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ObjectiveTo analyze the types and risk factors of communityacquired infections (CAI) in diabetic patients by system analysis method of evidencebased medicine. MethodsChina National  Knowledge Infrastructure (CNKI),  Wanfang database, VIP database were searched by computer,  domestic published researches on CAI and related risk factors in diabetic patients were aggregated, Metaanalysis was conducted by stata 11．0 software.ResultsA total of 12 literatures were included in the study . The average rate of CAI in diabetic patients was 39.55% (22.12%-55.86%). The major infections  were  respiratory system infection（40.74%）, urinary tract infection（27.35%）, tuberculosis（10.80%）, skin and soft tissue infection（9.19%）, and hepatobiliary system infection （5.57%）. Stratified analysis on risk factors revealed that OR and OR95％CI  of chronic complication, age, disease course, glycemic control, gender, type of diabetes, subtype of ketoacidosis was 1.63（ 1.45，1.82）,1.30（1.19，1.42）,1.47（ 1.35，1.61）, 0.68（0.61，0.76）,0.69（0.64，0.75）,1.37（1.13，1.66 ） and 0.87（0.62，1.23）,respectively. There was no publication bias and combined results were stable. ConclusionThe main CAI in diabetic patients are respiratory system infection, urinary tract infection, tuberculosis, skin and soft tissue infection, and so on ;several factors, such as female, older age, longterm  disease course,  poor glycemic control， and complication, can contribute to the increase of CAI in diabetic patients.

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ObjectiveTo study the risk factors for surgical site infections (SSIs) in patients with hepatobiliary and pancreatic surgery. MethodsSixty  patients who received hepatobiliary and pancreatic surgery and suffered SSIs from January 2006 to January 2010 were selected as infections group, 119 patients who also received hepatobiliary and pancreatic surgery but didn’t develop infection were as control group,  retrospective investigation was performed. ResultsUnivariate analysis revealed the associated factors for postoperative SSIs were  age, history of cardiocerebrovascular disease, history of abdominal surgery, history of smoking, preoperative anemia, abnormal preoperative coagulation  and  blood sugar, preoperative infection, use of laparoscope, incision type, duration of operation, ASA score, postoperative  drainage and dressing chang within 24 hours of postoperation(all P<0.05). Multivariate analysis revealed that abdominal surgery history (OR95%CI：3.09［1.21-7.91］), high NISS score (OR95%CI：6.18［2.41-15.85］) were risk factors of SSIs in patients with hepatobiliary and pancreatic surgery, and dressing chang within 48 hours of postsurgery were protective factor (OR95%CI:3.81［1.56-9.34］).ConclusionHistory of abdominal surgery and high score of NISS are major risk factors for SSIs in patients with hepatobiliary and pancreatic surgery. To reduce the risk of SSIs, blood glucose should be actively adjusted， anemia and coagulation abnormalities should be treated; duration of operation should be shortened as far as possible,  wound should be kept clean and dressing should be changed timely after surgery.

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ObjectiveTo realize the detection of pathogens and antimicrobial resistance of pathogens isolated from wound secretion in patients with open fractures, so as to guide clinical treatment.  Methods1 472 patients with open fractures from May 2012 to July 2013 were selected from a hospital, pathogens from wound secretions before and after debridement were identified and performed antimicrobial susceptibility testing. ResultsBefore debridement, 1 246 of 1 472 patients (84.65%) were isolated 2 246 bacterial strains, 824 (55.98%) of patients were isolated at least 2 kinds of bacteria. Eight  hours after  debridement, 201 pathogenic bacteria were isolated from 195 patients  (13.25%).  The more serious of  Gustilo type, the higher the positive rate of bacterial culture. Positive rate of wound culture were all ＞50% in patients of  all Gustilo types before debridement；positive rate were all ＜5% in patients of  type I,  Ⅱ and  ⅢA, but type ⅢB and  ⅢC were still high after debridement. Staphylococcus aureus and Staphylococcus epidermidis were sensitive to vancomycin， the resistant rates to furantoin were <5%, the resistant rates to penicillin G and erythromycin were all >75%. Acinetobacter baumannii had higher resistance to multiple antimicrobial agents, to cefoperazone / sulbactam was 20%; Pseudomonas aeruginosa to imipenem was 10.80%, sensitivity to cefoperazone / sulbactam,cefepime and ceftazidime  were all higher. ConclusionFor patients with open fractures, timely debridement can reduce wound pathogen, antimicrobial susceptibility testing result is helpful for guiding rational antimicrobial use.

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ObjectiveTo investigate the causes of an outbreak of Serratia marcescens (S. marcescens) catheterrelated bloodstream infection(CRBSI) in a breast surgery department，and provide  basis for the prevention and control of healthcareassociated infection(HAI). MethodsEpidemiological investigation was performed by analyzing clinical data and sampling. ResultsNine cases of CRBSI occurred in a breast surgery department  on January 2—8,2014. Four  patients isolated S. marcescens from their catheter tips and blood culture specimens, and 5 patients only isolated S. marcescens from their catheter tips.The resistant spectrum of S. marcescens were basically the same, but cefoxitin susceptibility results were different, 7 strains were  intermediate, 1 resistant, and 1 sensitive, antimicrobial susceptibility testing results of S. marcescens from catheter tips and blood culture specimens of the identical patients were the same. S. marcescens were detected from the hands of medical staff(n=1)，door handle of the therapeutic room (n=1), and surface of the treatment trolley (n=1), the resistant spectrum were consistent with that of bacteria from blood culture. All infected patients were effectively controlled after catheter removal and antimicrobial use. Wards were not detected S. marcescens and no new infection occurred again after strict disinfection. ConclusionThe main causes of the outbreak are contamination of environment of breast surgery department，nonstandardized hand hygiene，long time catheterization. Medical staff should strengthen hand hygiene compliance，pay attention to disinfection of environment and surface，effectively prevent and control HAI.

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ObjectiveTo investigate the antimicrobial susceptibility and the carrying of virulence genes of Shigella sonnei (S. sonnei) in Changsha area. MethodsSusceptibilities of  30 S. sonnei strains to 6 kinds of antimicrobial agents (ampicillin, cefotaxime, nalidixic acid, ciprofloxacin, gentamicin, compound sulfamethoxazole) were detected by disc diffusion method; 4 virulence genes (set1, sen, ial,ipaH) were amplified by polymerase chain reaction (PCR). ResultsOf all  detected antimicrobial agents, ampicillin, nalidixic acid and compound sulfamethoxazole had the highest resistance rate(100%); while ciprofloxacin and gentamicin had higher susceptibility  rate (93.33% and 83.33％ respectively). PCR revealed that the carrying rate of  set1, sen, ial and ipaH in 30 S. sonnei strains was 0,13.33%, 13.33% and 53.33% respectively. ConclusionResistance of S. sonnei to the thirdgeneration cefalosporins and  sulfonamides are quite serious,  thirdgeneration quinolones can still be used as the first choice of drug treatment for S. sonnei infection. Carrying rate of virulence genes are low among S. sonnei in Changsha area.

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ObjectiveTo evaluate antimicrobial resistance and antimicrobial resistance mechanisms of Enterococcus faecalis (E. faecalis)  to linezolid(LNZ)，and provide basis for clinical rational drug use.  MethodsTwelve E. faecalis strains isolated from sputum of patients who received LNZ therapy in a hospital between January  2012 and January  2013 were collected. The minimum inhibitory concentrations (MICs) of antimicrobial agents were determined by agar dilution method， 23S rRNA V region gene of E.faecalis was amplified by polymerase chain reaction, the amplified products were sequenced. ResultsOf 12 isolates, 2 were intermediate strains and 10 sensitive strains. The G2576U mutation was detected in 2 intermediate strains， 1 of which was also detected  G2424U mutation; the variations were not detected in 10 sensitive strains. C2424U and G2576U mutation existed in R1 and R4 region respectively. Conclusion23S rRNA V region gene mutations are found in the intermediate strains of E. faecalis. Change in MIC values of linezolid should be paid close attention in clinical use.

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ObjectiveTo investigate the influence of different handling factors in the hand hygiene compliance rate of health care workers’(HCWs). MethodsEight clinical departments in JulyDecember 2012 were selected for study, the baseline data of hand hygiene in July were investigated. In AugustOctober, 6 departments were provided free hand disinfectant, only 2 departments took comprehensive intervention measures; in NovemberDecember, all selected  hospitals took intervention measures, but without being provided free hand disinfectant. Hand hygiene compliance rates among HCWs were compared. ResultsThe overall hand compliance rate of HCWs in JulyDecember 2012 was 59.50%，hand compliance rate of  different months were significantly different (P<0.01), compliance rate was lowest in July（36.73%），after providing free hand disinfectant plus performing comprehensive intervention, hand compliance rates of different months increased obviously （57.20%-72.08%）;When disinfectant was not provided free, compliance rate in each month still maintained a high level（65.20%-65.50%）; compliance rates in AugustOctober were all  higher than July （［45.41%-73.63%］vs ［18.97%-47.17%］）(all P≤0.05）;except north section of intensive care unit （ICU）, compliance rates in NovemberDecember （61.67%-72.73%）were both higher than July (both P<0.05).Healthcareassociated infection rate decreased from 3.39% in July to 1.75% in NovemberDecember （χ2=5.122，P=0.024）.ConclusionProviding free hand disinfectant can promote  HCWs’ hand hygiene compliance, repeated stressing hand hygiene awareness is the key measure to improve hand hygiene compliance.

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ObjectiveTo investigate hand hygiene compliance of health care workers(HCWs)  in a tertiary hospital, and to explore effective methods to improve hand hygiene compliance.MethodsBy direct observation method, hand hygiene compliance and practice among HCWs in 23 clinical departments were surveyed in SeptemberDecember 2012, and hand hygiene compliance monitor forms were filled in. ResultsA total of 721 opportunities of hand hygiene were recorded, overall compliance rate of hand hygiene was 58.53%, 32.18% used instant hand antiseptic, 26.35% selected running water, and 19.42% wore gloves without taking hand hygiene measures. For different occupations, hand hygiene compliance among nurses was the highest (68.65%), and cleaners was the lowest (39.25%). Of the five moments for hand hygiene, hand hygiene compliance after body fluid exposure was the highest (73.75%), followed by the moment after touching a patient (65.00%), while the moment after touching patients’ surroundings was the lowest (47.85%). ConclusionHand hygiene compliance of HCWs needs to be improved, and the management should be further strengthened, corresponding measures should be taken for different personnel.

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ObjectiveTo investigate the influence of health care workers’(HCWs) hand hygiene intervention in healthcareassociated infection(HAI) in an intensive care unit(ICU).MethodsIntervention measures of hand hygiene were adopted,  effective supervision and management systems were established, hand hygiene compliance and HAI rate before intervention(JanuaryDecember 2012) and after intervention (the first stage: JanuaryJune 2013; the second stage: JulyDecember 2013）were compared. ResultsA total of 4 066 patients were surveyed, HCWs’ hand hygiene compliance rate before intervention was 50.03%, the first and  second stage after intervention was 61.80%  and 64.57% respectively, there was increasing trend  （rs=1.00, P<0.001）.HAI before intervention was 5.48%, the first and second stage after intervention was 3.86% and 3.30% respectively, there was decreasing trend （rs=-1.00, P<0.001）. Significant decreasing trends were found in rates of catheterrelated bloodstream infection(CRBSI), catheterassociated urinary tract infection(CAUTI) and ventilatorassociated pneumonia(VAP) (rs=-1.00, P<0.001). There were negative correlations between hand hygiene compliance rate and the infection rate of ICU, infection rate of CRBSI,CAUTI and VAP  (P<0.05).ConclusionThe improvement of hand hygiene compliance can effectively reduce the incidence of HAI in ICU ward.

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ObjectiveTo improve hand hygiene compliance among health care workers(HCWs) through continuous quality improvement, and effectively reduce the incidence of healthcareassociated infection(HAI). MethodsContinuous quality improvement was performed by adopting plandocheckaction(PDCA) cycle, all HCWs were trained, hand hygiene was stressed, periodical  and random checking was conducted. ResultsAfter the implementation of PDCA cycle, the acknowledge  rate of hand hygiene enhanced from 48.00% to 63.99%; hand hygiene compliance rate enhanced from 65.11％ to 82.40％，the difference were both significant（χ2=12.75, 259.65， respectively， both P＜0.05）.The daily consumption of instant hand antiseptic per 1 000 bed day increased obviously, which was 2.95fold of preimplementation. ConclusionContinuous quality improvement through PDCA cycle can effectively improve hand hygiene compliance rate of HCWs.

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ObjectiveTo investigate the qualified rate of midwives’ surgical hand disinfection and perineal incisional infection in parturients, so as to provide reference for reducing perineal incisional infection. MethodsData of 7 148 women who delivered naturally in an obstetrics department between January 2012 and December 2013 were collected, 3 569 midwives who weren’t intervened in surgical hand disinfection between January and December 2012 were as control group, and 3 579 midwives who were intervened between January and December 2013 were as intervention group, the perineal incisional infection rate of parturients and qualified rate of midwives’  hand hygiene of two groups were compared. ResultsThere were no significant difference in maternal age, body mass index, underlying diseases, No. of  vaginal delivery examination, delivery season, delivery lasting time, incision suture technique, antimicrobial prophylaxis, and neonatal weight between intervention group and control group (all P>0.05). The qualified rate of midwives’ surgical hand disinfection method increased from 19.31%（n=689）before intervention to 71.03%（n=2 542） after intervention, the difference was significant between two groups（χ2=752.58，P＜0.05）. Perineal incisional infection rate in intervention group was significantly lower than control group (［(0.28%,10/3 579］ vs ［0.81%， 29/3 569］）, there  was significant difference between two groups （χ2=9.36，P＜0.05）. ConclusionThe improvement of qualified rate of midwives’ hand hygiene can reduce perineal incisional infection rate of parturients.

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ObjectiveTo investigate the current status of knowledge, attitude and practice of occupational exposure to blood and precaution among health care workers (HCWs), and to evaluate the factors affecting  wearing gloves and isolation gowns. MethodsHCWs in a hospital on October 16，2102  were investigated through  questionnaires. ResultsA total of 374 HCWs were investigated, the average training  per HCW  were（1.47±1.54）times, HCWs in internal medicine department  were  （2.00±2.12）times, which was higher than HCWs in the other departments (P＜0.001).The score of occupational blood exposure and precaution knowledge among  HCWs with Master’s degree or above and doctors was （88.43±11.09）and （88.14±11.48）respectively. There was no significant difference in attitude and practice among different HCWs (P>0.05). The main factors affecting wearing gloves and isolation gowns were inconvenient  for manipulation and inadequate facility. ConclusionThe knowledge, attitude and practice of occupational blood exposure and precaution among HCWs are not desirable. Measures should be taken to improve HCWs’occupational precaution standard.

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ObjectiveTo realize the current situation of glove perforation during surgical operation process, and provide basis for preventing surgical glove perforation. MethodsIn January 2014, an investigation on glove perforation was conducted among operation personnel in 9 operating rooms in a hospital, glove perforation rates, sites, causes and noticed ways were analyzed. ResultsA total of 2 909  persontime was investigated, 147 persontime occurred glove perforation， persontime rate of glove perforation was 5.05%; 153 of 5 818 gloves (2.63%) were perforated， 6 persontime occurred perforation of double gloves; gloves perforation rates of each specialized surgery were significantly different (χ2=87.945，P＜0.001）,cardiac surgery（11.84%） and plastic surgery（10.78%）had the hight perforation rates. The common sites of perforation were index finger,thumb, and middle finger,the main cause of perforation was sharp damage by stitches and devices.  Most perforations were noticed intraoperatively, and seldom found postoperatively by naked eyes; gloves of different brands  had different perforation rates（χ2=33.845，P＜0.001）.ConclusionIn order to reduce and prevent the perforation during operation process, glove brands with good quality should be chosen, and measures for the prevention of glove perforation should be formulated according to the types of surgery.

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ObjectiveTo compare disinfection efficacy of three different air disinfection methods on the air in blood collection room. MethodsAir disinfection  in blood collection room was conducted by ultraviolet (UV) light, ozone disinfector (OD)and air purification disinfector  respectively , natural sedimentation method was used to take air specimens  before , after disinfection , and during working condition of staff , air disinfection efficacy was detected. ResultsAll three methods could decrease air bacterial count after disinfection , the total number of bacteria in indoor air after disinfection met the class Ⅲ environmental requirement. Under working condition of staff ，the number of bacteria of OD and UV light group increased rapidly, at 4 hours was （7.53±1.28）CFU/5 min·Φ90petri dish and （8.16±1.57）CFU/5 min·Φ90petri dish respectively; air purification disinfector disinfected for 4 hours under the condition of  movement of personnel in blood collection environment, bacteria count still remained ＜4.0 CFU/5 min·Φ90petri dish. ConclusionDisinfecting continuously by air purification disinfector can ensure the effectiveness of air cleanliness in blood collection room.

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慢性播散性念珠菌病(chronic disseminated candidiasis,CDC)是全身性侵袭性深部假丝酵母菌属感染的一种特殊的临床和病理类型,最常见受累的靶器官为肝脾,又称肝脾念珠菌病(hepatosplenic candidiasis, HSC)。急性白血病化学治疗（化疗）后CDC的发病率为3%～29%［1］。本院2013年1月收治此类病例1例，现将其诊断与治疗情况总结报告如下。

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乙型肝炎仍是当前危害人民健康最严重的传染病之一，每年约有100万人死于乙型肝炎病毒（HBV）感染所致的肝硬化、肝衰竭和原发性肝癌。近年来，随着HBV标志物检测技术的迅速发展，学界认识到HBV标志物在乙型肝炎患者管理中具有重要的指导意义，并且某些HBV标志物的病理作用被进一步认识。本文对此领域的若干进展作一综述。