Abstract:Objective To discuss the disinfection effect of persistent hypochlorous acid supply to final rinse water for endoscope. Methods Water specimens of final rinse water for endoscope were collected at baseline, and identified by microbial culture and metagenomic next-generation sequencing (mNGS). After introducing a slightly acidic hypochlorous acid water generator, water specimens were collected at a specific time after installation for culture and mNGS analysis. Results A total of 27 water specimens were collected before installation, and 10 (37.03%) were qualified. Aquatic bacteria such as Rhizobiumradiobacter, Stenotrophomonas maltophilia, Microbacterium flavum, Cupriavidus, Methylobacterium fujisawaense and Sphingomonas paucimobilis can be detected in unqualified water specimens, 54 water specimens were collected after installation, and all of them were qualified. mNGS shows that abundant sequences of Ralstonia Pichia, Cupriavidus metallidurans, Moraxella osloensis, Rhizobium japonicum, Aquatic methylbacterium, Mycobacterium Gordon and Sphingosine neobacterium could be detected in water specimens before installation, but only background bacteria in mNGS were found after disinfection. Conclusion Persistent hypochlorous acid supply can effectively remove bacteria and reduce biofilm formation in water pipeline, improving the quality of final rinse water for endoscope.

Abstract:Objective To evaluate the effect of axial-flow cabinet mechanical ventilation, exhaust fan mechanical ventilation and natural ventilation on cleaning and disinfecting aerosol in digestive endoscope cleaning and disinfection room. Methods The experiment was divided into three groups: Axial flow cabinet mechanical ventilation (group A), exhaust fan mechanical ventilation (group B) and natural ventilation (group C). Air in digestive endoscope cleaning and disinfection rooms in two wards of a hospital under three ventilation modes were collected: before and after 2 hours of ventilation in the static environment (the cleaning and disinfection work was stopped for 12 hours), 0 hour in the initial state of the dynamic environment (the cleaning and disinfection work was in progress) and 1, 2, 4, 6 hours of continuous ventilation, contents of particulate matter, microorganisms, glutaraldehyde in air aerosol were detected, effect of three ventilation modes on purifying the aerosol in digestive endoscope cleaning and disinfection room were compared. Results In static environment, contents of particulate matter, microorga-nism and glutaraldehyde in the cleaning and disinfection endoscope room showed a downward trend after 2 hours ventilation, differences between group A and B before and after 2 hours of ventilation were statistically significant (P < 0.05). At 0 hour of initial working state of cleaning and disinfection room, contents of particulate matter, microorganism and glutaraldehyde in air among three groups were not significantly different (all P>0.05). After continuous ventilation for 1, 2, 4 and 6 hours, contents of particulate matter, microorganism and glutaraldehyde in air among all groups and between any two groups were significantly different (all P < 0.01), group A was lower than group B and C, and group B was lower than group C. In group A, contents of particulate matter, microorganism and glutaraldehyde in dynamic environment was low and the fluctuation range was small, and content of particulate matter reached the specified range of class 1 million clean room. Contents of glutaraldehyde in group B and C exceeded the maximum safe exposure limit of 0.175 mg/m³ at 1, 2 and 4 hours of continuous ventilation, content of gluta- raldehyde in group C still exceeded the maximum safe exposure limit during the lunch break of 4-6 hours. Conclusion Among three ventilation modes, axial flow cabinet mechanical ventilation mode can most effectively purify the aerosol in air of digestive endoscope cleaning and disinfection room, and it is recommended to introduce axial flow cabinet ventilation mode to ensure the occupational safety of staff.

Abstract:Objective To evaluate the quality management status and existing problems of central sterile supply department (CSSD) in China, and provide reference basis for standardizing the management of CSSD as well as prevention and control of healthcare-associated infection (HAI). Methods Literatures on the current status of CSSD quality management in hospitals in various regions of China published on China National Knowledge Infrastructure (CNKI), VIP, Wanfang Data, PubMed, Embase, and Web of Science from January 1, 2012 to January 31, 2022 were searched, literatures were screened and data were extracted by two researchers, Stata14.0 software was adop-ted for Meta-analysis. Results A total of 12 literatures were included, involving 1 435 hospitals, Meta-analysis results showed that according to the subgroup analysis of hospital level, the implementation rate of CSSD centralized management in tertiary hospitals was higher than that in secondary hospitals (81% [95%CI: 65%-97%] vs 61% [95%CI: 30%-92%]); staffing and management of professionals in tertiary hospitals was better than that in se-condary hospitals (86% [95%CI: 76%-97%] vs 74% [95% CI: 59%-89%]); in terms of architectural layout design: the rationality selection of CSSD building location of tertiary hospitals was better than that of secondary hospitals (85% [95%CI: 75%-95%] vs 62% [95%CI: 34%-91%]); in terms of important equipment allocation: the allocation rate of automatic cleaning sterilizer in tertiary hospitals was higher than that in secondary hospitals (79% [95%CI: 64%-94%] vs 48% [95%CI: 20%-76%]); the allocation rate of medical insulation detector in tertiary hospitals was higher than that in secondary hospitals (44% [95%CI: 30%-58%] vs 18% [95%CI: 8%-28%]); allocation rate of pressure steam sterilizer in tertiary hospitals was higher than that in secondary hospitals (86% [95%CI: 68%-105%] vs 80% [95%CI: 67%-94%]); implementation rate of information quality traceability system in tertiary hospitals was higher than that in secondary hospitals (47% [95%CI: 34%-61%] vs 23% [95%CI: 14%-32%]). Conclusion There are some problems in quality management of hospital CSSD in China, including inadequate implementation of centralized management, insufficient allocation and non-standard management of professionals, irrational building layout design, insufficient allocation of equipment and facilities, as well as incomplete adoption of information-based quality traceability system, which exists certain potential safety problems. It is suggested that hospitals should conscientiously implement the requirements of health industry standards, strengthen the scientific management of CSSD, ensure medical quality and patient life safety.

Abstract:Objective To investigate the management status of water preparation, equipment maintenance and water quality monitoring for the final rinsing for flexible endoscopes in all levels of medical institutions(MIs) in Jilin Province, provide a scientific basis for the standardized management of water for the final rinsing of flexible endoscopes. Methods From January to May 2020, based on the platform of endoscopic nursing and infection control professional committee of Jilin Research Hospital Association, MIs in 9 cities in Jilin Province carrying out flexible endoscopy diagnosis and treatment projects were selected, and self-made questionnaire for flexible endoscope was adopted to investigate persons in charge of the management of final rinsing water in endoscopy centers (departments) and voluntarily participated in the project. Results A total of 75 questionnaires were distributed, and 72(96.0%) were available, among 72 MIs, 64(88.9%) endoscopy centers (departments) were independently supplied water by departments. In terms installation of final rinsing water production equipment, 22(45.8%) MIs were equipped with water pre-treatment devices for raw water, and 19(26.4%) MIs were equipped with reverse osmosis systems. In terms of maintenance of production equipment for final rinsing water, 19(26.4%) MIs have formulated equipment-related quality inspection, repair and maintenance systems, and 34(47.2%) MIs recorded equipment maintenance, consumables replacement and so on; among the MIs that installed equipment such as raw water pre-treatment and filter membrane, 18(54.5%) MIs replaced pre-treatment consumables regularly, and 50(75.8%) MIs replaced filter membranes regularly; 35(48.6%) MIs regularly disinfected the final rinsing water pipeline and water storage tank. In terms of quality monitoring of final rinsing water, 26(36.1%) MIs had relevant monitoring systems and corresponding records for the quality of final rinsing water, 59(81.9%) MIs regularly performed microbiological testing of final rinsing water. Conclusion MIs at all levels have insufficient scientific understanding and attention to the management of final rinsing water for flexible endoscopes, resulting in low allocation rate of water producing equipment, corresponding systems, and low implementation rate of equipment maintenance, water quality monitoring and water use records. Quality control of endoscopic final rinsing water should be paid more attention, strengthen scientific research, formulate relevant specifications, and unify industry standards and behaviors, so as to ensure the quality of final rinsing water and medical safety.

Abstract:Objective To study the performance of resistance to dry microbial penetration of key areas of surgical gowns, determine the necessity of evaluation on resistance to dry microbial penetration of key areas. Methods Disposable surgical gowns (fabric was polypropylene SMS non-woven) and reusable surgical gowns (fabric was 100% cotton woven fabric, 99% polyester fiber +1% carbon fiber woven fabric) were selected, 5 groups of specimens were taken respectively, test method of resistance to dry and wet bacterial penetration were performed according to YY/T 0506.5-2009 and YY/T 0506.6-2009 test method. Results Resistance to dry microbial penetration of key area of disposable surgical gowns were 1-4 CFU, two results (A1, A2) of penetration test of resistance to wet microbial penetration were < 2.8 I_B, which did not meet the standard requirements. Resistance to wet microbial penetration of reusable surgical gowns were all > 2.8 I_B, three results (B1, B2, C1) of test of resistance to wet micro-bial penetration were >300 CFU. Conclusion Resistance to dry microbial penetration performance of key areas of surgical gowns is good, key areas of reusable surgical gowns have poor performance of resistance to wet penetration, it is suggested that resistance to dry microbial penetration of key areas of surgical gowns should be evaluated.

Abstract:Objective To analyze the difficulties in the cleaning of loaner luminal spinal surgical instruments, and provide basis for improving and perfecting the cleaning quality control system. Methods 291 loaner luminal spinal instruments in a hospital were selected, and the endoscopic lumen inspection system was used to check the cleaning quality of lumen of instruments when they were received and after manual cleaning, statistical analysis was performed. Results The contamination rates of contaminants were 89.69% and 59.45% at receiving time and after cleaning of luminal instruments, the main contaminants were tissue, stain and rust. Instruments with blind ends were more difficult to be cleaned than those with openings at both ends, there were significant differences in tissue and stain removal rates between two groups (both P < 0.05). Conclusion It is difficult to clean the loaner luminal spinal surgical instruments, so the cleaning process should be optimized and cleaning quality of inner surface of lumen should be included in the assessment system.

Abstract:Objective To analyze the clinical characteristics of patients with nocardiosis, and provide experience for the diagnosis and treatment of nocardiosis. Methods Clinical data of hospitalized patients with nocardiosis diagnosed in the First Hospital of Lanzhou University between January 2017 and November 2021 were analyzed retrospectively. Results A total of 10 patients with nocardiosis were admitted for treatment, 8 were males and 2 were females, with an average age of (59.1±15.4) years, 3 cases were ≥60 years old. The main occupation of patients was far-mer (n=5, 50.0%). There were 5 cases of pulmonary nocardiosis, 4 cases of cutaneous nocardiosis and 1 case of disseminated nocardiosis. Nocardia asteroides was the main pathogen (n=5). 80.0% of the patients had underlying diseases, mainly bronchiectasis (n=3) and long-term use of glucocorticoids (n=3). Patients with pulmonary nocardiosis had cough and expectoration, rales could be heard during physical examination; cutaneous nocardiosis was mainly swelling and purulent at the focus; one case of cerebral nocardiosis was disseminated infection with loss of consciousness and with central nervous involvement. C-reactive protein in patients was 72.75 (39.25-96.74) mg/L, all increased. Pulmonary CT examination showed small nodule shadow and patch shadow (n=6), multiple cord shadow of both lung (n=4), large ground-glass shadow (n=3) and pleural effusion (n=3). After active anti-infective treatment, 9 patients got well and were discharged, one patient gave up treatment due to aggravation of disease. Conclusion For the middle-aged and elderly people with underlying pulmonary diseases and poor resistance, Nocardia infection should be considered when the effect of routine anti-infective treatment is poor, and the key is to actively perform pathogenic detection.

Abstract:Objective To understand the clinical characteristics of pulmonary nocardiosis, analyze antimicrobial resistance of Nocardia, and provide basis for clinical standard diagnosis and treatment. Methods Medical records of patients clinically diagnosed as pulmonary nocardiosis in Henan Chest Hospital from 2016 to 2021 were collected, the isolated strains were identified by matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) and molecular biological technology, antimicrobial susceptibility testing was performed by micro-broth dilution, clinical characteristics and antimicrobial susceptibility testing results of patients were analyzed. Results There were 42 patients with Nocardia infection, including 24 males and 18 females. 88.1% of the patients had underlying diseases, including bronchiectasis, diabetes, chronic obstructive pulmonary disease, etc. 50.0% of the 42 patients were complicated with other pathogens, 5 of whom were with Aspergillus and 5 with Mycobacterium tuberculosis infection. The imaging findings of pulmonary CT examination of 41 patients were mainly nodular shadow (78.0%) and patchy shadow (58.5%), and 24.4% of patients were accompanied by pleural effusion. In the laboratory examination, 66.7% of the patients had an increase in the percentage of neutrophils, 75.0% of the patients had an increase in C-reactive protein and erythrocyte sedimentation rate, and 54.8% of the patients had hypoproteinemia. Nocardia cyriacigeorgica was the main strain (11 strains) isolated from patients with pulmonary nocardiosis, antimicrobial susceptibility testing results of different Nocardia strains were different, but all strains were susceptible to compound sulfamethoxazole, amikacin and linezolid. Most patients adopted the combined treatment based on sulfonamides, and 83.3% (35 cases) of patients improved and were discharged. Conclusion Pulmonary nocardiosis is easy to occur in patients with bronchiectasis and low immunity, its clinical characteristics are not obviously specific, and is easy to be complicated with infection of Aspergillus, tubercle bacillus and other pathogens, labor-atory should perform antimicrobial susceptibility testing of Nocardia, provide basis for clinical precision treatment.

Abstract:Objective To explore the clinical characteristics as well as early diagnosis and treatment of Chlamydia psittaci (C. psittaci) pneumonia. Methods 12 patients admitted in Pingxiang People's Hospital from February 2019 to February 2022 and diagnosed as C. psittaci pneumonia by metagenomic next-generation sequencing (mNGS) were selected, clinical data were analyzed and clinical characteristics as well as key points of diagnosis and treatment of the disease were summarized retrospectively. Results Most of the 12 patients with C. psittaci pneumonia had a history of contact with birds, pigeons or poultry (n=8), the main manifestations of the disease onset were high fever (n=12), general fatigue (n=12), cough (n=10), dyspnea (n=9) and headache (n=7), disease could rapidly progress to respiratory failure, septic shock, and even multiple organ failure. Laboratory tests showed that C-reactive protein increased in 12 patients, procalcitonin increased in 9 patients, blood routine lymphocytes all decreased, percentage of neutrophils increased in 10 patients, and white blood cells were normal in 9 patients. Chest CT showed inflammatory exudation and consolidation of one or both pulmonary lobes. Respiratory tract specimens or blood specimens were detected C. psittaci by mNGS, and the diagnosis was confirmed in combination with the contact history, clinical manifestations and imaging examination results. Quinolones were effective for treatment of 10 cases of C. psittaci pneumonia, and 1 patient who failed to use quinolones were treated with tetracyclines, and could still improve in a short time of disease condition. Conclusion C. psittaci pneumonia has obvious pulmonary symptoms, extrapulmonary symptoms are common and can progress rapidly, mNGS is an important detection technique for early diagnosis, which can reduce the delay of diagnosis. Patients with C. psittaci pneumonia recover well after timely initiation of targeted antimicrobial treatment.

Abstract:Objective To analyze the clinical characteristics of patients with brucellosis complicated with pleural effusion, and provide reference for clinical diagnosis and treatment. Methods Medical records of four patients with brucellosis complicated with pleural effusion in Hulunbuir People's Hospital from January 2013 to December 2020 were analyzed. General data, epidemiological history, clinical characteristics, laboratory examination and curative effect were analyzed retrospectively. Results All four cases of brucellosis complicated with pleural effusion were male, the youngest was 22 years old and the oldest was 62 years old. All patients had symptoms of fever, fatigue, accompanied by chills, sweating, lumbago, pain in back and bilateral flanks, cough, expectoration, chest tightness, shortness of breath, and dyspnea. Bengal plate agglutination test (RBPT) and standard tube agglutination test (SAT) of serum and pleural effusion were positive in all patients, and Brucella was isolated from blood culture and pleural effusion of one patient. C-reactive protein and erythrocyte sedimentation rate increased in all patients, and tuberculin test was negative or weakly positive. Pleural puncture was performed to extract yellow liquid from pleural effusion in three cases and purulent in one case, the effusion was medium or above, which was exudate. The short-term effective rate was 100% after patients were given 12 weeks or more of enough combination therapy with antimicrobial agents. Conclusion Incidence of brucellosis complicated with pleural effusion is low, when patient has fever, fatigue, sweating and respiratory system discomfort, clinician should ask patient about the epidemiological contact history in detail, considering the possibility of brucellosis, early diagnosis and treatment can lead to a good prognosis.

Abstract:Epstein-Barr (EB) virus, as a human host virus, lurks in the human body for a long time and can cause diseases when the body's immunity is low. This paper reports a case of EB virus pneumonia complicated with EB virus encephalitis in an adult patient admitted to a hospital. Fever was the main clinical manifestation, and the diagnosis was confirmed by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) and cerebrospinal fluid, patient was completely improved after antiviral therapy.

Abstract:Objective To investigate the drug resistance of clinically isolated Acinetobacter baumannii (AB) and distribution of biofilm-related genes and integrons, explore the relationship between extensively drug-resistant AB (XDR-AB) biofilm-related genes, integrons and drug resistance. Methods Minimum inhibitory concentration (MIC) of 17 kinds of antimicrobial agents against 59 AB strains isolated from clinical specimens of a hospital in Chengdu from 2019 to 2020 were performed by micro-broth method, 17 biofilm-related genes and class Ⅰ, Ⅱ and Ⅲ integrase genes were amplified by polymerase chain reaction (PCR), variable regions of class Ⅰ integrase positive strains were amplified and sequenced. Results Resistance rate of 59 AB strains to minocycline was 1.69%, to imipenem and meropenem were 67.80% and 71.19% respectively, and to other antimicrobial agents were 59.32%-84.75%. Among 59 AB strains, 40 strains (67.80%) were XDR-AB, 5 strains (8.47%) were multidrug-resis-tance AB (MDR-AB), and 14 strains (23.73%) were sensitive strains. Among 17 biofilm-related genes of 59 AB strains, detection rates of 6 biofilm-related genes bfmR, bfmS, csuC, csuD, csuE, and pgaD were 100%, detection rates of the other 11 biofilm-related genes were 74.58%-98.31%. Detection rates of 4 biofilm-related genes abaI, epsA, pglC, and ompA in XDR-AB were 100%, 95.00%, 87.50% and 100% respectively, which were higher than those in sensitive AB strains (64.29%, 7.14%, 42.86% and 50.00%, all P < 0.05). The detection rate of intI-1 integrase gene of AB and XDR-AB were 66.10% (39/59) and 90.00% (36/40) respectively, and sensitive AB strain was not found. Among 39 class Ⅰ integrase positive strains, 38 strains of class Ⅰ integron variable region were detected, including 35 XDR-AB strains and 3 MDR-AB strains. Conclusion Detection rate of XDR-AB among AB is high, it is speculated that the biofilm-related genes abaI, epsA, pglC, ompA and class Ⅰ integron carried by XDR-AB are closely related to drug resistance.

Abstract:Objective To evaluate the clinical efficacy of early treatment with vancomycin in extremely severe burned patients, and provide references for anti-infection treatment of patients with extremely severe burn. Methods Clinical data of 15 patients with extremely severe burn and treated in the department of critical care medicine of a hospital were retrospectively analyzed, burn grade evaluation, infection index and trough blood concentration monitoring results of burn patients treated with vancomycin were statistically analyzed. Trough concentration prediction and Bayesian feedback method were adopted to compare the currently published population pharmacokinetic models of severe patients, optimal model for vancomycin treatment in extremely severe burned patients was screened out, administration of vancomycin in severely burned patients was optimized through Monte Carlo simulation. Results All 15 patients were administered vancomycin via continuous intravenous drip or pump, the average time of vancomycin administration was (11.07±1.71) days, and 79.31% of the steady-state trough blood concentrations met the standard (10-20 μg/mL), one patient developed renal toxicity during treatment. After screening, two-compartment model of severe patients reported in literatures was selected as the optimal model for vancomycin treatment in patients with extremely severe burns. Monte Carlo simulation results showed that 24 hours of continuous intravenous drip or pump administration was the best method for vancomycin treatment in patients with extremely severe burn, and the loading dose of 1.5 times of the normal dose can help quickly reach the effective concentration range. Conclusion The development of sepsis in extremely severe burned patients can be well controlled with early application of vancomycin. Continuously drip or pump administration combined with sufficient loading dose are critical to obtain best treatment of vancomycin.

Abstract:Objective To explore the competitive situation of scientific and technological innovation in the field of healthcare-associated infection (HAI) control in China, and reveal the trend and direction of technology as well as product research and development in this field, promote scientific and technological innovation in the field of HAI prevention and control. Methods Based on the authoritative patent retrieval database and industrial think tank data, the patent technologies in the field of HAI prevention and control in China from 2012 to 2021 as well as the competitive situation of innovative products of enterprises with a certain scale are analyzed by using a combination of quantitative and qualitative methods. Results From 2012 to 2021, a total of 22 475 patents in the field of HAI control were applied in China, including 6 320 (28.12%) invention patents and 16 155 (71.88%) utility model patents. Invention patents and utility model patents in 2021 increased by 5.1 times and 2.6 times compared with 2012, but the overall effective rate of invention patents was only 16.72%. The company and individual invention patent holding rates were 44.17% and 34.57% respectively, and the utility model patent holding rates of universities and hospitals were 43.08% and 24.42% respectively; the percentage of invention and utility model patents of methods or devices for sterilization or disinfection of materials or objects were 42.52% and 45.47% respectively; the layout of overseas market is less than 1%; the scale of innovative product development in recent years is only 10 million RMB level. Conclusion The competitiveness of scientific and technological innovation in the field of HAI control needs to be strengthened, it is necessary to promote the transformation of scientific and technological achievements, strengthen the construction of infection control disciplines, promote the transformation of innovative applications, and improve the refinement and intelligence level of scientific and technological innovation achievements.

Abstract:Hand-foot-and-mouth disease (HFMD) is an acute infectious disease mainly caused by enterovirus infection and is easy to invade skin and mucosa of children's hands, feet, and mouth, reports of adult infection are not rare in recent years. There are some differences in epidemiology and clinical features of HFMD between adults and children. Domestic and foreign scholars have carried out relevant research on the epidemic and clinical features of adult HFMD, this paper summarizes the current research progress on the epidemiology and clinical features of adult HFMD.

Abstract:The problem of healthcare-assocaited infection (HAI) and multidrug-resistant organism persists, but the role of antimicrobial agents is gradually weakened. Among many new antimicrobial agents, nano-selenium has relatively low toxicity and strong antimicrobial efficacy. Therefore, this paper introduces nano-selenium materials from three aspects: antimicrobial activity and its influencing factors, antimicrobial mechanism, and research progress of improved nano-selenium materials, elaborating and looking forward to the clinical application of nano-sele-nium, so as to provide reference for its research and application in antimicrobial field.