Abstract:Objective To explore the effect and feasibility of bedside operation for premature infants in laminar flow clean neonatal intensive care unit (NICU). Methods Clinical data of critically ill neonates who underwent bedside ligation of patent ductus arteriosis (PDA) and exploratory laparotomy in NICU of a tertiary first-class army general hospital from September 2017 to October 2020 were analyzed retrospectively, neonates who underwent bedside operation in NICU were classified as NICU group and those who transferred to operating room were classified as operating room group (OR group), differences in post-operative body temperature, incisional infection rate and mortality between two groups of neonates were compared. Results A total of 258 neonates were included, 166 in NICU group and 92 in OR group. Gestational age, birth weight, body weight during operation and neonatal critical illness score in neonates in NICU group were all lower than those in OR group; the proportion of ventilation through ventilator in neonates in NICU group was higher than that in OR group, differences were both statistically significant (both P < 0.05). There were no significant difference in microbial colony count of air culture of intra-operative air samples, pre-operative body temperature, constitute ratio of PDA and exploratory laparotomy, as well as incidence of post-operative incisional infection and mortality between NICU group and OR group (all P>0.05), but the post-operative average body temperature of neonates in OR group was lower than that in NICU group (P < 0.05). Conclusion Premature neonates in laminar flow clean NICU undergoing bedside PDA and abdominal operation is clinically feasible, and bedside operation is more conducive to reducing the occurrence of post-operative hypothermia. Routine standardized maintenance of laminar flow clean ward can effectively ensure the safety of bedside operation for critically ill premature neonates.

Abstract:Objective To evaluate the application value of a new biomarker PEG-344 in the identification of hypervirulent Klebsiella pneumoniae (KP) and classical KP. Methods KP isolated from blood specimens of patients with bloodstream infection in a hospital from 2020 to 2021 were collected, virulence test results of Galleria mellonella was as the gold standard for grouping, strains were divided into hypervirulent group and classical group; string test, wzi gene sequencing and virulence gene detection (_prmpA, _prmpA2, PEG-1631, PEG-589, PEG-344) were performed. Results A total of 36 KP strains were collected, according to Galleria mellonella virulence test results, KP strains were divided into hypervirulence group (n=16 strains) and classical group (n=20 strains); string test positive strains in hypervirulence group and classical group were 87.50% (14 strains) and 15.00% (3 strains) respectively; the sensitivity and specificity of detection of virulence gene PEG-344 were higher than those of classical independent biomarkers _prmpA and _prmpA2. Except one wxwh3 (wzi-2) strain in classical group was PEG-344 positive, results of other strains were completely consistent with the virulence grouping. Conclusion PEG-344 gene encoding metabolite transporter can more accurately identify hypervirulent strains, timely remind clinical rational drug use, and provide basis for clinicians to optimize diagnosis and treatment plan.

Abstract:Objective To understand the management of loaner medical instruments and implants in medical institutions in Hubei Province after the implementation of three standards of Regulation for central sterile supply department in hospital (WS 310-2016). Methods According to the requirements of WS 310.1-2016, questionnaire was designed, multi-stage stratified random sampling method was adopted to select secondary and above medical institutions in Hubei Province as the survey objects, the handling status of loaner medical instruments and implants as well as the provision of product instructions was surveyed. Results Among hospitals participating in the survey, 75.76% achieved the centralized supply of loaner medical instruments and implants, 76.36% cleaned and disinfected the loaner medical instruments according to the methods required by the manufacturers, 75.15% met the requirements of sterilization methods and parameters of instructions, and 56.97% returned the used loaner medical instruments to central sterile supply department (CSSD) for re-cleaning and disinfection, only 28.48% of hospitals indicated that they could receive the product instruction of all loaner medical instruments. There were significant differences in the centralized supply, re-cleaning and disinfection after use, as well as the provision of instructions of loaner medical instruments and implants between tertiary hospitals and hospitals below tertiary level (all P < 0.05). Conclusion The cleaning, disinfection, and sterilization of loaner medical instruments and implants in hospitals in Hubei Province do not fully meet the relevant standards, and the proportion of product instructions provided by manufacturers is low, the implementation rate of tertiary hospitals is better than that of hospitals below tertiary le-vel. Medical institutions at all levels should strengthen the management of loaner medical instruments in accordance with relevant regulations to ensure medical quality and patient safety.

Abstract:Objective To evaluate the disposal and management status of loaner medical instruments and implants in central sterile supply department(CSSD)of China, provide data support for standardizing the disposal and mana-gement of loaner medical instruments and implants, prevent and control the risk of healthcare-associated infection. Methods Literatures on the disposal and management status of loaner medical instruments and implants in Chinese hospitals between January 2008 and August 2021 were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, China Biology Medicine disc (CBM) and PubMed, literatures were screened and data were extracted strictly according to the inclusion and exclusion criteria, Stata 16.0 software was adopted for Meta-analysis. Results A total of 12 literatures involving 2 769 hospitals were included in the study. The combined results of Meta-analysis showed that the implementation rate of the management and disposal system of loaner medical instruments and implants was 90% (95%CI: 84%-96%), implementation rate of professional training was 68% (95%CI: 48%-89%), implementation rate of CSSD as receiving location was 58% (95%CI: 42%-75%), implementation rate of delivery one day before operation was 68% (95%CI: 54%-82%), implementation rate of cleaning and disinfection in CSSD after operation was 48% (95%CI: 20%-75%), implementation rate of correct sterilization procedures and parameters provided by manufacturers was 54% (95%CI: 27%-81%), and the implementation rate of special post responsibility was 63% (95%CI: 41%-86%). Conclusion There are still some problems in the disposal and management of loaner medical instruments and implants in Chinese hospitals, such as low implementation rate of special post responsibility system, inadequate training of professionals, low implementation rate of cleaning and disinfection in CSSD after operation, and correct sterilization procedures and parameters are not provided by some manufacturers. It is still necessary to standardize the disposal and management system, refine the disposal process and quality control details, and strengthen professional training.

Abstract:Objective To construct the risk prediction model for intracranial infection (ICI) after craniotomy in neurosurgery department by logistic regression analysis, and evaluate its effect. Methods Patients who underwent craniotomy from January 2019 to June 2021 in the neurosurgery department of a hospital were selected as research objects, according to whether ICI occurred after the operation, they were divided into case group and control group, logistic regression analysis was used to analyze the risk factors for ICI after craniotomy, the risk prediction model was constructed, and the effect was comprehensively evaluated by means of Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve. Results A total of 778 patients undergoing craniotomy were included, 121 of whom had post-operative ICI, incidence was 15.55%; logistic multivariate regression analysis showed that subtentorial surgery, ventricular drainage time ≥3 days, use of gelatin sponge ≥3 pieces, bleeding volume ≥300 mL, cerebrospinal fluid leakage of incision were independent risk factors for ICI after craniotomy (all P < 0.05); the risk prediction model of ICI after craniotomy was logit(P)=5.408+0.833×(subtentorial surgery)+0.083×(ventricular drainage time)+1.059×(use gelatin sponge)+0.456×(bleeding volume)+2.821×(incision cerebrospinal fluid leakage); Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference in the predicted probability and the actual incidence of intracranial infection (P=0.768); the validation accuracy of logistic regression risk prediction model was 86.00%, the area under ROC curve was 0.847, and 95%CI was 0.814-0.878. Conclusion Subtentorial operation, ventricular drainage time ≥3 days, use of gelatin sponge ≥3 pieces, bleeding volumn ≥300 mL and cerebrospinal fluid leakage of incision are independent risk factors for ICI after neurosurgical craniotomy, the risk prediction model constructed by logistic regression analysis has a good prediction effect on post-operative ICI.

Abstract:Objective To establish a nomogram of national early warning score (NEWS) combined with relevant indicators to predict the prognosis of patients with sepsis, so as to provide clinicians with a more accurate prediction model and improve the prognosis of patients with sepsis. Methods Clinical data of patients with sepsis who admitted to emergency intensive care unit (EICU), surgical intensive care unit (SICU) and medical intensive care unit (MICU) of a hospital from January 2019 to December 2021 were retrospectively collected, those who met the inclusion criteria were randomly divided into test group and verification group. In test group, patients in death group and survival group were analyzed by univariate and multivariate analysis, differences in clinical manifestations and laboratory indicators between two groups of patients were compared, the nomogram was constructed based on its independent risk factors, the accuracy was verified. Results A total of 330 patients were finally included in analysis, there was no significant difference in the baseline data between test group and verification group (all P>0.05). Univariate and multivariate analysis results of death group and survival group in test group showed that NEWS (OR=1.70, 95%CI: 1.36-2.14), combined with respiratory failure (OR=3.82, 95%CI: 1.13-12.92), ventilator use during disease course (OR=0.26, 95%CI: 0.09-0.80), red blood cell distribution width (OR=1.25, 95%CI: 1.05-1.50), and lactic acid value (OR=1.55, 95%CI: 1.27-1.91) were independent risk factors affecting the 30-day prognosis of patients with sepsis. The nomogram model for evaluation and validation of prognosis showed that the C-index of test group and validation group were 0.903 and 0.905 respectively, the calibration curves between two groups fit well with the ideal curve, and the areas under receiver operating characteristic curve were 0.916 and 0.899 respectively, indicating that the model has good prediction efficiency. Decision curve analysis showed that nomogram had high clinical benefit in test group and validation group. Conclusion There are multiple relevant factors affecting the prognosis of patients with sepsis, combined with the most valuable influencing factors, a nomogram for predicting the prognosis of patients with sepsis based on NEWS has good prediction performance, which can further provide clinicians with a simple and effective evaluation method, improve the prediction accuracy.

Abstract:Objective To explore the occurrence and influencing factors of surgical site infection (SSI) following craniotomy, put forward intervention measures and establish a risk prediction model. Methods Patients undergoing craniotomy in a tertiary first-class hospital in 2020 were surveyed retrospectively, influencing factors for SSI follo-wing craniotomy were analyzed, risk prediction model was established, and the model was verified with the data in the first half of 2021. Results Incidence of SSI among 203 cases of craniotomy was 17.73%, multivariate logistic regression analysis showed that 5 factors were independent factors influencing SSI following craniotomy: peri-operative use of H₂ receptor blockers and glucocorticoids, rational use of antimicrobial agents, diabetes mellitus, and operation time ≥180 minutes. The SSI risk prediction model (AUC=0.818) was established, and the cut-off point value of the score was 3.5, incidence of SSI was high when score ≥3.5, the verified accuracy rate was 85.19%, and the verification effect was good(χ²=24.279, P < 0.001). Conclusion Patients undergoing craniotomy have a higher incidence of SSI, peri-operative use of antimicrobial agents and protective use of H₂ receptor blockers can reduce SSI; long operation time, diabetes mellitus and peri-operative use of glucocorticoids are independent risk factors for SSI. The risk prediction model of SSI in craniotomy based on its independent influencing factors has high prediction accuracy.

Abstract:Objective To explore the effect of applying risk assessment combined with plan-do-check-action (PDCA) cycle method to improve the management of healthcare-associated infection (HAI) and its impact on relevant HAI indexes. Methods According to risk assessment results and analysis in 2017, PDCA cycle method was used to implement the common and individual intervention measures for each clinical department in a hospital, risk assessment was conducted again in 2019, two risk assessment results were compared. Results The risk assessment in 2019 showed that most departments were at a medium risk level, the high-risk departments were obstetrics, neurosurgery, and neonatology. In 2019, the number of extremely high-risk departments dropped by one and the number of medium-risk departments increased by one; department of neurosurgery dropped from extremely high-risk to high-risk, obstetrics upgraded to high risk department, department of critical care medicine and neurosurgery intensive care unit (ICU) were still extremely high risk departments. Compared with the monitoring data in 2017, the compliance rate and accuracy rate of hand hygiene in 2019 improved significantly, incidence of HAI and multidrug-resistant organism (MDRO) HAI reduced significantly, differences were all statistically significant (P < 0.05). Conclusion Through the risk assessment combined with PDCA cycle method, focusing on key departments, key links and factors, as well as continuous and effective promotion of HAI management, incidence of HAI can be reduced.

Abstract:Objective To observe the dynamic changes of bacterial survival and endotoxin content in dialysis water during two disinfection processes. The data model was used to fit the changing regulation of microbial indexes during the process of disinfection, and provide basic data support for daily infection control as well as management decisions for pipeline disinfection maintenance. Methods The time and temperature parameters of disinfection procedure mode were analyzed, dialysis water at backwater outlet of water supply pipeline or the entrance of mixing chamber before and after thermal disinfection and chemical disinfection were collected to detect endotoxin, parallel specimens of dialysis water were enriched by membrane filtration method and cultured with TGEA at 20℃ for 7 days, bacterial colonies were counted. Data fitting of Origin software was used to describe the characteristic relationship between the content of bacteria as well as endotoxin and temperature as well as time. Results The survival rate of bacteria decreased with the extension of disinfection procedure time, bacterial survival changed greatly at 50-160 minutes, the decrease of bacterial content in thermal disinfection was more gentle than that in chemical disinfection. The content of endotoxin in thermal disinfection increased with the enhancing of temperature and decreased with the dropping of cooling temperature. Endotoxin content was the highest at 70℃ and 80℃, endotoxin content in the first machine was higher than that in the middle machine and the tail machine. The concentration of endotoxin in chemical disinfection increased during the period of immersion and washing of disinfectant, and then decreased and tended to be stable. After thermal disinfection and chemical disinfection, endotoxin continued to decrease to a lower value first, endotoxin increased slightly at 15 hour and 12 hour after thermal disinfection, with a small peak. Conclusion Temperature and time are the decisive parameters affecting the microbial indexes of dialysis water. Fitting data based on microbial data can be established to describe the differences and similarities of bacterial inactivation and endotoxin changes in dialysis water during two disinfection processes. At the same time, the model tool supplemented the monitoring method of dialysis water, which is helpful to achieve the disinfection control and effect of dialysis water better.

Abstract:Objective To investigate the etiology, pathogen distribution and antimicrobial resistance of calcaneal osteomyelitis. Methods Clinical data of patients with calcaneal osteomyelitis in a hospital from January 2017 to December 2020 were analyzed retrospectively. Results There were 174 cases of calcaneal osteomyelitis, 136 of which were caused by trauma (78.2%), 32 (18.4%) were caused by diabetic foot infection. 126 strains of pathogenic bacteria were isolated, the main pathogenic bacteria were Gram-positive bacteria (70 strains, 60.3%), Staphylococcus aureus and Enterococcus accounted for 36.5% (46 strains) and 11.1% (14 strains) respectively; Pseudomonas aeruginosa (19 strains, 14.3%) was the main Gram-negative bacillus; multidrug-resistant organisms (MDROs) were isolated from 50 bone tissue specimens of calcaneal osteomyelitis, accounting for 28.7%. Univariate analysis showed that body mass index (BMI), age, cause of disease, types of pathogens and number of operations were relevant factors for MDRO infection in patients with calcaneal osteomyelitis, compared with non-MDRO infection in patients with calcaneal osteomyelitis, differences were all statistically significant (all P < 0.05); logistic regression analysis showed that age >60 years, diabetic foot combined with infection, anaerobic infection and number of operations >5 times were independent risk factors for MDRO infection in patients with calcaneal osteomyelitis. BMI 18.5-24 kg/m² was an independent protective factor for MDRO infection in patients with calcaneal osteomyelitis. Conclusion Calcaneal osteomyelitis is mainly caused by trauma and diabetic foot, the main pathogenic bacteria are Staphylococcus aureus, Enterococcus and Pseudomonas aeruginosa. MDRO infection is common, which need ratio-nal use of antimicrobial agents.

Abstract:Objective To investigate the epidemiological characteristics and influencing factors of hand-foot-and-mouth disease (HFMD) outbreak in a kindergarten, and provide strategies for effective control of epidemic. Methods HFMD cases in a kindergarten from June 8 to July 8, 2021 were searched, characteristics of cases were analyzed, environmental hygiene survey and case-control study were carried out, and factors that caused the spread and outbreak of the epidemic were analyzed. Results The epidemic cases were concentrated in the first class, the middle-first class and the second class, a total of 25 cases (5 confirmed cases) of HFMD were found, including 14 males and 11 females, the overall incidence was 9.12% (25/274). The main clinical manifestations were herpes or rash on hands, feet and mouth, symptoms were typical. Nasopharynx swab specimens from 5 cases were positive for Coxsackie A16. The epidemic curve indicates that the epidemic situation basically conformed to the characteristics of "human to human transmission". Case-control study results showed that the main risk factors for the outbreak were contacting with suspected HFMD patients (OR=6.50, 95%CI: 2.73-45.44), not washing hands at school (OR=4.92, 95%CI: 1.56-22.52), the habit of touching lips/eating fingers (OR=6.20, 95%CI: 1.74-38.33), and unclean of hands and nails (OR=2.92, 95%CI: 1.23-6.92). Conclusion This outbreak was caused by Coxsackie A16, exposure to HFMD children is the main cause of this outbreak, and contact with undisinfectant public facilities is the most important route of transmission.

Abstract:Objective To investigate and analyze a suspected outbreak of healthcare-associated infection (HAI) caused by human parvovirus B19 (HPV-B19). Methods Epidemiological investigation and environmental hygiene monitoring were used to investigate the rash incident among nurses in intensive care unit (ICU) of a tertiary first-class hospital from May 12 to May19, 2021, the possible factors for the occurrence of rash were analyzed and effective control measures were taken. Results During the hospitalization period of patients with HPV-B19 infection and hemophagocytic syndrome, there were 50 health care workers (HCWs) in ICU, including 11 doctors and 39 nurses. Eleven nurses (22.0%) developed rash on the 5th day after patients' discharge. The main rash sites were lower limbs (100.0%), most rash was red papules (45.5%), accompanied by joint pain (72.7%), superficial lymphadenec- tasis (63.6%), fatigue (54.5%), and muscle soreness (45.5%). Eleven nurses were all female, with an average age of (27.82±2.6) years. Nine nurses were tested for HPV-B19 DNA and/or specific antibody IgM, results were all positive. All nurses were given symptomatic treatment such as compound glycyrrhizin tablets, loratadine and Gangmei Ganmao granules, the rash lasted for 5-60 days. One nurse was pregnant, without abortion, fetal abnormality was not found during regular prenatal monitoring. No relevant cases have been found since the control mea-sures were taken from May 19. Conclusion This incident is a suspected outbreak of HPV-B19 HAI in ICU, clinicians need to strengthen the correct understanding of the virus as well as implement infection prevention and control measures to avoid the occurrence of HAI outbreak.

Abstract:One bacterial strain isolated from human infection wound secretion was identified and performed antimicrobial susceptibility testing. Wound secretion specimen of the patient was collected, blood agar plate and McConkey agar plate were used for isolation and culture. Bacterial strain was identified as Bordetella spp. by VITEK 2 Compact automatic microbial identification system (confidence 97%), Bordetella trematum (B. trematum) was identified by VITEK MS automatic rapid microbial mass spectrometry detection system and 16S rRNA analysis (confidence 99.9%). Antimicrobial susceptibility testing showed that B. trematum was resistant to cefazolin, ceftazidime, cefepime, cefatriaxone, gentamicin, tobramycin, levofloxacin, and compound sulfamethoxazole, it is mediate resistant to piperacillin/tazobactam, imipenem and meropenem, while susceptible to amikacin. This case is the first report on the isolation of B. trematum from clinical specimens in China, which provides a reference for guiding the rapid and accurate identification of B. trematum infection and clinical rational antimicrobial use.

Abstract:Based on the enterprise risk management integration framework (COSO-ERM framework) as the theoretical basis, this paper aims to analyze the risk characteristics and risk management status of multidrug-resistant organism (MDRO) infection, and comprehensively construct the risk management system of MDRO healthcare-asso-ciated infection (HAI), so as to provide reference basis for the risk management of MDRO HAI.

Abstract:Spinal internal fixation surgery is often used to treat spinal diseases such as spinal stenosis, scoliosis and spondylolisthesis. With the continuous progress of spinal surgery technology and evolution of internal fixation materials, the amount of spinal internal fixation surgery is increasing year by year. Although the current aseptic condition of surgery has made great progress, post-operative spinal infection is still a problem that can not be ignored, which affects the cure rate and survival rate of patients after spinal internal fixation surgery, especially methicillin-resistant Staphylococcus aureus (MRSA) infection after spinal internal fixation surgery, which not only increases the medical cost as well as physical and mental burden of patients, but also may lead to the failure of internal fixation surgery and even threaten life. This paper reviews the treatment and prevention of MRSA infection after spinal internal fixation surgery.