Abstract:Objective To conduct healthcare -associated infection (HAI) risk assessment for each clinical department in the hospital, identify priority projects for infection risk control, and apply the integrated enterprise risk management framework (COSO-ERM) to build an optimized management system for extremely high risk departments. Methods According to the monitoring data from April to June 2021, risk identification, risk indicators establishment and weight coefficient assignment in 37 clinical departments in a hospital was carried out, and risk of HAI in the departments was assessed from three aspects (possibility of risk occurrence, severity of consequences, and current management system) in July 2021, percentile was adopted to conduct stratified risk assessment accor-ding to common departments and ICU departments, risk levels was determined, risk control measures for extremely high-risk departments and projects were taken, COSO-ERM optimization management system was built to evaluate the effect before and after risk assessment. Results General departments and ICU departments respectively rated one department with extremely high risk, namely neurosurgery and general ICU, COSO-ERM optimization management system of neurosurgery and general ICU were constructed respectively, intervention effect was evaluated. Compared with risk indicator value in April-June 2021, compliance rate and accuracy rate of hand hygiene in hand hygiene indicator improved, utilization rate of devices reduced, incidence of VAP in inpatients reduced in April-June 2022, differences were all significant (all P < 0.05). Conclusion Neurosurgery and general ICU are departments with extremely high risk of HAI, which should give priority to risk control, building a risk optimization ma-nagement system is conducive to infection risk control.

Abstract:Objective To explore the risk factors for the occurrence of stroke-related infection in patients with acute ischemic stroke (AIS), and construct a decision tree prediction model. Methods AIS patients admitted to the department of neurology of a hospital from June 2020 to June 2021 were retrospectively selected as the research objects. They were divided into training group and validation group in a certain proportion. The predictors were screened by Lasso regression, and a decision tree model for stroke-related infection in AIS patients was constructed based on the CHAID algorithm. Random split validation method was adopted for internal validation, and the area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the effect of the model. Results A total of 693 AIS patients were treated, 484 in training group and 209 in validation group. Incidence of stroke-related infection in training group and validation group were 17.8% (n=86) and 20.1% (n=42) respectively. Age, fasting blood glucose, history of diabetes, triglycerides, smoking, complicated respiratory diseases, complicated cardiovascular diseases, disturbance of consciousness, and long length of hospitalization were risk factors for stroke-related infection in AIS patients. The above factors were included and a decision tree model was constructed. The decision tree model contained 3 layers and a total of 7 nodes. Complicated respiratory disease, history of diabetes, and smoking were predictors of stroke-related infection. The AUC of ROC of validation group decision tree model was 0.980, the sensitivity and specificity were 97.0% and 97.6% respectively, Youden index was 0.946, Kappa value was 0.914. Conclusion The model constructed in this study can better predict the risk of stroke-related infection in AIS patients, and can be used as an evaluation tool for clinical nurses to predict the risk of patients.

Abstract:Objective To establish a comprehensive and scientific risk assessment system under the normalized si-tuation of coronavirus disease 2019 (COVID -19) prevention and control, and provide support for decision-making of hospital management. Methods A comprehensive tertiary first-class hospital in Shandong Province was as the research object, risk assessment was carried out on hospital at overall level, risk points and risk indicators were determined with brainstorming method by members of healthcare-associated infection (HAI) management committee, risk scores of clinical departments were calculated through risk assessment matrix, risk grades were assessed with percentile method, differences among different risk groups were compared using one-way ANOVA or non-parame-tric test, clinical departments were performed stratified clustering analysis according to the difference of risk scores of risk points, the evaluated extremely high-risk departments were conduct internal risk assessment with failure model and effect analysis, and risk response was finally carried out according to results of two rounds of risk assessment. Results A total of 61 clinical departments participated in the assessment. Eight risk points and 24 risk indicators were ultimately determined by the risk assessment of the clinical departments. Risk grades assessment results indicated that the extremely high-risk departments were respectively as follows: neurosurgical departmentⅠ, neurosurgical departmentⅡ, neurological intensive care unit, respiratory intensive care unit and intensive care units, accounting for 8.20%; risk scores of management indicators, process indicators and outcome indicators of six risk groups were all significantly different (all P < 0.05); clinical departments were divided into 3 categories accor-ding to their characteristics with stratified cluster analysis, which were designated as general departments clustering group, key departments clustering group and neurosurgery department clustering group. Seven high-risk priority issues were assessed through internal risk assessment of extremely high-risk departments, targeted solutions were put forward. Conclusion The risk assessment system established in this study can effectively assess and analyze the risk grade of clinical departments, effectively respond to the high-risk priority issues of extremely high-risk departments, and clarify the key points of HAI management in the next step.

Abstract:Objective To explore the differences in anti-blood penetration performance of different types of masks, study the influence of mask shape on blood penetration, and evaluate anti-blood penetration performance of masks. Methods Three types of masks were selected: medical protective masks (folded), KN95 masks (arched), and disposable surgical masks (flat), the surfaces of water repellent layer of masks were tested, morphological tracks of blood ejection and flow were observed by high-speed photography, and blood areas on the surface of masks under different conditions (pressure, distance, time) were calculated. Results The surfaces of masks were all hydrophobic (contact angle >130 °). Under standard conditions (120 mmHg, 30 cm), blood adhesion areas of medical protective masks (folded), KN95 masks (arched), and disposable surgical masks (flat) were 1.79, 2.53 and 4.72 cm² respectively; under high pressure conditions (160 mmHg, 30 cm), blood adhesion area increased; under short distance conditions (120 mmHg, 15 cm), blood adhesion areas of medical protective masks (folded) and KN95 masks (arched) decreased, while disposable surgical masks (flat) increased; under high pressure ejection (60 seconds, 160 mmHg), the inner layer of KN95 mask (arched) appeared blood penetration. Conclusion Blood penetration performance of three types of masks all meet the highest standards at home and abroad. KN95 mask (arched) has the best liquid discharge and barrier performance, followed by medical protective masks (folded), however, under extreme conditions, KN95 mask (arched) failed due to blood penetration.

Abstract:Objective To explore the differences in anti-blood penetration performance of different types of masks, study the influence of mask shape on blood penetration, and evaluate anti-blood penetration performance of masks. Methods Three types of masks were selected: medical protective masks (folded), KN95 masks (arched), and disposable surgical masks (flat), the surfaces of water repellent layer of masks were tested, morphological tracks of blood ejection and flow were observed by high-speed photography, and blood areas on the surface of masks under different conditions (pressure, distance, time) were calculated. Results The surfaces of masks were all hydrophobic (contact angle >130 °). Under standard conditions (120 mmHg, 30 cm), blood adhesion areas of medical protective masks (folded), KN95 masks (arched), and disposable surgical masks (flat) were 1.79, 2.53 and 4.72 cm² respectively; under high pressure conditions (160 mmHg, 30 cm), blood adhesion area increased; under short distance conditions (120 mmHg, 15 cm), blood adhesion areas of medical protective masks (folded) and KN95 masks (arched) decreased, while disposable surgical masks (flat) increased; under high pressure ejection (60 seconds, 160 mmHg), the inner layer of KN95 mask (arched) appeared blood penetration. Conclusion Blood penetration performance of three types of masks all meet the highest standards at home and abroad. KN95 mask (arched) has the best liquid discharge and barrier performance, followed by medical protective masks (folded), however, under extreme conditions, KN95 mask (arched) failed due to blood penetration.

Abstract:Objective To analyze the expression of T helper 17 cells (Th17) and suppressor of cytokine signaling 3 (SOCS3) mRNA in peripheral blood of patients with chronic hepatitis B (CHB), and explore the relationship between SOCS3 mRNA expression and Th17 in patients with CHB. Methods 30 CHB patients who were admitted to the outpatient department of a hospital from February to August 2021 were selected as the research objects, and 15 healthy subjects were selected as control during the same period. Frequency of Th17 cells in peripheral blood was conducted with flow cytometry (FCM), expression levels of serum cytokines interleukin-17A (IL-17A) and IL-23 were detected with enzyme-linked immunosorbent assay (ELISA); mRNA expression levels of SOCS3 and retinoid-related orphan receptor gamma t (RORγt) in peripheral blood were determined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR), results of two groups of patients were compared. Results The frequency of Th17 cells and expression levels of its effector molecules IL-17A and IL-23 in peripheral blood of patients with CHB were higher than those in control group (all P < 0.05), there were positive correlations between Th17 cell frequency, IL-17A and HBV DNA levels (r=0.570, r=0.563, both P < 0.005). The expression levels of SOCS3 and RORγt mRNA in peripheral blood of CHB patients were both higher than those of healthy control (both P < 0.05), they were also positively correlated with HBV DNA levels (r=0.662, r=0.561, both P < 0.05). In CHB patients, SOCS3 mRNA was positively correlated with RORγt mRNA, Th17 cell frequency and IL-17A (r=0.552, r=0.626, r=0.826, all P < 0.05). Conclusion The abnormal expression of SOCS3 mRNA in peripheral blood of patients with CHB may affect the differentiation of Th17 and the secretion of its effector molecules by regulating the expression of RORγt mRNA.

Abstract:Objective To investigate the medical students' education needs and teachers' suggestion on course design of healthcare -associated infection (HAI) prevention and control. Methods Medical students' and teachers' education needs and opinions on course design of HAI prevention and control in 10 medical universities in 5 regions of China was conducted questionnaire survey, the course design scheme was demonstrated by referring to course design steps of Taba curriculum model. Results Among 584 students, only 11.8% (n=69) believed that the current education on HAI prevention and control could fully meet their needs, and the top four in demand scores were hand hygiene, disinfection and sterilization isolation, as well as introduction to HAI and occupational protection. Among 352 teachers, 72.7% (n=256) suggested setting up compulsory courses; 86.4% (n=304) chose 8-24 class hours in total, 12.5% (n=44) chose more than 24 class hours, the surveyed teachers suggested that the average total class hours of 10 chapters be 19.5; it is required to master 13 items and be familiar with 9 items of knowledge and skills; 86.4% (n=304) of teachers suggested that the ratio of theoretical and probation hours should be 1 ∶0.5 or more; 53.4% (n=188) of teachers suggested taking the form of theoretical courses+group probation (including skill manipulation)+online learning; 63.7% (n=224) of teachers suggested that the teaching team should be composed of teachers from HAI management department+infectious diseases department+nursing department. Conclusion At present, education of HAI prevention and control for medical students is far from fully meeting the needs, so it is necessary to have independent courses, it is suggested to set up 16-24 class hours of compulsory courses, integrate theory with practice, implement diversified teaching for multidisciplinary teachers, and assess according to the compulsory courses.

Abstract:Objective To explore the predictive value of the ratio of serum procalcitonin (PCT) to Simpson's diversity index (SDI) in alveolar lavage fluid for the short-term prognosis of patients with bacterial pneumonia in intensive care unit (ICU). Methods Medical records of 56 patients with bacterial pneumonia who were performed alveolar lavage fluid metagenomic next-generation sequencing (mNGS) technology in ICU of the Affiliated Hospital of Yangzhou University from October 2019 to July 2021 were retrospectively investigated, according to the acute physiology and chronic health evaluation (APACHE-Ⅱ) scoring system within 24 hours after admission to ICU, patients were divided into non-critical group (n=21) and critical group (n=35). Taking death caused by bacterial pneumonia as the end event, 28-day prognosis was recorded, patients were divided into survival group (n=38) and death group (n=18). SDI, PCT, C-reactive protein (CRP), PCT/SDI and CRP/SDI of patients in each group were compared and analyzed. Results Compared with non-critical group, critical group had higher levels of PCT/SDI and PCT, longer duration of ventilator-assisted ventilation, and higher 28-day mortality (all P < 0.05); compared with survivor group, death group had lower SDI, as well as higher PCT/SDI and PCT (both P < 0.05); SDI was negatively correlated with duration of ventilator-assisted ventilation (r values were -0.655, P < 0.001). PCT, PCT/SDI were positively correlated with duration of ventilator-assisted ventilation time (r values were 0.660, 0.734, respectively, both P < 0.001). The receiver operating characteristic curve (ROC curve) shows that the area under the ROC curve (AUC) of PCT/SDI for predicting 28-day mortality of patients was 0.851, followed by PCT+SDI (0.845), PCT (0.808), SDI (0.785), and CRP/SDI (0.731), when optimal cut-off value of PCT/SDI was 11.56, sensitivity and specificity for predicting 28-day mortality of patients were 89.5% and 66.7% respectively. Cox regression analysis showed that high PCT/SDI value (HR=1.562, 95%CI: 1.271-1.920, P=0.031) and high PCT level (HR=1.106, 95%CI: 1.021-1.198, P=0.024) were independent risk factors for death of ICU patients with bacterial pneumonia. Conclusion PCT/SDI, PCT, PCT+SDI, SDI and CRP/SDI can all be used as short-term prognostic indicators for bacterial pneumonia in ICU patients. Compared with other indicators, PCT/SDI is more valuable in predicting the short-term prognosis of patients.

Abstract:Objective To analyze the pathogenic characteristics and affecting factors for prognosis of patients with malignant hematological diseases complicated with blood stream infection (BSI). Methods Hospitalized patients with malignant hematological diseases complicated with BSI in the Department of Hematology in Affiliated Hospital of Zunyi Medical University between January 2016 and May 2022 were selected as the study subjects.Patients were divided into survival group and death group according to the treatment outcome within 30 days after BSI.Pathogenic characteristics and prognosis of patients were analyzed, risk factors for the prognosis of malignant hematological diseases complicated with BSI were analyzed by univariate and logistic regression. Results A total of 185 patients were included in study, the main underlying disease was acute leukemia (n=125, 67.6%).197 strains of pathogenic bacteria were isolated, 109 strains (55.3%) were Gram-negative bacteria, 55(27.9%) of which was Escherichia coli; 86 strains (43.7%) were Gram-positive bacteria, 24(12.2%) of which were Staphylococcus hominis; 2 strains were fungi (1.0%).28 strains (50.9%) of Escherichia coli and 2 strains (10.0%) of Klebsiella pneumoniae produced extended-spectrum β-lactamases.Isolation rates of methicillin-resistant coagulase negative staphylococcus, methicillin-resistant Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus were 70.8%, 71.4% and 36.4% respectively; univariate analysis showed that 30-day mortality was higher in patients with age ≥ 70 years, duration of agranulocytosis ≥ 7 days, irrational use of antimicrobial agents, combined with cardiac insufficiency, combined with acute renal insufficiency, septic shock and pulmonary infection, diffe-rences were all significant (all P < 0.05).Multivariate logistic regression analysis showed that duration of agranulocytosis ≥ 7 days (OR=3.306, 95%CI[1.224-8.927]), combined with cardiac insufficiency (OR=6.291, 95%CI[1.930-20.508]), combined with acute renal insufficiency (OR=8.419, 95%CI[2.198-32.241]), and septic shock (OR=22.150, 95%CI[3.639-134.806]) were all independent risk factors for 30-day mortality in patients with malignant hematological diseases complicated with BSI (all P < 0.05). Conclusion Among the most common pathogenic bacteria of malignant hematological diseases complicated with BSI, Escherichia coli is the main Gram-negative bacteria, and Staphylococcus hominis is the main Gram-positive bacteria.There are multiple risk factors affecting the prognosis of patients with malignant hematological diseases complicated with BSI.Shortening the duration of agranulocytosis, improving cardiac and renal function, and actively controlling septic shock are effective measures to reduce 30-day mortality in patients with malignant hematological diseases complicated with BSI.

Abstract:Objective To investigate the clinical characteristics and impact factors for prognosis of patents with multi-bacteria and mono-bacteria blood stream infection (BSI). Methods Medical records of patients with clinical and pathogenic diagnosis of BSI in a tertiary first-class hospital from January 2017 to December 2021 were retrospectively analyzed.According to the detected species of pathogenic bacteria, patients were divided into multi-bacteria and mono-bacteria groups, the study outcome was all-cause mortality during hospitalization.Clinical characteristics of two groups of patients and impact factors for prognosis of patients with multi-bacteria infection was compared. Results 430 patients were positive in blood culture, 367 cases (85.3%) were infected by mono-bacteria and 63 cases (14.7%) were infected by multi-bacteria.Healthcare-associated infection (HAI) rate in multi-bacteria group was higher than that in mono-bacteria group (76.2% vs 56.9%, P=0.003);lower respiratory tract infection rate in patients in multi-bacteria group was higher than that in mono-bacteria group (44.4% vs 29.2%, P=0.018).Hospitalization time of patients in multi-bacteria group was higher than that in mono-bacteria group (24[16-39]vs 19[13-26]day, P=0.002).Death rate of patients in multi-bacteria group was higher than that in mono-bacteria group (12.7% vs 3.8%), and hospitalization time was prolonged, difference was both significant (both P < 0.05).Multivariate analysis showed that independent risk factors for death in patients with BSI were multi-bacteria infection (OR=3.24, 95%CI=1.20-8.75), gastrointestinal tumor (OR=3.28, 95%CI=1.21-8.84), invasive mechanical ventilation (OR=3.40, 95%CI=1.22-9.42), deep vein catheterization (OR=2.76, 95%CI=1.00-7.64), and urinaryt ract catheterization (OR=3.28, 95%CI=1.04-10.40).Compared with the mono-bacteria group, the interval between specimen submission for detection and patients'discharge in multi-bacteria group was significantly longer (20[15-36]vs 16[10-22]days, P < 0.001).The constituent of Staphylococcus aureus, Staphylococcus haemolyticus and Escherichia coli detected in patients in multi-bacteria group and mono-bacteria group was significantly different (all P < 0.05). Conclusion The risk for death in hospitalized patients with multi-bacteria BSI is significantly increased, digestive tract tumor, invasive mechanical ventilation, deep vein catheterization, and urinary catheterization are independent risk factors for death of patients with BSI, which should be paid attention in clinic.

Abstract:Objective To investigate the relationship between premature rupture of membranes (PROM) combined with chorioamnionitis and neonatal respiratory distress syndrome (NRDS) in very preterm infants (VPIs). Methods Medical records of newborns with gestational age < 32 weeks in a neonatal intensive care unit (NICU) from June 2016 to June 2019 were retrospectively analyzed, according to whether the pregnant mother had PROM, newborns were divided into control group and PROM group, PROM group was subdivided into PROM with chorioamnionitis group (PROM infection group) and PROM without chorioamnionitis group (PROM non-infection group).Clinical data of three groups of VPIs was compared, effect of chorioamnionitis after PROM on the occurrence and development of NRDS was explored. Results A total of 284 preterm infants were included in study, 136 were in control group, incidence of NRDS was 74.3%(n=101);97 cases were in PROM non-infection group, incidence of NRDS was 68.0%(n=66);51 cases were in PROM infection group, incidence of NRDS was 82.4%(n=42);there was no significant difference in the NRDS incidence between VPIs in PROM non-infection group and control group (χ²=1.080, P=0.299);there was significant difference in NRDS incidence between VPIs in PROM infection group and PROM non-infection group (χ²=3.471, P=0.062).The severity of NRDS was compared through gastric foam test, pulmonary surfactant (PS) use times, ventilator use and chest radiography re-examination result after PS use, the results showed that disease condition of NRDS in VPIs in PROM non-infection group was milder, and the invasive ventilator use rate was lower (26.0%); after PS use, the proportion of no-NRDS in chest radiography re-examination was higher (88.0%) in VPIs in PROM non-infection group, and there was no severe NRDS; the proportion of severe NRDS in chest radiography re-examination in PROM infection group was still higher (9.5%), multiple use of PS was necessary, and the use rate of invasive ventilator was the highest (73.8%). Conclusion PROM combined with chorioamnionitis may be a risk factor for NRDS, which may affect the progression and prognosis of NRDS.

Abstract:Objective To analyze the causes of exceeding standard of colony count of enteroscope after disinfection, and further improve the reprocessing level of flexible endoscope. Methods Data of the third quarter routine environmental hygiene monitoring of digestive endoscopy center of a hospital conducted in August 2021 were analyzed, causes of secondary contamination of enteroscope after disinfection were found out and rectified. Results The monitored four gastroscopes, two specimens of purified water, two specimens of in-use disinfectants, three specimens of environmental object surfaces and two specimens of hygienic hand disinfection of health care workers were all qualified; however, a large number of bacteria were detected from four enteroscopies, bacterial colony number were 252, 315, 273, and 268 CFU/piece respectively, all specimens were detected Rhizobium radiobacter, Micrococcus luteus, and Sphingomonas paucimobilis. Possible risk factors leading to the failure of enteroscope monitoring were identified, specimens of air from air spray gun, inside of air filter and air line of filter outlet were detected further, a large number of the above microorganisms were found out.After the replacement of air compressor, air filter and air line, the number of bacteria in air from air spray gun decreased obviously.The 4 unqualified enteroscopes were cleaned, disinfected and dried again, bacterial contamination was detected, all were all qualified. Conclusion Contamination of air line of the digestive endoscope cleaning workstation is the main cause for the excessive number of bacteria in the lumen of enteroscope after disinfection.It is suggested that air line maintenance and biological monitoring should be included in the corresponding guidelines, so as to reduce healthcare-associated infection.

Abstract:Objective To explore the main risk factors for incisional infection after ankle fracture surgery. Methods Literatures in China National Knowledge Infrastructure (CNKI), Wanfang, VIP, PubMed, Embase, Web of Science, and Cochrane Library from the establishment of the database to June 2021 were searched by computer.After two reviewers independently screened the literatures, extracted the data and evaluated the quality according to the inclusion and exclusion criteria, Meta-analysis was performed with Rev Man 5.3 and STATA 12.0 software. Results 12 literatures were included for analysis, involving10 037 patients, including 560 cases of incisional infection, incidence of incisional infection was 5.58%.Meta-analysis results showed that the main risk factors for incisional infection after ankle fracture surgery included: age (MD=4.70, 95%CI: 3.05-6.34), body mass index (MD=0.82, 95%CI: 0.36-1.29), preoperative albumin < 35 g/L (OR=2.30, 95%CI: 1.26-4.22), combined with diabetes (OR=1.71, 95%CI: 1.26-2.30), combined with heart disease (OR=2.92, 95%CI: 1.74-4.91), smoking (OR=1.51, 95%CI: 1.05-2.16), drinking (OR=1.56, 95%CI: 1.19-2.05), open fracture (OR=5.59, 95%CI: 4.05-7.73), combined with fracture dislocation (OR=1.72, 95%CI: 1.35-2.18), duration of surgery (MD=24.56, 95%CI: 17.59-31.53), American Society of Anesthesiologists (ASA) grade ≥3(OR=2.05, 95%CI: 1.51-2.78), and grade Ⅱ-Ⅳ contaminated incision (OR=4.66, 95%CI: 2.93-7.43). Conclusion There are multiple risk factors for incisional infection after ankle fracture surgery, health care workers should pay attention to the main risk factors for incisional infection after ankle fracture surgery and take targeted measures to reduce incisional infection rate.

Abstract:Objective To investigate an outbreak of suspected carbapenem-resistant Acinetobacter baumannii(CRAB) infection in the emergency intensive care unit (EICU) of a hospital, and evaluate the effect of intervention measures. Methods Epidemiological investigation was carried out on 6 CRAB patients with detection of CRAB and were warned by healthcare-associated infection (HAI) monitoring software in EICU of a hospital from February 9 to 14, 2022, environmental specimens that may be contaminated were performed microbial sampling, culture, identification and antimicrobial susceptibility testing, and comprehensive control measures were taken, detection of CRAB in patients and environment after intervention was continuously monitored. Results Among 6 patients with CRAB, 4 had HAI and 2 had colonization.Cases 1, 3, 4 and 5 originated from CRAB, except intermediately resistant to tegacyclin and levofloxacin, they were all resistant other antimicrobial agents and had the same resistance spectrum.Environmental hygiene monitoring showed that the detection rate of CRAB was 20.00%(40/200) in the outbreak, CRAB was detected from bed units, equipment and instruments, health care workers and cleaners, antimicrobial susceptibility results were consistent with the strains from patients.By improving the implementation rate of contact isolation, strictly implementing hand hygiene, taking targeted intervention measures such as joint prevention and control training on infection and supervision of multiple departments in the hospital, CRAB target monitoring was carried out in this department for three months, results showed that CRAB infection rate from March to May were 25.00%(12/48), 18.75%(9/48) and 12.50%(6/48) respectively, showing a downward trend (χ_trend²=56.00, P < 0.05);continuous environmental hygiene sampling didn't isolate CRAB, and this event was effectively controlled. Conclusion Inadequate implementation of contact isolation, nonstandard use of antimicrobial agents, inadequate implementation of hand hygiene and incomplete environmental cleaning may be the main causes for the outbreak of CRAB, timely identification, investigation and targeted prevention and control strategies are the key mea-sures to effectively control the infection of multidrug-resistant organism.

Abstract:Objective To evaluate the effect of fluorescent labeling method on improving the contamination of personal protective equipment (PPE) of health care workers (HCWs) during removing of PPE. Methods 69 HCWs were recruited from 8 tertiary hospitals in Chengdu City for training on PPE wearing and taking off, and the effects of PPE removing were assessed by ultraviolet fluorescent labeling method before training, on the day after training, half a month after training and one month after training, the number and sites of residual fluorescent contamination on inner clothing and skin surface after removing PPE were recorded, changes in contamination points and contamination rate were compared. Results Compared with before training, the number of residual fluorescent contamination points of all HCWs after removing PPE on the day after training, half a month after training and one month after training decreased (Z values were 5.306, 5.813 and 6.641 respectively, all P < 0.001).Contamination rates of female, nurse, HCWs with primary-and medium-grade professional title after training decreased significantly compared with before training (all P < 0.05).The number of HCWs'fluorescent contamination points obtained in three assessments gradually decreased over time (all P < 0.05).Work shoes are most likely to be contaminated du-ring PPE removing. Conclusion HCWs are easy to be contaminated in the process of removing PPE, contamination rate can be reduced and contamination situation can be improved after practical training, fluorescent labeling can be used to observe contamination situation in the process of PPE removing.

Abstract:Short-chain fatty acids are metabolites produced by dietary fiber in foods fermented by intestinal flora, mainly organic fatty acids and their salt compounds containing 1-6 carbon atoms. Intestinal flora imbalance is associated with diarrhea. Changes in intestinal flora composition caused changes in intestinal short-chain fatty acid content. More and more studies have shown that short-chain fatty acids play an important role in the occurrence and treatment process of diarrhea. This paper introduces the origin and composition of short-chain fatty acids, and reviews the effect of short-chain fatty acids on diarrhea based on intestinal energy metabolism, intestinal mucosal barrier function, intestinal immune function as well as intestinal electrolyte and water absorption, so as to provide references for the diagnosis and treatment of diarrhea.

Abstract:The invasiveness of endoscopic diagnosis and treatment manipulation as well the openness of cleaning and disinfection manipulation have made endoscopy center a key area for aerosol generation, long term exposure to aerosol by health care workers (HCWs) can cause great harm to health. This paper summarizes the sources, HCWs' exposure risk as well as prevention and control strategies of aerosol in endoscopy center through reviewing domestic and foreign literatures, provides reference for HCWs in endoscopy center to prevents occupational exposure and protect health.