Abstract:Pressure ulcer complicated infection is an important component of healthcare-associated infection. This paper summarizes the classification, risk assessment, clinical manifestations, as well as diagnosis and treatment of pressure ulcer through reviewing literatures and the latest guidelines, providing a basis for the prevention and treatment of pressure ulcer in clinical practice.

Abstract:Objective To understand the occurrence of healthcare-associated infection (HAI) in intensive care unit (ICU) through conducting targeted monitoring, and provide scientific basis for reducing the occurrence of HAI. Methods Patients in the ICU in a hospital from May 2010 to December 2022 were selected as research objects. Targeted monitoring was carried out. Incidence of HAI, incidence of device-associated infection, distribution of pathogens, sites of HAI, and compliance rate of hand hygiene were statistically analyzed. Results A total of 8 998 patients were admitted to the ICU, with a HAI rate of 10.35% and a HAI case rate of 14.66%. The adjusted HAI case rate was 3.72%. Difference in HAI rates among different years was statistically significant (P < 0.001). Utilization rates of ventilators, urinary catheters, and central venous catheters were 57.56%, 95.92%, and 79.14%, respectively. Incidences of ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI) were 10.62‰, 3.08‰, and 0.65‰, respectively. Utilization rate of ventilators increased from 37.12% in 2010 to 72.35% in 2022, and the incidence of VAP dropped from 23.36‰ to 5.61‰. Incidences of CAUTI and CLABSI tended to be relatively stable. A total of 1 673 pathogenic bacteria strains were detected, and the top 5 pathogens were Acinetobacter baumannii (34.79%), Klebsiella pneumoniae (18.35%), Pseudomonas aeruginosa (10.58%), Stenotrophomonas maltophilia (2.81%) and Escherichia coli (2.75%). The top 3 detected multidrug-resistant organisms (MDROs) were carbapenem-resistant Acinetobac-ter baumannii (CRAB, 83.88%), methicillin-resistant Staphylococcus aureus (MRSA, 56.37%) and carbapenem-resistant Klebsiella pneumoniae (CRKP, 50.29%). MDROs with the top 3 highest HAI rates were CRAB (6.39%), CRKP (2.56%) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) (1.09%). The main site of HAI was respiratory system (55.80%), followed by urinary system (16.53%), blood system (16.38%), and digestive system (6.75%). Hand hygiene compliance rate of ICU health care workers increased from 62.25% in May-December 2010 to 87.86% in 2022. The consumption of alcohol-based hand rub and hand sanitizers increased from 65.66 mL/day/bed in 2013 to 95.49 mL/day/bed in 2022. Conclusion The targeted monitoring results of HAI in ICU in the past 13 years help health care workers understand the trend of HAI, provide powerful data support for formulating effective prevention and control measures, and reduce the occurrence of HAI.

Abstract:Objective To evaluate the characteristics and related influencing factors of blood-borne occupational exposure among pediatric health care workers (HCWs), so as to provide effective references for their occupational safety protection. Methods 643 cases of blood-borne occupational exposure among pediatric HCWs in a tertiary first-class children's hospital from 2013 to 2022 were analyzed retrospectively, including basic information of occupational exposure, exposure sites, exposure occasions, exposure causes, post-exposure emergency treatments and follow-up. Results Nurses were the main occupational exposure group of pediatric HCWs (86.00%), with a relatively high proportion of occupational exposure among those aged ≤25 years (64.39%) and those with less than 5 years of service experience (77.76%). The department with the highest incidence of occupational exposure was the emergency department (27.53%), and the peak of occupational exposure throughout the year was from June to August. Through the implementation of the plan-do-check-act (PDCA) cycle projects to improve the implementation of protective measures for blood-borne occupational exposure, the overall incidence of blood-borne occupational exposure in this hospital from 2013 to 2022 showed a decreasing trend year by year (χ²=195.79, P < 0.001). The major type of exposure was sharp instrument injuries (89.89%). Hands were the most exposed sites (91.44%). The top three exposure occasions/operations were sorting/cleaning items/instruments (38.41%), blood collection (16.95%) and needle extraction (14.15%). The main sources of occupational exposure in children's hospital were non-blood-borne pathogens (71.38%), with a certain proportion of accidental injuries by others during operations (18.66%). Conclusion The influencing factors of occupational exposure for pediatric HCWs are complex. Causes should be analyzed based on their exposure characteristics. Attention should be paid to key populations, key sites and key seasons, and targeted prevention and control measures should be taken to prevent the occurrence of blood-borne occupational exposure.

Abstract:Objective To investigate the current situation of the construction of healthcare-associated infection(HAI) management system at all levels of maternal and child health care (MCH) institutions in China, and provide reference for national policy-making on strengthening HAI management in MCH institutions. Methods A stratified sampling was conducted in MCH institutions at provincial, municipal, and district/county levels in 8 provinces/ci-ties/autonomous regions, and online surveys were carried out via a unified survey questionnaire designed through "questionnaire star". Results The data of 123 MCH institutions were included for analysis. Among all the HCM institutions, 97.56% have set up HAI management committees; 98.33% convened special meeting sessions on HAI management at least twice a year; 87.81% have set up independent HAI management departments; 92.68% were directly led by the directors or deputy directors of the institutions; 90.24% have set up clinical HAI management teams. 52.03% of the institutions met the quantity requirements of full-time infection prevention and control (IPC) personnel, only 11.38% met both major and quantity requirements. More than 90% of institutions had established 9 (out of the 12) HAI management systems included in this survey. Conclusion All levels of national MCH institutions have generally established relatively complete organizational structures and HAI management systems, but the construction of a dedicated team of HAI personnel needs to be strengthened.

Abstract:Objective To investigate the current status, clinical antimicrobial use, and antimicrobial resistance of hospitalized patients due to lower respiratory tract (LRT) infection with Pseudomonas aeruginosa (PA), so as to provide reference for clinical treatment. Methods Medical records of hospitalized patients with LRT PA infection from January 2021 to November 2022 in a hospital were collected retrospectively. Basic characteristics, infection status, treatment department, infection site, clinical medication, and antimicrobial susceptibility test results of patients were analyzed statistically. Results A total of 91 patients were selected, out of which 64 patients (70.33%) were ≥80 years old and 72 (79.12%) cases had healthcare-associated infection. Besides PA, the most commonly detected strains were Klebsiella pneumoniae (17.98%), followed by Acinetobacter baumannii (16.23%) and Streptococcus viridans (14.47%). Cefoperazone/sulbactam, piperacillin/tazobactam and meropenem were the most frequently used antimicrobial agents treating LRT PA infection, accounting for 67.03%, 58.24%, and 58.24%, respectively. After using imipenem and meropenem, resistance rates of PA to both antimicrobials increased from 32.69% and 40.38% to 69.23% and 63.46%, respectively. Conclusion Continuous use of antimicrobial agents is associated with the rapid development of resistance in PA. It is particularly important to adjust treatment plans timely based on patient clinical indications and antimicrobial susceptibility test results.

Abstract:Objective To establish a quantitative index system for risk assessment of postoperative pneumonia in surgical wards, and construct a risk assessment model of postoperative pneumonia based on quantitative index system. Methods The quantitative assessment index system for the severity of postoperative pneumonia was initia-lly developed through literature research. Fifteen domestic experts in the fields of healthcare-associated infection, clinics and nursing were selected and invited for consultation by the Delphi method. Indexes were screened with threshold method. Weight of indexes was determined through analytic hierarchy process. A risk assessment model for postoperative pneumonia was constructed based on risk matrix. Results The positive coefficients of experts in two rounds of consultation were 93.33% and 100%, the authority coefficients were 0.842 and 0.891, and the coordination coefficients were 0.370 and 0.425. The index system for the severity of the consequences of postoperative pneumonia included prolongation of mechanical ventilation, prognosis of postoperative pneumonia, prolonged hospital stay, increased medical expenses, ventilator dependence, mortality of postoperative pneumonia, and increased ICU visits due to postoperative pneumonia. The risk matrix was constructed using the index system of postoperative pneumonia incidence and severity of consequences. Conclusion The risk assessment model of postoperative pneumonia constructed based on the analytic hierarchy process and risk matrix provides an objective basis for the quantitative evaluation of the risk in healthcare-associated infection.

Abstract:Objective To analyze the colonization and influencing factors of oral microbiota in preterm infants at different time points of mechanical ventilation, and provide a basis for the development of targeted intervention measures. Methods Clinical data of 97 premature infants from the neonatal intensive care unit (NICU) in a tertiary first-class maternal and child health care hospital from July 2021 to December 2022 were selected. Oral microbiota of premature infants 0, 12, 24, 48 and 72 hours after mechanical ventilation were detected. Correlation and the influencing factors between oral microbiota colonization and duration of mechanical ventilation were analyzed. Results A total of 485 specimens from premature infants were collected for oral microbiota detection, out of which 127 specimens (26.19%) were positive. Detection rates of oral microbiota at different time points were positively correlated with duration of mechanical ventilation (r=0.292, P < 0.01). Pairwise comparison showed statistically significant differences in the detection rates of oral microbiota between 0 hour and 24, 48, 72 hours, as well as those between 12 hours and 48, 72 hours, respectively (all P < 0.05). Among 97 premature infants, 65 cases had oral microbiota colo- nization, with a colonization rate of 67.01%; 146 strains were detected, including 94 Gram-positive bacterial strains (64.38%) and 52 Gram-negative bacterial strains (35.62%). The top 5 pathogenic bacteria were Streptococcus oralis, Escherichia coli, Staphylococcus epidermidis, Klebsiella pneumoniae, and Staphylococcus hemolyticus. Univariate analysis showed that gestational age at birth, birth weight, lactation within 72 hours, and the use of antimicrobial agents were associated with oral microbiota colonization. Logistic regression analysis showed that birth weight ≥1 500 g (OR=0.102, 95%CI: 0.017-0.634) and lactation within 72 hours (OR=0.290, 95%CI: 0.107-0.783) were independent protective factors for oral microbiota colonization (both P < 0.05). Conclusion Oral microbiota of premature infants underwent mechanical ventilation should be detected as soon as possible within 24 hours after treatment, and targeted intervention measures should be carried out based on changes in microbiota. Breastfeeding or oral care with breast milk should be given as soon as possible. If breast milk is inaccessible, donated human milk or premature infant formula milk should be adopted within 72 hours.

Abstract:Objective To understand nurses' cognition and behaviour on the management of ventilator circuit in intensive care units (ICUs) of hospitals at all levels in Jiangsu Province, and provide reference for standardizing health care workers' management on ventilator circuit. Methods Self-designed survey questionnaires and conve-nient sampling were adopted to investigate ICU nurses. Results 575 questionnaires were finally collected, with an effective response rate of 93.57%. 538 ICU nurses from 63 hospitals in 13 cities participated in the survey. Four types of ventilator circuits used in hospitals were investigated, including disposable double heating ventilator circuit (49 hospitals, 77.78%), disposable anaesthesia ventilator circuit (46 hospitals, 73.02%), disposable single hea-ting ventilator circuit (34 hospitals, 53.97%), and repeated disinfectant reusable silica gel circuit (22 hospitals, 34.92%). A total of 12 brands of ventilator circuits used in hospitals were investigated, with Fisher & Paykel being the most popular (28 hospitals, 44.44%), followed by Comen (18 hospitals, 28.57%). Besides replacing ven-tilator circuit when there was visible contamination or circuit dysfunction, 44.61% (240/538) ICU nurses would judge whether ventilator circuits need to be replaced based on their clinical experience. ICU nurses believed that intermittent turning off machine (79.93%), multidrug-resistant organism infection (84.20%), and inhalation therapy (83.83%) could/might impact the duration of ventilator circuit use. 21.00% (n=113) ICU nurses were aware of the incidence of ventilator-associated pneumonia (VAP) in their departments in 2021. Conclusion Multiple types and brands of ventilator circuits are used clinically. There is no unified replacement frequency for ventilator circuit. Currently, common replacement frequency is every 7 days. It is recommended to replace ventilator circuit according to the nursing care process and the standards of hospital or department.

Abstract:Objective To explore the application effect of group closed-loop nursing + AB role management mode on the emergency intensive care unit. Methods 65 nursing staff from a temporary intensive care unit of a hospital from December 26, 2022 to January 30, 2023 were selected as the research subjects. Group closed-loop nursing + AB role management mode was applied to the newly established emergency intensive care unit, nurses' satisfaction was surveyed with cluster sampling method, and intervention effect was valuated. Results Under this management mode, the overall satisfaction of nurses was 92.60%, the satisfaction rates of both group closed-loop nursing mode and AB role management mode were 96.30%. The incidence of catheter-associated urinary tract infection (CAUTI) in patients was 3.10‰, incidences of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were both 0. Conclusion The application of group closed-loop nursing + AB role ma-nagement mode in emergency intensive care unit optimizes the nursing management process, stimulates team's cohesion, motivates nurses, prevents the occurrence of healthcare-associated infection, thus improves the treatment and safety of patients with acute and critical diseases.

Abstract:Objective To evaluate the effectiveness of hand hygiene (HH) compliance management system in the control of healthcare-associated infection (HAI). Methods From July 2020 to June 2021, staff in the respiratory intensive care unit of a tertiary first-class hospital were selected as research objects. Changes in staff's HH compliance rate and HAI management indicators before and after the application of HH compliance management system were observed and analyzed. Results After applying HH compliance management system, overall HH compliance rate and HH compliance rates of staff at different job positions (including doctors, nurses, and cleaners) improved significantly (P < 0.05). Incidence of HAI and HAI with multidrug-resistant organisms (MDROs) in the trial group were significantly lower than those in the control group (P < 0.05). Conclusion The application of HH compliance management system can effectively increase staff's HH compliance rate and reduce the occu-rrence of HAI.

Abstract:Objective To isolate and identify Candida auris (C. auris) colonized in the environment of intensive care unit (ICU) and patients' body surface, and analyze the antimicrobial susceptibility. Methods Ninety-six environmental specimens from ICU and 14 specimens from body surfaces of ICU patients with C. auris infection were taken and cultured. Culture products were identified by mass spectrometry and Vitek 2 Compact automated microbial identification system. Species were confirmed by whole genome sequencing (WGS) technology. Antimicrobial susceptibility was determined through minimum inhibitory concentration (MIC). Results 16 strains of C. auris were identified by mass spectrometry, 8 of which were environmental strains and 8 were colonized on the patients' body surface. Vitek 2 Compact system only identified 5 strains. Sixteen environmental/colonized isolates were confirmed to be C. auris through sequencing, exhibiting high genomic similarity with the South Asian branch (Ⅰ) of C. auris. Antimicrobial susceptibility testing results of the 16 C. auris strains were consistent, all of which were resistant to amphotericin and fluconazole, susceptible to 5-fluorocytosine and voriconazole, and susceptible to or intermediated to itraconazole. Conclusion Patients infected with C. auris can cause environmental contamination and colonization on body surface of other patients. Establishing effective monitoring methods for environmental/colonized C. auris can promote infection control.

Abstract:Objective To explore the effectiveness of antimicrobial stewardship (AMS) in reducing antimicrobial use density (AUD) in children. Methods An AMS team was established to analyze the causes for high AUD in a tertiary first-class children's hospital. With the target of an AUD ≤20 defined daily doses (DDDs) in this hospital, comprehensive improvement strategy was proposed based on the current situation. Relevant indicators of antimicrobial agents in this hospital before and after AMS improvement were compared, and the effectiveness was analyzed. Results AUD in this hospital gradually decreased from 24.83 DDDs in 2021 to 19.06 DDDs in 2022, with 21 out of 23 departments decreased. Microbial examination rate before therapeutic antimicrobial use increased from 82.01% to 89.09%, and antimicrobial use rate decreased from 45.74% to 43.63%. Antimicrobial prophylactic use rate in class Ⅰ incision decreased from 27.21% to 24.18%, the incidence of healthcare-associated infection decreased from 3.18% to 2.66%, and the detection rate of multidrug-resistant organisms decreased from 12.45% to 10.99%, while the incidence of class Ⅰ incision infection remained unchanged. Conclusion Antimicrobial management system centered on AMS is effective in promoting the rational application of antimicrobial agents in pediatric specialty hospitals.

Abstract:Objective To study the effect of QCC (quality control circle)-based continuous quality improvement scheme on improving the sterilization quality of hydrogen peroxide plasma sterilizers. Methods Sterilization quality of hydrogen peroxide plasma sterilizers in a hospital from August 2019 to July 2022 was analyzed. Pre-implementation period of QCC was from August to December 2019. The implementation of QCC-based continuous quality improvement scheme was initiated since January 2020, and the post-implementation period of QCC was from January 2020 to July 2022. The incidence of sterilization failure and sterilization quality of hydrogen peroxide plasma sterilizers in different time periods were compared respectively. Results Hydrogen peroxide plasma sterilizers were used 514, 1 245, 2 174, and 1 289 times in the periods from August to December 2019, 2020, 2021, and from January to July 2022, respectively. Sterilization failure rate of hydrogen peroxide plasma sterilizers was 7.78% in the period from August to December 2019, 2.57% in 2020 after implementing QCC activities, 1.47% in 2021, and 0.85% in the period from January to July 2022. There were significant differences in sterilization failure rates of hydrogen pe-roxide plasma sterilizers in different years (χ²=121.656, P < 0.001). The qualification rates of cleaning, disinfection and sterilization, and packaging of hydrogen peroxide plasma sterilizers in different time periods showed statistically significant differences (χ²=33.740, 66.558, 84.675, respectively, all P < 0.001). The qualification rate after implementing QCC activities was higher than before, and there was increasing trend year by year. Conclusion QCC-based continuous quality improvement scheme can effectively reduce the sterilization failure rate of hydrogen peroxide plasma sterilizers, and improve sterilization quality.

Abstract:Objective To analyze the changing trend of the incidence of healthcare-associated infection (HAI) before and after the response of medical institutions to major public health emergencies, and provide a basis for the construction of emergency response system of infection prevention and control (IPC) in medical institutions under major public health emergencies. Methods HAI incidence density rate in a tertiary first-class specialty hospital from January 2018 to June 2021 were analyzed. Enhanced IPC measures in response to public health emergencies on the incidence of HAI were quantitatively evaluated with piecewise regression of interrupted time-series (ITS) analysis. Results From 2018 to 2019, the baseline HAI incidence density rate of this hospital before the intervention with enhanced IPC measures was 1.44 ‰(95%CI: 1.35‰-1.53‰). From January 2020 to June 2021, HAI incidence density rate after the intervention was 0.94‰ (95%CI: 0.88‰-1.02‰). In December 2019, HAI incidence density rate immediately dropped after the launch of the enhanced IPC measures, with significant short-term effect(aIRR=57.60%, 95%CI: 46.84%-70.66%, P < 0.001). HAI incidence density rate gradually increased thereafter, with a long-term slope of 100.08% (aIRR=100.08%, 95%CI: 100.04%-100.12%, P < 0.001). Stan-dardized infection ratio (SIR) of the actual number of emerging HAI per month after intervention to the number from model prediction without intervention showed that except January 2020 (SIR: 0.62, 95%CI: 0.41-0.91, P=0.013), February 2020 (SIR: 0.51, 95%CI: 0.31-0.78, P < 0.001), March 2020 (SIR: 0.37, 95%CI: 0.21-0.61, P < 0.001), and July 2020 (SIR: 0.48, 95%CI: 0.29-0.75, P < 0.001), HAI incidence density rate in other months after intervention were not significantly different from that before intervention. Conclusion The enhanced IPC measures in response to major public health emergencies can significantly reduce HAI incidence density rate of each month in a short period, but the effect gradually disappears over time and returns to the pre-intervention level. The specific causes for the V-shaped effect of intervention need to be further analyzed.

Abstract:Objective To explore the effect of one-to-one practical training and multi-dimensional assessment for cleaning staff on the disinfection efficacy of bed units.Methods Two rounds of one-to-one practical training were conducted on 10 cleaning staff from 5 wards with prospective research method. Multiple indicators were adopted to assess the process and efficacy of disinfection on bed units in three rounds (before training, after the first training, and after the second training).Results Compared with before practical training, natural bacteria killing rate increased from 51.95% to 91.85% (P < 0.05) after one-to-one practical training. The percentage of decreased ATP detection value increased from 45.00% to 82.50% (P < 0.05). The fluorescence labeling clearance rate increased from 55.00% to 85.00% (P < 0.05). The implementation rate of disinfection specification increased from 62.00% to 92.00% (P < 0.05).Conclusion Carrying out one-to-one practical training and assessment for cleaning staff can significantly improve the disinfection efficacy of bed units and reduce the risk of healthcare-associated infection. The ward cleaning staff should conduct at least one-to-one practical training once to ensure the disinfection efficacy before taking office.

Abstract:Tropheryma whipplei (TW) is Gram-positive bacillus, a kind of opportunistic pathogen, which can cause Whipple's disease. Caused by TW infection, TW pneumonia is relatively rare and lacks specific clinical symptoms. It is difficult to be detected through traditional pathogen culture methods and is prone to be misdiagnosed in clinical practice. This paper reports a case of acquired immunodeficiency syndrome (AIDS) patient with severe pneumonia caused by TW and Pneumocystis jiroveci, confirmed by metagenomic next-generation sequencing (mNGS) and successfully treated. Based on mNGS results, antimicrobial and anti-inflammatory treatments were continuously adjusted, till the patient improved and were ultimately discharged.

Abstract:A 68-year-old male patient developed multiple painless soybean-sized erythema and papules on the back of the right wrist, and spread to the upper arm without obvious inducement for more than 1 year. Pyoderma gangrenosum was diagnosed at another hospital and immunosuppressive treatment was applied. Erythema and pain in the right upper extremity aggravated with ulceration 3 months ago. Histopathological detection of the lesion in a hospital suggested consistence with chronic granulomatous inflammation, and metagenomic next-generation sequencing (mNGS) of the lesion tissue indicated Mycobacterium marinum. Therefore, the patient was diagnosed as Mycobacterium marinum infection. This article reports the case with Mycobacterium marinum infection, aiming to improve the clinical understanding on Mycobacterium marinum infection, achieve early diagnosis and treatment, and improve patient prognosis.

Abstract:Hydrogen peroxide gas sterilization is a widely used low temperature sterilization technique, yet still with limitations in material compatibility and penetration, resulting in a high failure rate of biological monitoring. Through review of literatures, this paper comprehensively and deeply explores the causes and mechanisms of failures in biological monitoring by hydrogen peroxide gas sterilization (including true positive, false positive, and false fluorescence negative reaction), helps professionals analyze and judge the causes of failures in biological monitoring, and provides ideas and references for reducing failure rate.

Abstract:Trimethylamine-N-oxide (TMAO) is produced through the conversion of the dietary compound choline, carnitine and betaine by intestinal microbiota. With the improvement of people's living standard, high-fat diet has increased the production of TMAO. Acting as a bridge, intestinal microbiota participates in metabolism, through which TMAO is produced and exerts harmful effect on human body. This review mainly focuses on the role of intestinal microbiota in the production of TMAO, the impact of TMAO on intestinal microbiota, as well as the effect of intestinal microbiota on the role of kidney and intestine in the "renal-intestinal axis" through TMAO. It explores the relationship between TMAO and kidney/intestine and diarrhea from the perspective of the "renal-intestinal axis", and is of great significance to reveal the impact of TMAO on the occurrence and development of related diseases through inflammatory mechanisms and oxidative stress processes.

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