceutical and chemical medical waste is prominent, the classified disposal methods of other common waste in MIs, such as uncontaminated oxygen humidification bottles, disposable articles, empty reagent bottles and fixed gypsum, are not unified, which needs to be further standardized.

Abstract:Objective To analyze the clinical and epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients who were complicated with diabetes mellitus (DM), so as to determine whether DM is a risk factor for disease progression and poor prognosis of COVID-19. Methods A total of 856 hospitalized patients who were confirmed with COVID-19 in Zhejiang Province from January 17 to February 7, 2020 were collected, including 64 patients with DM. Clinical characteristics, epidemiology, treatment and prognosis of patients with and without DM were compared and analyzed. Results Age of 64 patients with DM were (58.1±11.2) years, which was higher than that of patients without DM (P < 0.001), the most common symptoms at onset included fever (89.1%), cough (71.9%), expectoration (39.1%) and fatigue (25.0%), patients with DM were more likely to develop muscle soreness (P=0.047). Compared with patients without DM, serum inflammatory-related markers (such as neutrophils and C-reactive protein) in patients with DM increased (P < 0.05), proportion of severe cases was higher, and acute respiratory distress syndrome was more prone to occur (P < 0.01). After adjusting smoking and gender factors, the risk of reaching the composite endpoint (including admission in ICU due to disease progression, shock, mechanical ventilation and death) in DM patients was higher than that in non-diabetic group, and the hazard ratio (HR) was 3.50 (95%CI: 1.51-8.11). Conclusion COVID-19 patients with DM have a higher age and higher proportion of severe cases and are more likely to cause serious adverse outcomes, DM should be regarded as a risk factor for disease progression and poor prognosis of COVID-19.

Abstract:Objective To investigate incidence and risk factors of surgical site infection (SSI) after radical mastectomy for breast cancer in Beijing City. Methods Trough the infection surveillance and management system of hospitals in Beijing, prospective surveillance on radical mastectomy/modified radical mastectomy for breast cancer were performed in 83 secondary and above medical institutions in the whole city, descriptive analysis and logistic regression analysis was conducted by SPSS 20.0 software. Results A total of 8 248 cases of SSI in surveillance database from 2012 to 2017 were included in analysis, 62 cases of SSI occurred, incidence was 0.75%. Diabetes, post-operative stay in ICU, length of operation and ASA score were risk factors for SSI in patients undergoing radical mastectomy/modified radical mastectomy for breast cancer. Diabetes patients had an increased risk of SSI compared with non-diabetic patients (OR=2.99, 95% CI: 1.33-6.73); risk of SSI in patients who had stayed in ICU was 5.72 times higher than that in patients who didn't stay in ICU (OR=5.72, 95% CI: 1.68-19.45); risk of post-operative infection increased by 27% for each additional 1 hour of operation time (OR=1.27, 95% CI: 1.11-1.46); risk of SSI increased by 54% for each higher ASA score (OR=1.54, 95% CI: 1.01-2.35). Conclusion The multi-center large sample surveillance indicates that the incidence of SSI after mastectomy for breast cancer is lower in Beijing from 2012 to 2017. Diabetes, stay in ICU, duration of operation and ASA score should be taken as an important factor for predicting SSI, after considering factors affecting wound infection, a personalized preventive stra-tegy should be formulated.

Abstract:Objective To analyze the epidemic characteristics and changing trend of pulmonary tuberculosis(PTB) in children in Guangzhou City, and provide reference for formulating scientific prevention and control measures. Methods Data of reported PTB occurrence among children aged 0-14 years in Guangzhou City from 2006 to 2020 were collected, spatial, temporal and population distribution were analyzed, the Joinpoint regression model was used to analyze the trend of disease incidence. Results A total of 1 397 PTB children aged 0-14 years were reported, accounting for 0.66% of the reported cases of PTB in the whole population. The reported incidence dropped from 7.31/100 000 in 2006 to 2.90/100 000 in 2020, and presented overall declining trend, with an average annual decline of 3.90% (AAPC=-3.90, 95%CI: -5.64﹣-2.13), the average annual decline rate of boys (AAPC=-4.74, 95%CI: -6.77﹣-2.66, P < 0.01) was faster than that of girls (AAPC=-2.86, 95%CI: -4.78﹣-0.91, P < 0.01); reported incidence of PTB in children in urban areas averagely decreased by 4.14% (AAPC=-4.14, 95%CI: -5.99﹣-2.24, P < 0.01) annually, there was no significant change in incidence in children in rural areas (β=-0.02, t=1.00, P=0.34), but the overall reported incidence was slightly lower than that of urban children; incidence of PTB in children aged 0-2 and 10-14 was relatively higher, except for the 10-14 year old group without significant change in the reported incidence of PTB, children in other age groups showed a downward trend. Conclusion Reported incidence of PTB in children aged 0-14 years in Guangzhou City generally showed a downward trend, decline trend for children in rural area and aged 10-14 years is not obvious, it is necessary to focus on strengthening the prevention and control of PTB for these children.

Abstract:Objective To understand the characteristics of healthcare-associated infection (HAI) in intensive care unit (ICU) of a hospital, and provide scientific basis for management of HAI. Methods From January 2010 to December 2020, continuous targeted monitoring on HAI was carried out in ICU of the hospital, monitoring results of HAI in ICU patients were analyzed. Results A total of 4 901 patients were admitted to this hospital in 11 years, 400 cases of HAI occurred, incidence of HAI was 8.16%, and the adjusted HAI rate was 4.14‰ per 1 000 bed-day. Incidence of ICU in different years showed a decreasing trend with the change of year (P < 0.01). The main HAI was respiratory system infection (46.08%), there were 160 cases of device-associated infection, ventilator-associated pneumonia (VAP) accounted for 66.25%. Incidences of VAP, central line-associated bloodstream infection, and catheter-associated urinary tract infection were 8.64‰, 2.37‰, and 1.51‰ respectively. Utilization rate of devices decreased in different years, device-associated infection rate decreased with years (all P < 0.05). A total of 2 198 strains of pathogens were isolated, mainly Gram-negative bacteria (72.61%). Conclusion Device-associa-ted infection is still the focus of HAI in ICU, targeted monitoring on HAI in ICU should continue to be carried out, problems should be found in time, effective control measures should be taken to reduce the incidence of HAI.

Abstract:Objective To understand the distribution and antimicrobial resistance changes of pathogens from blood culture of children in 74 hospitals of monitoring network of antimicrobial resistance of pathogen in Hebei Province from 2016 to 2019. Methods WHONET software was used to retrospectively analyze the distribution and antimicrobial susceptibility characteristics of pathogens from blood culture of children in 45 tertiary hospitals and 29 se-condary hospitals. Results After eliminating repeated strains, a total of 7 591 strains were isolated from blood culture of hospitalized children from 2016 to 2019, Gram-positive bacteria and Gram-negative bacteria accounting for 71.7% and 28.3% respectively. In the four age groups defined in this study, the proportion of Staphylococcus aureus and Stenotrophomonas maltophilia increased with age. Resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 7.8%-35.5%. In the past 4 years, isolation rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) showed an upward trend (from 12.9% to 30.1%), isolation rate of methicillin-resistant coagulase negative staphylococcus (MRCNS) showed a downward trend (from 81.7% to 75.2%). Conclusion Gram-positive bacteria are the main pathogens of blood culture of hospitalized children in Hebei Province, distribution of pathogens is different from that of adult blood culture. Distribution of pathogens varied with age, attention should be paid to the characteristics of blood culture of children in clinical empirical treatment of blood stream infection in children.

Abstract:Objective To evaluate the management effectiveness of infection control intervention measures in preventing central line-associated bloodstream infection (CLABSI). Methods The domestic studies on prevention and control of CLABSI in domestic and foreign databases from January 2010 to December 2020 were retrieved through computer system, the reported data in the original study were extracted, OR value and 95% confidence interval (CI) were combined, intervention methods were summarized. Results A total of 263 studies were retrieved, 142 of which were included in the final analysis, prevention and control of CLABSI in recent 10 years has achieved remar-kable results (OR=0.26, 95%CI: 0.24-0.29), about 68.53% of CLABSI can be prevented. There is no heterogeneity among studies, a total of 43 614 patients are involved, far exceeding the cut off points of trial sequential analysis. Conclusion Prevention and control of CLABSI in China has achieved remarkable results in recent ten years, there is no need to carry out more trial to prove it, follow-up quality improvement study can be carried out according to the 2021 guidelines, further reduce the rate of vascular catheter-associated infection.

Abstract:Objective To explore whether there is any difference between the simplified two-step hygienic hand disinfection and the six-step hygienic hand disinfection method recommended in the WHO guidelines for hand hygiene in health care. Methods 32 clinical health care workers (HCWs) in a tertiary general hospital were grouped randomly by randomized controlled cross-over trial, two-step method was adopted in trial group and six-step method was adopted in control group, trial was crossly conducted with each other between two periods, with an interval of one day, the average killing logarithm of natural bacteria on hands of two groups of HCWs before and after hygienic hand disinfection was compared. Results The average killing logarithm values after HCWs' hygienic hand disinfection in trial group and control group were both >1, disinfection effect were both qualified, the decrease of colony number after hygienic hand disinfection of HCWs in two groups were both statistically significant (both < 0.001); there was no significant difference in the average killing logarithm of bacteria between two kinds of hygienic hand disinfection (P=0.973). Conclusion The effect of two-step hygienic hand disinfection is the same as that of six-step hygienic hand disinfection, two-step method takes less time and has higher efficiency, which is worthy of clinical promotion.

Abstract:Objective To understand the microbial culture results of organ preservation solution (PS) and post-transplant infection of recipients. Methods Microbial culture results of organ PS of 485 organ transplant patients in a tertiary hospital in Shanghai from June 2016 to December 2020 were collected retrospectively, according to organ PS culture results, patients were divided into positive group and negative group, positive group were subdivided into different groups according to the distribution of pathogens, infection of different groups within 3 months after transplant was statistically analyzed. Results Among 485 organ transplant patients, 221 cases (45.57%) were PS culture positive, 142 (64.25%) of whom were isolated single kind of pathogen, 54 (24.43%) were isolated two kinds of pathogens, and 25 (11.31%) were isolated ≥ three kinds of pathogens. A total of 327 strains of pathogens were isolated, the top three were coagulase negative staphylococcus (n=67, 20.49%), Klebsiella pneumoniae (n=37, 11.31%) and Escherichia coli (n=27, 8.26%). A total of 47 strains (14.37%) of multidrug-resistant organisms were isolated, including 20 strains (42.55%) of carbapenem-resistant Klebsiella pneumoniae (CRKP) and 18 strains (38.29%) of carbapenem-resistant Acinetobacter baumannii. Infection rate after transplant in positive group was higher than that in negative group (12.22%[27/221] vs 6.82%[18/264]), but difference was not statistically significant (P=0.243); infection rate after transplant in patients with ≥ 3 pathogen group was 32.00% (8/25), which was higher than 9.15% (13/142) in single pathogen group (P=0.004); infection rates of CRKP and Candida albicans positive groups were 45.00% (9/20) and 21.74% (5/23) respectively, which were both higher than 8.20% (15/183) of other pathogen groups (P < 0.001 and P < 0.034, respectively). Conclusion Routine monitoring on organ PS culture results can guide the prevention and control of infection after transplant, if PS culture is positive for CRKP, yeast or Candida, it is recommended to carry out corresponding anti-infection treatment immediately.

Abstract:Objective To monitor hemodialysis events (DE) in hemodialysis outpatients, obtain the incidence of DE, and verify the effectiveness of monitoring on DE through optimized information monitoring software. Methods Based on the optimized information monitoring software, patients who underwent maintenance hemodialysis in outpatient department of the Affiliated Hospital of Xuzhou Medical University in the first two working days of each month from August 2019 to July 2020 were selected, prospective survey method was adopted to investigate antimicrobial use, vascular access infection and positive blood culture results of patients, the occurrence of DE was monitored. Results A total of 5 393 hemodialysis outpatients were monitored, there were 206 cases (3.82/100 patients·month) of DE. DE was monitored by optimized monitoring software, it was found that after software was updated, incidence of DE at vascular access sites increased according to the comparison of different types of DE (0.70/100 patients·month vs 0.10/100 patients·month), difference was significant (P < 0.001); according to the comparison of different vascular access types, after software was updated, incidence of DE in other vascular access types decreased(4.19/100 patients·month vs 4.60/100 patients·month), while incidence of DE in tunneled and non-tunneled catheters increased significantly (11.79/100 patients·month vs 2.64/100 patients·month, 13.20/100 patients·month vs 7.33/100 patients·month), difference were both significant (both P < 0.05). In August 2019, incidence of DE in patients was the highest (9.51/100 patients·month), during the monitoring period, incidence of DE showed a downward trend and decreased to 1.05/100 patients·month by July 2020. Conclusion Incidence of DE is high, monitoring through optimized information monitoring software is feasible, which can effectively obtain infection-related baseline data, find weak points in infection prevention and control, and effectively reduce the incidence of infection.

Abstract:Objective To perform epidemiological investigate on the suspected outbreak of blood stream infection (BSI) in orthopaedic patients after operation in a hospital, so as to provide reference for the prevention and control strategy of healthcare-associated infection (HAI). Methods Epidemiological data of patients with chill and high fever after operation in this hospital from July 16 to 18, 2020 were collected, bacteria isolated from patients, as well as their surroundings and articles were performed antimicrobial susceptibility testing, multilocus sequence typing (MLST) was used for homology analysis. Results A total of 4 cases of healthcare-associated blood stream infection caused by Enterobacter cloacae (E. cloacae) were found in department of orthopedics, the onset time was concentrated and antimicrobial susceptibility testing results of pathogens were similar. A total of 61 environmental specimens were collected, 26 of which were isolated bacteria, with a positive rate of 42.62%, 8 isoosmotic rinsing solution with batch number of 2020071* * were isolated E. cloacae, 2 isoosmotic rinsing solution with batch number of 2020061* * were not isolated E. cloacae. MLST results of 12 strains of E. cloacae were ST1190 (1 strain), ST531 (2 strains), ST547 (2 strains), ST290 (1 strain), ST777 (3 strains), ST422 (1 strain), ST1032 (1 strain) and ST717 (1 strain), there are homologous E. cloacae. Conclusion The suspected outbreak of post-operative BSI in orthopaedic patients in this hospital may be related to the contamination of a new batch of isoosmotic rinsing solution used for operation during transportation or production. Hospitals should strengthen the supervision of disposable foreign medical supplies, regularly sample sterile items, and use them only after passing the test, so as to reduce the risk of exogenous infection and prevent the outbreak of BSI events.

Abstract:Objective To analyze the risk factors for healthcare-asssociated infection (HAI) in patients with acute organophosphorus pesticide (OP) poisoning in Zhoukou City, provide scientific basis for taking targeted intervention measures. Methods Patients with acute OP poisoning treated in 9 hospitals in Zhoukou City from 2018 to 2020 were selected for retrospective study, HAI and its influencing factors were analyzed. Results A total of 959 patients with acute OP poisoning were collected, incidence of HAI was was 5.6%, the main HAI site was lower respiratory tract (n=43, 76.8%). The age and days of mechanical ventilation in cute OP poisoning patients with HAI were significantly higher than those in patients without HAI (both P < 0.05). Incidence of HAI was higher in patients with chronic respiratory diseases, low cholinesterase activity, severe poisoning, coma, invasive procedure, as well as use of glucocorticoid, immunosuppressive agents and antimicrobial agents, differences were all statistically signi-ficant (all P < 0.05). Multivariate logistic regression analysis showed that long-term mechanical ventilation, history of chronic respiratory diseases, use history of immunosuppressive agents and and antimicrobial agents were independent risk factors for HAI in patients with acute OP poisoning (all P < 0.05). Conclusion Incidence of HAI in patients with acute OP poisoning is high, mainly lower respiratory tract infection, comprehensive preventive mea-sures should be taken according to its influencing factors, so as to reduce the incidence of HAI.

Abstract:Hemodialysis patients are at high risk of infection, they may not only be infected by bloodborne pathogens, but also by bacteria, fungi and other viruses. Hemodialysis procedures are numerous and complex, multiple causes can lead to infection outbreak. In this paper, the outbreak of healthcare-associated infection (HAI) in hemodialysis facilities of foreign countries from 1987 to now was summarized and analyzed by searching HAI outbreak-related literatures from PubMed, so as to provide reference for the formulation and supervision of hemodialysis HAI prevention and control measures in the future.

Abstract:Influenza is an acute respiratory infectious disease caused by influenza virus. The elderly are a high risk group of influenza. The epidemic outbreak of influenza is likely to occur in old-age care institutions where the elderly gather. This will not only increase the hospitalization rate and mortality of the elderly, affect their quality of life, increase the family and socio-economic burden, but also increase the care burden of old-age care institutions. This article reviews the research progress in prevention and control strategies of influenza vaccination, healthcare-associa-ted infection management, influenza monitoring and antiviral drug prevention in elderly care institutions at home and abroad, so as to provide reference for better prevention and control of influenza.