Abstract:In order to scientifically guide the infection prevention and control in centralized isolation sites for medical observation during the outbreak of coronavirus disease 2019 (COVID-19), effectively avoid cross infection while identifying infected person at an early stage in centralized isolation sites for medical observation, Healthcare-associa-ted Infection Control Branch of Chinese Preventive Medicine Association, Healthcare-associated Infection Management Committee of Chinese Hospital Association, and Editorial Office of Chinese Journal of Infection Control jointly organize experts to formulate this consensus. This consensus is applicable to centralized isolation sites for medical observation of close contacts of confirmed COVID-19 cases, suspected cases and asymptomatic infected person, se-condary contacts, entry personnel, or other personnel who "should be isolated" according to the needs of prevention and control work, instruct staff to properly perform personal protection and prevent infection transmission, so as to avoid infection and spread within the site. This consensus draws on the basic principles and document specifications for the prevention and control of COVID-19 in medical institutions, and combines the characteristics and actual working conditions of centralized isolation sites for medical observation to carry out risk assessment of transmission for staff in different regions and different work links. Based on assessment, guidance will be given to infection control-related work, including organizational structure of infection prevention and control, site selection and layout, personnel protection, personnel closed-loop management, cleaning and disinfection, environmental monitoring of nucleic acid, personnel health monitoring, occupational exposure treatment, and judgement principle of cross infection.

Abstract:Objective To analyze the current status and trend of main healthcare-associated infection (HAI) indicators in national tertiary public hospitals. Methods The hospital self-reported data investigated by the institutional group of "third party evaluation of action plan for further improvement of medical services" were adopted for analysis. Results In 2018-2020, prevalence rates (cases) of HAI of 142 sample hospitals in 2018-2020 were 1.91%, 1.86% and 1.65% respectively, the missed reporting rates of HAI were 2.39%, 1.23% and 1.44% respectively, incidence of ventilator-associated pneumonia were 2.72‰, 2.68‰ and 1.82‰ respectively, incidence of intra-vascular catheter-related bloodstream infection were 0.48‰, 0.35‰ and 0.31‰ respectively, incidence of catheter-associated urinary tract infection were 0.71‰, 0.66‰ and 0.53‰ respectively, indicators of hospitals in the central region decreased significantly. Hand hygiene compliance rate of medical staff in sample hospitals increased year by year, which were 74.66%, 78.60% and 83.55% respectively (P < 0.05). Compared with 2018, the number of full-time HAI professionals in the sample hospitals increased by an average of 1 person in 2019 and 2020. Conclusion The main indicators of HAI in national tertiary public hospitals generally shows a downward trend, construction of HAI management and prevention capacity as well as talent team achieved certain results. In the future, it is still necessary to continue to strengthen the monitoring of HAI and explore the construction of multi-system information collaboration platform.

Abstract:Objective To explore the effect of phosphodiesterase PA4781 on bacterial motility and virulence. Methods Motility of bacteria was detected by measuring the diameter of bacterial lawn, the ability of bacterial biofilm to secrete extracellular polysaccharides was detected by Congo-red staining and phenol-sulphate colorimetry. The expression levels of mRNA of twitching motility-mediating gene PilZ, extracellular polysaccharide synthesis relevant gene PelA and pyocyanin-controlling gene PhzM were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR). Extracellular DNA produced by bacteria during different periods was detected by agarose gel electrophoresis, the overall activity of extracellular protease was detected by measuring the diameter of transparent circle of plaque in milk plate. Results Compared with PA03 wild-type strain, motility and mRNA expression of PilZ of PA4781 knockout strain decreased, motility and mRNA expression of PilZ of PA4781 overexpressed strain increased, differences were both significant (both P < 0.05); compared with PA03 wild-type strain, secretion of extracellular polysaccharide and mRNA expression of PelA of PA4781 knockout strain increased, secretion of extracellular polysaccharide and mRNA expression of PelA of PA4781 overexpressed strain decreased, diffe-rences were both significant (both P < 0.05); extracellular DNA secretion, expression of pyocyanine gene PhzM, and hydrolysis ability of extracellular protease of PA4781 knockout strain and overexpressed strain were all lower than PA03 wild-type strain, differences were all significant (all P < 0.05). Conclusion PA4781 may promote the motility of Pseudomonas aeruginosa by promoting the expression of gene PilZ. PA4781 may inhibit the secretion of extracellular polysaccharide by inhibiting the expression of gene PelA. PA4781 may not directly affect the secretion of extracellular DNA, as well as the production of virulence factor pyocyanine and extracellular protease.

Abstract:Objective To analyze the infection and risk factors of hepatitis C virus (HCV) among drug users. Methods Drug users from drug rehabilitation center, methadone clinic, and community of Jinghong City, Xishuangbanna Autonomous Prefecture, Yunnan Province were recruited by researchers from January to July 2021 according to the inclusion and exclusion criteria. A structured questionnaire was adopted, 3 mL serum specimens were taken from the respondents, HCV serological screening test was performed with enzyme-linked immunosorbent assay (ELISA). HCV infection and its risk factors among drug users in Jinghong City, Xishuangbanna Autonomous Prefecture, Yunnan Province were analyzed. Results A total of 404 drug users were investigated, 26 (6.44%) were HCV antibody positive. Intravenous drug injection (OR=4.236, 95%CI: 1.644-10.913, P=0.003), female (OR=0.135, 95%CI: 0.019-0.987, P=0.048), as well as high school and above education (OR=6.745, 95%CI: 1.113-40.890, P=0.038) drug users had a higher risk of HCV infection, differences were all statistica-lly significant (all P < 0.05). Conclusion Intravenous drug injection is a high risk factor for HCV infection among drug users in Jinghong City, Xishuangbanna Autonomous Prefecture, Yunnan Province, the age, educational level and gender of drug users are also related to HCV infection.

Abstract:Objective To analyze the distribution characteristics of pathogens, antimicrobial resistance and treatment of peri-prosthetic joint infection (PJI) after artificial joint replacement, and provide basis for clinical rational choice of antimicrobial agents. Methods Clinical data of patients with PJI and admitted to a hospital from January 2019 to November 2021 were collected retrospectively, distribution characteristics of pathogens, antimicrobial susceptibility testing results and antimicrobial use of patients were statistically analyzed. Results A total of 96 patients with PJI were included in the study, 112 strains of pathogenic bacteria were isolated, 80.36% of which were Gram-positive strains, mainly Staphylococcus spp.. Antimicrobial susceptibility testing results showed that resistance rate of Staphylococcus epidermidis to penicillin and oxacillin were 96.30% and 81.48% respectively, resistance rates of Escherichia coli to gentamicin, compound sulfamethoxazole and ampicillin were all 100%. Antimicrobial use in PJI patients during hospitalization period was mainly combination, vancomycin combined with meropenem accounted for 26.04%; vancomycin and meropenem were also the main antimicrobial agents artificially added to bone cement. Conclusion The main pathogen of PJI after joint replacement is Staphylococcus epidermidis, which is ge-nerally resistant to penicillin and oxacillin, anti-infection treatment is mainly vancomycin combined with meropenem.

Abstract:Objective To summarize the evidence of prevention of surgical site infection (SSI) after total joint arthroplasty, provide reference basis for clinical practice. Methods Evidence related to the prevention of SSI after hip and knee arthroplasty were retrieved from BMJ Best Practice, Up to Date, BMJ Clinical Evidence, World Health Organization (WHO), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurse's Association of Ontario (RNAO), Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG), American College of Physicians (ACP) Club, The Cochrane Central Register of Controlled Trials (CENTRAL), The JBI Model of Evidence Based Healthcare, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Biomedical Literature Datbase (CBM), and System for Information on Grey Literature in Europe (SIGLE). The retrieval time was in recent 5 years, evidence extraction and quality evaluation were completed independently by two researchers. Results A total of 11 studies were involved, including 6 evidence-based guidelines, 1 expert consensus and 4 systematic reviews. The researchers extracted 23 pieces of evidence for the prevention of SSI after hip and knee arthroplasty in 3 aspects (pre-operative, intra-operative and post-operative), 11 of which were grade A recommendations and 12 of which were grade B recommendations. Conclusion The best evidence shows that there are multiple factors for SSI after hip and knee arthroplasty, severe SSI will hinder the process of enhanced recovery, evidence users should adjust measures according to local conditions, accurately grasp every link before, during, and after surgery, optimize the surgical and nursing procedures to prevent SSI.

Abstract:Objective To observe the residual tissue glue in forceps channel after endoscopic tissue glue injection, and evaluate the effect of residual tissue glue on the cleaning and disinfection quality of endoscope. Methods 41 pieces of gastroscopes used by patients who underwent endoscopic tissue glue injection in the digestive endoscopy center of a tertiary first-class hospital from June to August 2021 were randomly selected, residual of tissue glue in endoscopic forceps channel after cleaning and disinfection was observed with lumen detector visual method, and microbial detection was performed, qualified rate of cleaning and disinfection as well as bacterial colony distribution between endoscopes with and without residual tissue glue were compared. Results Among 41 forceps channel after endoscopic tissue glue injection, 28 (68.29%) had tissue glue residue after cleaning and disinfection. The residual sites of tissue glue were mainly 0-2 cm away from the outlet of forceps channel (n=23), most residual of tissue glue presented lumpy shape (n=23). Qualified rates of the initial cleaning and disinfection of 28 pieces of endoscopes with residual tissue glue and 13 pieces of endoscopes without residual tissue glue were 46.43% (n=13) and 100% respectively, there was significant difference in the initial cleaning and disinfection qualified rate between two groups (χ²=8.794, P=0.003). There was significant difference in the distribution of bacterial colony number between endoscope groups with and without residual tissue glue (Z=-3.767, P < 0.001). The qualified rate of repeated cleaning and disinfection of 28 pieces of endoscopes with residual tissue glue was 53.57% (n=15), there was no significant difference compared with qualified rate of the initial cleaning and disinfection of endoscopes with residual tissue glue (χ²=0.286, P=0.593). There was no significant difference between the number of bacterial colony in endoscopes with residual tissue glue after repeated cleaning and disinfection as well as the initial cleaning and disinfection (Z=-1.185, P=0.236). Conclusion Residual rate of tissue glue in forceps channel after endoscopic tissue glue injection is high, which leads to the high unqualified rate of cleaning and disinfection as well as high detection rate of bacteria of forceps channel, and reduces the quality of endoscopic cleaning and disinfection.

Abstract:Objective To study the effect of application of disposable endoscope bedside pre-treatment kit on endoscope cleaning in pre-treatment link and the amount of cleaning solution in the cleaning tank during cleaning process, so as to explore feasible measures to improve the quality of endoscope cleaning and reduce the clinical cost. Methods 112 pieces of used gastrointestinal endoscopes were randomly divided into two groups (groups A and B), during pre-treatment process, group A used traditional pre-treatment barrel and group B used disposable endoscope bedside pre-treatment kit. During the cleaning process, each group was subdivided into two groups (groups A1, A2, B1 and B2). The cleaning solution in the cleaning tanks of group A1 and group B1 were replaced after several times of use, while group A2 and group B2 were replaced every time. The relative light unit value (RLU) and protein residue in the inner surface of endoscopic lumen before and after bedside pre-treatment as well as after cleaning were detected with adenosine triphosphate (ATP) bioluminescence method and nice check residual protein detection me-thod, cleaning effect of each group was compared. Results There was no significant difference in ATP detection value and mean protein residue between group A and group B before pre-treatment (both P > 0.05); the detection value of ATP in group B was lower than that in group A after pre-treatment (P < 0.05), and there was no significant difference in protein residue between group B and group A (P > 0.05). ATP detection values of group B1 and group B2 were both lower than those of group A1 and group A2 after cleaning (both P < 0.05), but there was no significant difference between group A1 and group A2 as well as group B1 and group B2 (both P > 0.05); there was no significant difference in protein residues among four groups (all P > 0.05). Conclusion Using a disposable endoscope bed-side pre-treatment kit for pre-treatment and adopting the mode of one time replacement for multiple use of cleaning solution in the cleaning tank during the manual cleaning process is the best choice for comprehensive clinical cost and cleaning effect.

Abstract:Objective To study the effect of different sampling methods on microbial monitoring results of dialysis water at the connection between dialysis machine and water supply circuit. Methods Dialysis water at the connection between 54 dialysis machine and water supply circuit in a hospital from January 2018 to December 2020 was sampled, according to different sampling methods, samples were divided into three groups: single-person sampling group (January-December 2018), double-person sampling group (January-December 2019) and sampling-valve sampling group (January-December 2020). Bacteria, endotoxin and sampling time of dialysis water in three groups were monitored. Results The endotoxin contents of dialysis water in single-person sampling group, double-person sampling group, and sampling-valve sampling group were (0.24±0.33), (0.11±0.09), and (0.06±0.03) EU/mL respectively, the total colony numbers of bacterial culture were (19.43±23.13), (9.17±14.73), and (1.26±1.62) CFU/mL respectively, and the sampling time were (196.50±16.52), (144.17±11.50), and (55.02±5.87) seconds respectively, the overall difference was significant (all P < 0.05). Multiple comparisons among groups showed that differences were all significant (all P < 0.05). In sampling-valve sampling group, sampling time was the shortest (55.02 seconds), average content of endotoxin was the lowest (0.06 EU/mL), and the colony number of bacterial culture was the lowest (1.26 CFU/mL). The qualified rates of endotoxin content in dialysis water of single-person sampling group, double-person sampling group and sampling-valve sampling group were 66.67%, 92.59% and 98.15% respectively, and qualified rates of bacterial culture were 77.78%, 94.44% and 100% respectively, difference of the overall comparison was significant, except that there was no significant diffe-rence between double-person sampling group and sampling-valve sampling group, pairwise comparison of the other groups were all significantly different (all P < 0.016 7). Conclusion Sampling of dialysis water at the connection between dialysis machine and water supply circuit through sampling-valve can effectively ensure qualified rate and accuracy of sampling results, improve sampling efficiency, ensure dialysis quality and safety, and effectively avoid the increase of department cost.

Abstract:Objective To analyze the clinical significance of serum pentraxin (PTX3), interleukin (IL-10), and heparin-binding protein (HBP) in the diagnosis of pulmonary tuberculosis (PTB). Methods 122 patients with PTB treated in a hospital from December 2018 to June 2021 were selected as the tuberculosis group, they were subdivided into cavity group and non-cavity group according to whether there was a pulmonary cavity; 113 patients who underwent physical examination in this hospital during the same period were selected as control group, and 109 patients with latent infection were selected as latent group. The expression levels of PTX3, IL-10, and HBP in different populations and with or without pulmonary cavity were compared; the expression levels of PTX3, IL-10, and HBP were compared between patients with and without cavity absorption after treatment; the expression levels of PTX3, IL-10, and HBP in patients with PTB after 1, 2 and 3 months treatment were compared, the value of PTX3, IL-10, and HBP in the diagnosis of PTB were analyzed. Results The expression levels of PTX3, IL-10, and HBP in tuberculosis group were all higher than those in latent infection group and control group, differences were all significant (all P < 0.05). The expression levels of PTX3, IL-10, and HBP in cavity group were all higher than those in non-cavity group, differences were all significant (all P < 0.001). After treatment, the expression levels of PTX3, IL-10, and HBP in the cavity absorption group were all lower than those in cavity non-absorption group (all P < 0.001). Levels of PTX3, IL-10, and HBP decreased gradually after treatment, levels of PTX3, IL-10, and HBP in patients with PTB at 3 months were all lower than those at 1 and 2 months after treatment (all P < 0.05). The area under the curve (AUC) of PTX3, IL-10, and HBP for the diagnosis of PTB were 0.756, 0.745 and 0.752 respectively, PTX3 was slightly higher than IL-10, and HBP, but there was no significant difference among the three (P > 0.05). Conclusion PTX3, IL-10, and HBP are highly expressed in patients with PTB, which is expected to become a reference indicator for the evaluation of disease condition of patients with PTB, and provide new ideas for clinical diagnosis and treatment.

Abstract:Objective To explore the risk factors and establishment of risk nomogram model for multidrug-resistant organism (MDRO) infection in patients undergoing orthopedic trauma surgery. Methods Clinical data of 458 patients who undergoing orthopedic trauma surgery in an intensive care unit of a hospital from January 2019 to Ja-nuary 2021 were retrospectively analyzed, univariate and lasso logistic regression analysis were used to analyze independent risk factors for MDRO infection in hospitalized patients after orthopedic trauma surgery. The screened independent risk factors were included to establish nomogram prediction model, in addition, 224 orthopedic trauma patients from February to October 2021 were selected to establish a verification group to verify the data of modeling group. Results A total of 458 trauma patients were as the modeling group, including 114 trauma patients complicated with MDRO infection, with an infection rate of 24.89%; there were 344 patients in non-MDRO infection group. Clinical data of two groups of patients were conducted lasso logistic regression analysis, APACHE Ⅱ score≥20 points (OR=2.567, 95%CI: 1.593-4.178), fever days ≥ 3 days (OR=2.656, 95%CI: 1.631-4.361), hospitalization days≥10 days (OR=3.563, 95%CI: 2.207-5.808), antimicrobial use (OR=2.314, 95%CI: 1.415-3.848), combined antimicrobial use days ≥7 days (OR=2.114, 95%CI: 1.329-3.624) were independent risk factors for MDRO infection in patients after orthopedic trauma surgery. Based on the five independent risk factors in the regression analysis, a nomogram model for predicting MDRO infection after trauma surgery was established, the verification results showed that the predicted value was basically consistent with the measured value in the internal verification of Bootstrap, the area under the prediction curve (AUC) of modeling group and verification group were 0.877 8 and 0.871 8 respectively, which showed that the prediction model had good prediction ability. The decision curve analysis (DCA) showed that the model had high benefit. Conclusion The establishment of nomogram prediction model is conducive to early identification of the high-risk factors of post-operative MDRO infection in trauma surgery patients, and timely take prevention and control measures, so as to reduce MDRO healthcare-associated infection.

Abstract:Objective To explore the effect of disinfection of urethral orifice with antiseptic agent before catheteri-zation on the prevention of catheter-associated urinary tract infection (CAUTI) by Meta-analysis, provide reference for domestic clinical work and the formulation of CAUTI prevention strategy. Methods WanFang data, China national knowledge infrastructure(CNKI), China Biology Medicine disc (CBM), PubMed, The Cochrane library, Web of Science databases and EMbase were electronically retrieved to collect randomized controlled trials (RCTs) about the effect of urethral orifice disinfection before catheterization on the prevention of CAUTI, the retrieval time was from database establishment to August 2021. Two researchers independently screened the literatures, extracted data, evaluated the bias risk of the included literatures, Stata 12.0 software was adopted to conduct Meta-analysis, sensitivity analysis and publication bias analysis, GPower 3.1 software was used for efficacy analysis. Results A total of 7 RCTs were included, including 3 030 patients with urinary catheterization. Meta-analysis showed that there was no significant difference in the incidence of CAUTI between disinfection and cleaning of urethral orifice before catheterization (OR=0.78, 95%CI: 0.57-1.08, P=0.380), whether the countries were with extremely high human development index (OR=0.75, 95%CI: 0.46-1.22, P=0.243) or high human development index (OR=0.91, 95%CI: 0.56-1.47, P=0.839), whether the positive criterion of urine culture was colony number >10⁵ CFU/mL (OR=0.71, 95%CI: 0.47-1.08, P=0.316) or >10³ CFU/mL (OR=1.06, 95%CI: 0.58-1.91, P= 0.642), difference in the incidence of CAUTI between disinfection and cleaning of the urethral orifice before catheterization was not statistically significant. Conclusion Systematic evaluation and Meta-analysis results show that there is no difference in the efficacy of preventing CAUTI between disinfection and cleaning of urethral orifice before catheterization, which is inconsistent with the requirements of relevant guidelines for CAUTI prevention in China, however, more high-quality studied in medical environment of China are still need to be conducted to formulate CAUTI prevention standards in line with national conditions of China.

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Abstract:Drying is usually the last key step in the reprocessing of flexible digestive endoscopes, it is as important as the cleaning, disinfection and sterilization for flexible digestive endoscope in the control of healthcare-associated infection, but the existing drying methods can not fully meet the safety requirements. This paper summarizes the current research of drying of flexible digestive endoscope, analyzes the factors which affect the drying effect of flexible digestive endoscope, the storage methods which are conducive to the drying of flexible digestive endoscope, and the evaluation method of drying effect, so as to provide evidence-based basis for clinical practice and future research.

Abstract:The main transmission mode of healthcare-associated infection (HAI) is contact transmission, whether the cleaning and disinfection of high-touch surfaces is qualified is very important for the prevention and control of HAI. This paper mainly reviewed the research progress of current situation and harm, cleaning and disinfection methods, and effect evaluation of contamination of high-touch surfaces in high risk areas of hospitals at domestic and abroad, so as to provide suggestions and references for HAI managers and future scientific research on cleaning and disinfection of high-touch surfaces in hospitals.