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ObjectiveTo investigate the major genotypes and prevalence of metalloβlactamases (MBLs) in Enterobacteriaceae from a hospital in 2007-2011. MethodsAll strains of Enterobacteriaceae were isolated from clinical specimens by routine method, antimicrobial susceptibility testing was performed by disc diffusion method(KirbyBauer) and agar dilution method, MBLs was screened by both modified Hodge test and Etest  , MBLs genes were amplified by polymerase chain reaction (PCR), the transference of IMP8encoding plasmid was performed by conjugation test , the homology of  MBLsproducing strains was detected by pulsedfield gel electrophoresis (PFGE). ResultsOf 3 297 Enterobacteriaceae isolates ,41 were   resistant to carbapenems, and phenotype confirmation test showed 14 strains produced carbapenemase, 3 Klebsiella pneumoniae isolates carrying blaIMP8 belonged to the same clone, which can be transferred to others by plasmid.ConclusionThree blaIMP8carrying Klebsiella pneumoniae isolates were found in this hospital，and has a high degree of  homology.

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ObjectiveTo monitor Staphylococcus infection in a hospital, and trace the source of  Staphylococcus isolated from infectious woundrelated hospital environment by molecular analysis. MethodsBy combination of fluorescence quantitative polymerase chain reaction (FQPCR) and culture method, environmental specimens related to 5 patients with wound infection were taken and performed multilocus sequence  and MecA gene typing analysis. ResultsA total of 71 environmental specimens were taken, Staphylococcus accounted for 36.62%（n=26），88.46% (23/26 ) of which were MecA+ methicillinresistant strains. 77.78% （7/9）of  Staphylococcus aureus (S. aureus) and 95.00%（19/20）of coagulase negative Staphylococcus (CNS) were  methicillinresistant strains. Multilocus sequence analysis revealed that ST239 (n=6) was the most common sequence type in S. aureus；Staphylococcal cassette chromosome mec (SCCmec)   analysis showed that the major type of S. aureus was type Ⅲ, and CNS were type Ⅲ and Ⅳ. ConclusionStaphylococcus is common in healthcareassociated infection, and most Staphylococcus are multidrugresistant, continuous monitor on drugresistant Staphylococcus is necessary, and risk of Staphylococcus variant to medical institutes need to be paid attention.

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ObjectiveTo investigate the risk factors for imipenemresistant Pseudomonas aeruginosa (IRPA) infections in Xi’an,  and provide reference for  the control of IRPA infections .Methods103 IRPA patients who were hospitalized at 4 hospitals in Xi’an between February and October 2013 were randomly selected(case group),103 imipenemsusceptible Pseudomonas aeruginosainfected patients during the same hospitalization period were as control group, risk factors for IRPA infection were analyzed.ResultsUnivariate analysis revealed that old age, length of hospital stay≥4 weeks, chronic pulmonary diseases, stay in intensive care unit, mechanical ventilation, use carbapenems (imipenem, meropenem) 2 weeks before the isolation of IRPA ,and early combination of  antimicrobial drugs were related risk factors for IRPA infection;Logistic multivariate analysis showed that length of hospital stay≥4 weeks（OR95%CI：1.44-139.73）, mechanical ventilation（OR95%CI：2.96-267.75）,and use carbapenems (imipenem, meropenem)2 weeks before the isolation of IRPA（OR95% CI：2.65-154.34）were independent risk factors for IRPA infection.ConclusionIRPA infection in patients in this area should be intervened to reduce risk factors for IRPA infection.

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Objective To evaluate the important role of information collection, exchange, and analysis in the management of healthcareassociated infection(HAI), and demonstrate the characteristics of HAI management platform.MethodsRole of  HAI management platform was demonstrated  according to  information fusion theory,the monitoring level ,feature level and decision level information fusion method, as well as examples and data of international/domestic and  historical comparison.ResultsHAI management committee as a platform, and HAI management departments as the fusion system of information analysis and process department is the foundation of HAI management.ConclusionHAI monitoring system should be strengthened, multidisciplinary integration should be developed, and HAI committee decision coordination platform should be intensified.

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ObjectiveTo assess the  prevalence of hand hygiene compliance rates of health care workers (HCWs) at general hospitals in China in 2010-2012.  MethodsLiteratures  about  hand hygiene compliance  of  HCWs from 2010 to 2012 were retrieved from  China Biology Medicine disc (CBM）, China National Knowledge Infrastructure（CNKI）,Wan Fang database, VIP ，and PubMed database , Comprehensive Meta Analysis V2 software and Stata12.0 software were adopted to conduct statistical analysis . ResultsNinety literatures  were selected with heterogeneity（Q=48 118.32，P＜0.01）, random effect model was used. The  overall  hand hygiene compliance rate of HCWs  was 47.83%（95%CI：43.27%-52.42%）; When stratified by occupation group， the overall compliance rate of doctors，nurses, and unclassified HCWs was 40.36%（95%CI：35.42%-45.49%）, 46.70%（95%CI：41.81%-51.65%）, and 40.72%（95%CI：27.75%-55.13%） respectively. According to subgroup analysis， there was no statistical difference in compliance rate between doctors and nurses（Q=3.12，P＞0.05）; the compliance rate after patient contact was higher than before patient contact （54.33% ［95%CI : 44.76%-63.59%］ vs 20.21%［ 95%CI: 14.12%-28.06%］）（Q=32.59，P＜0.01）; hand compliance rate from field observation was higher than from covert observation （70.91% ［95%CI ：70.71%- 71.10%］ vs  41.20%［95%CI ：37.55% -44.94%］）（Q=247.66，P＜0.01）.ConclusionThe overall hand hygiene compliance rate of HCWs in 2010-2012 was low,  in order to reduce the risk of healthcareassociated infection, hand hygiene compliance of HCWs need to be increased .

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ObjectiveTo investigate the changing trends in 4 continuous point prevalence surveys of healthcareassociated infection(HAI) in a hospital. MethodsThe occurrence of HAI  among all  hospitalized patients were investigated on a given day from 0:00 to 24:00 in May, 2006,2008, 2010, and 2012 respectively.ResultsA total of 4 497 patients should be investigated, 4 387 (97.55%) patients were actually investigated; 184 patients developed 209 times of HAI, point prevalence rate of HAI was 4.19%, case  prevalence rate was 4.76%. Trend χ2 test showed that HAI prevalence rate decreased gradually from 5.56% in 2006 to 2.76% in 2012（χ2=14.07，P＜0.001）.The main infection site was lower respiratory tract (55.03%),followed by urinary tract（14.83%）and upper respiratory tract（9.57%）.The overall usage rate of antimicrobial agents was 38.50%. Trend χ2 test showed that usage rate of antimicrobial agents decreased gradually from 2006 to 2012（χ2=5.13，P=0.023）；pathogenic detection rate in patients receiving therapeutic and  therapeutic plus prophylactic antimicrobial use increased gradually（χ2=40.81，P＜0.001）；single use of antimicrobial agents increased gradually（χ2=23.86，P＜0.001）. The rate of arteriovenous intubation , urinary catheterization , respirator use, and venous intubation in patients with HAI was significantly higher than those without HAI (27.17% vs 9.80%, 35.33%  vs 11.54%,13.59% vs  4.33% , 84.78% vs 63.24% respectively ,all P＜0.001）.  ConclusionManagement of rational use of antimicrobial agents has been achieved remarkably, control of HAI improved continuously; but control of invasive procedureassociated infection  need to be intensified, management of rational use of antimicrobial agents should  be paid  much attention.

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ObjectiveTo investigate the epidemiological and clinical characteristics, pathogen species, and antimicrobial resistance of bacillary dysentery in children in recent three years.MethodsClinical data of 175 children with bacillary dysentery in a hospital in 20102012 were analyzed retrospectively. ResultsPeaks month of occurrence of bacterial dysentery in children was in JulySeptember (74.86%), incidence in children in 1-3 years old group (1 year old was excluded, 3 years old was included) was 23.43%, and  in  3-5 years old group (3 years old was excluded, 5 years old was included) was 25.14%. The main clinical manifestations were diarrhea （100%）, paroxysmal abdominal pain(94.29%),and fever (77.14%), but the typical symptoms of bloody purulent stool and tenesmus were less than the previous. The isolation rate of Shigella flexneri and Shigella sonnei was 64.57% (n=113) and 35.43% (n=62) respectively. Antimicrobial susceptibility test result revealed that the resistance rate of 175 Shigella isolates  to ampicillin, ampicillin/sulbactam, and compound sulfamethoxazole  was 97.14%, 72.57%, and 78.29% respectively; sensitivity rate to gentamicin, ciprofloxacin, norfloxacin,  and  levofloxacin  were  still  high ,  resistance rates were 4.57%-16.57%,  sensitivity rate to cefotaxime and ceftazidime were up to more than 95%. ConclusionAtyptical bacillary dysentery in children increases gradually; the major Shigella in local area is Shigella flexneri; Susceptibility of Shigella to some antimicrobial agents changed obviously, antimicrobial use should be paid attention.

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ObjectiveTo analyze the change in immune function and therapeutic effectiveness of children with immune thrombocytopenic purpura and Helicobacter pylori（H. pylori） infection. MethodsEighty hospitalized children with thrombocytopenic purpura between March 2011 and March 2012 were as observation group, and then subdivided into infected group and noninfected group according to whether they were infected with H. pylori; 80 healthy children were as control group . Lymphocyte subsets , clinical therapeutic effectiveness and recurrence rate among three groups were compared. ResultsThe positive rate of H. pylori in observation group was significantly higher than control group( 55.00% ［44/80］ vs 2.50% ［2/80］; χ2=12.48，P=0.008）. There was significant differences in CD4+, CD4+/CD8+ ,and CD19+T lymphocyte among three groups （all P＜0.05）;  CD4+  and  CD4+/CD8+ T lymphocyte in infected group was significantly lower than noninfected group respectively  (［13.40±4.65］%) vs ［28.56±3.82］%; ［0.69±0.18］% vs ［1.04±0.23］%) , and CD19+T lymphocyte in infected group was significantly higher than noninfected group  (［45.21±10.20］% vs ［22.05±2.23］%) ; CD4+ and CD4+/CD8+T lymphocyte in noninfected group and infected group was significantly lower than control group (［40.20±3.42］%  ,［1.54±0.42］% respectively), and CD19+T lymphocyte was significantly higher than control group (［11.02±2.89］%) . The overall therapeutic effectiveness in infected  group and noninfected group was 90.91% and 91.67% respectively（P＞0.05） . The recurrence rate of thrombocytopenic purpura after antiH.pylori infection therapy in  infected group was significantly lower than noninfected group （20.45% vs 30.56%；χ2=6.396，P=0.038）. ConclusionDetection of immune function is helpful for clinical diagnosis of H. pylori infection associated with immune thrombocytopenic purpura .

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ObjectiveTo compare the humidification efficacy of sterile waterfilled cup and sterile waterfilled water reservoir on infant incubators, as well as  bacterial culture of incubators . MethodsTen infant incubators in a neonatal intensive care unit were randomly divided into observation group and control group, incubators in observation group were humidified through sterile water in single used cups, in control group were through water in water reservoirs , humidified water, air in incubators, and object surface were performed bacterial culture 24 hours after the change of humidified water. ResultsThe humidity in both groups achieved the requirement of >50%; the qualified rate of bacterial culture of humidified water in  observation group was significantly higher than control group(91.00% vs 74.00%,χ2=10.009，P=0.002）;bacterial count in observation group was significantly lower than control group(［26.85±16.67］ CFU/mL vs ［37.20±15.28］CFU/mL，t=4.577，P＜0.001）.The qualified rate of bacterial culture of air and surface of incubators in  observation group were both  significantly higher than control group （94.00% vs 85.00% ;98.00% vs 68.00%，both P＜0.05).ConclusionWaterfilled cups can achieve the air humidification efficacy on infant incubators, reduce the growth of bacteria, and is helpful for preventing the occurrence of healthcareassociated infection.

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ObjectiveTo investigate hand hygiene compliance of health care workers (HCWs) in a hospital, and evaluate intervention measures.MethodsQuestionnaires were designed and filled out by HAI management professionals through unannounced visits and random quiz. ResultsFrom July to September 2013, a total of 1 188 HCWs were surveyed , hand hygiene compliance rate was 61.87%, of which handwashing correct rate was 58.90%.Hand hygiene compliance rate of nurses  (71.00%) was higher than doctors (57.80%) and  other HCWs (32.14%)，correct hand washing rate (65.43%) was higher than other HCWs (38.89%) (P<0.0125) . Hand hygiene compliance of different work opportunities and different professions were different slightly, hand hygiene compliance rate after contact with patients’ blood, body fluid and wound dressing was the highest(81.58%);hand hygiene rate before contact with patients was the lowest(34.62%) .Only 297 patients (25.00%) used rapidly act hand disinfectant. ConclusionHand hygiene compliance rate of HCWs in this hospital need to be  improved.

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ObjectiveTo evaluate the intervention efficacy of hand hygiene of health care workers(HCWs) in a hospital before and after the comprehensive interventions were taken. MethodsThe baseline investigation stage was in AprilJune,2013 , intervention was performed from July,2013, postintervention efficacy evaluation stage was in OctoberDecember ,2013. Hand hygiene compliance was observed by investigators , and questionnaires were filled out.ResultsAfter multiple interventions were taken, hand hygiene compliance rate of HCWs increased from 38.02% to 53.86% （χ2=181.82，P＜0.05）, postintervention compliance rates of hand hygiene improved significantly  in departments of internal medicine, surgery and intensive care unit (all P<0.05).After intervention, the  overall hand hygiene compliance rate at different work opportunities rose from 41.87%(1 740/4 156) to 53.45%(2 044/3 824)（χ2=107.2，P＜0.05）;except sterile manipulation, the other 4 manipulation opportunities were all higher than preintervention(all P<0.05); HCWs of different  professions were all higher than preintervention(all P<0.05).ConclusionActive hand hygiene intervention can effectively improve hand hygiene compliance of HCWs.

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ObjectiveTo improve cleaning methods of ground towel in operating room , standardize the cleaning of ground of operating room, prevent and control the occurrence of healthcareassociated infection (HAI) ,and improve management quality.MethodsOperating room mops were changed into detachable mops, ground towels were cleaned and disinfected by automated washing machine (mechanical cleaning group), disinfection effect and time need to finish cleaning between mechanical cleaning group and manual cleaning group were compared.ResultsThe qualified rates of disinfection effect of ground and ground towels in mechanical cleaning group were both 96.67%(29/30) , in manual cleaning group was 83.33%（25/30）and 66.67%（20/30）respectively；the time need to complete the cleaning and disinfection of operating ground and batch cleaning of towels in mechanical cleaning group was（1.91±0.37）and （35.00±2.47）minutes respectively，and in mechanical cleaning group was（4.53±1.56 ）and （41.00±5.33）minutes respectively；there was significant difference between two groups (all P<0.01). ConclusionMechanically towel cleaning method can effectively improve ground cleaning effectively and shorten cleaning time.

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ObjectiveTo evaluate the effect of improved cleaning and disinfection method for subclavian venipuncture dressing change to prevent catheterassociated infection. Methods120 hospitalized patients with right subclavian venipuncture at an intensive care unit in JanuaryJune 2012 were divided into control group (n=60) and  experimental  group(n=60) according to venipuncture date. Control group adopted conventional dressing change : disinfected skin at and around puncture point by 2% iodine tincture, then used 75% alcohol for deiodination ; experimental  group adopted improved dressing change : Wiped skin at and around puncture point three times by normal saline, cleaned catheter, disinfected skin around puncture point (avoid puncture point) three times by 75% alcohol,  disinfected skin at and around puncture point three times by 0.5% iodine tincture , then disinfected catheter . Associated infection rate between two groups were compared . ResultsFocal infection rate and CRBI rate of experimental group were both lower than control group(5.00% vs 16.67% ;1.67% vs 13.33%), the difference was statistically different (P< 0.05). ConclusionEffect of improved dressing method is better than the conventional dressing method, it can effectively prevent occurrence of focal infection and CRBI. 

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ObjectiveTo realize types and changing trends of multidrug resistant organism(MDROs) infection, so as to provide reference for preventing and controlling  MDRO healthcareassociated  infection (HAI) . MethodsBacteria and MDROs isolated from patients in a general hospital from October 1, 2010 to September 30,2013 were analyzed. ResultsA total of 5 223 bacteria strains were isolated, 1 213 (23.22%) of which were MDROs. χ2 trend test showed that the percentage of MDROs increased year by year (χ2=16.885, P<0.001).Of all MDROs, rate of HAI strains ,communityassociated infection (CAI) strains, colonized strains ,and contamination strains were 37.51%(n=455), 50.54%(n=613) , 9.23%(n=112) , and 2.72%(n=33) respectively . From 2010 to 2013, the percentage of MDRO HAI showed decreased trend (χ2=13.477,P<0.001), CAI and colonization showed increased  trend (χ2=4.536, P=0.033) ,the main infection site was respiratory tract(84.49%，n=997) ,followed by urinary tract , skin and soft tissue, and bloodstream.  ConclusionMDRO infection become more and more serious,management of patients with MDRO CAI  and colonization  has become the focus of HAI prevention and control.

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ObjectiveTo investigate the occurrence and distribution characteristics of pathogenic fungi causing superficial mycosis in  a hospital. MethodsSpecimens from patients suspected of superficial mycosis were conducted direct microscope examination, cultivation and pathogenic identification.ResultsAmong 398 cases of suspected superficial mycosis, the positive rate of fungi was  51.01% (n=203 ) by direct microscopy and 59.55% (n=237) by fungi cultivation, positive rate of microscope examination was significantly lower than cultivation (χ2=6.057,P=0.014). Of 237 patients  with confirmed diagnosis of superficial mycosis ,100 （42.19%）were children and  137（57.81%） were adults ;109 cases (45.99%) were diagnosed with tinea of feet and hands, 89 (37.55%) tinea capitis, 26 (10.97%) tinea corporis, and 13 （5.48%）tinea unguium. The major fungi from children was Microsporum canis  (49.00%),  and from adults was Trichophyton rubrum（45.99%）. ConclusionThe most common superficial mycosis in this hospital is tinea of feet and hands, and the major fungi are Trichophyton rubrum and Microsporum canis, the species causing mycosis in adults and children are different.

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目的了解某院患者输血或介入性检查前乙型肝炎表面抗原(HBsAg)、丙型肝炎病毒抗体(抗 HCV)、梅毒螺旋体抗体(抗 TP)和人免疫缺陷病毒抗体(抗 HIV)的感染情况。方法对该院2010年1月—2013年1月临床各科收治的33 683 例拟输血及介入性检查前患者的上述4项感染指标进行检测。结果33 683例患者上述4项感染指标总阳性4 056例，阳性率为12.04%。其中HBsAg、抗 HCV、抗 TP和抗 HIV阳性率分别为8.94％(3 011例)、1.20％(405例)、1.86％（628例)和0.04％(12例)。32例患者合并感染乙型肝炎病毒（HBV）和HCV，1例抗HIV阳性的患者合并感染HBV和TP。结论患者血液传播性疾病感染率较高，术前检测有助于控制医院感染，减少纠纷。

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我国《母婴保健法》规定，新生儿在出生72 h后，应采集足跟血，以筛查先天性甲状腺功能低下症和苯丙酸酮尿症，达到早期筛查疾病，提高人口素质，减少和预防出生缺陷的目的。目前，此项工作已在国内普遍开展。国外曾报道［1］，某院在7个月内，连续发生5例足跟穿刺后感染葡萄球菌病例。2011—2013年，本院共收治2例足跟采血部位感染金黄色葡萄球菌的新生儿，现将诊疗情况报告如下。

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神经轴突导向分子Slit是一种分泌型糖蛋白。Slit蛋白在体内不仅可以阻止神经元的转移，同时在其他多个器官中都有表达，抑制血管内皮细胞、中性粒细胞、淋巴细胞、肿瘤细胞等多种细胞的转移。在机体重症感染时，病原菌的刺激使体内产生大量细胞因子，形成细胞因子风暴，而外源性Slit蛋白可以抑制趋化因子的趋化性，减少白细胞的黏附和迁移，同时通过稳定血管，降低血管通透性，防止过多细胞因子进入血液循环，加重炎症损伤。而该作用主要是通过Slit的第2个亮氨酸重复序列（Slit D2）与Robo的N端免疫球蛋白样区域IG12的结合后，诱导Src激酶、磷脂酰肌醇3（PI3）激酶等去磷酸化而失活、抑制多种趋化信号及细胞骨架重排、加强血管内皮VE钙黏蛋白间连接、紧密血管内皮等机制来实现。尽管很多研究都表明Slit蛋白在抗炎领域的重要意义，但目前Slit蛋白的作用机制尚未十分明确，其获得途径有限，因此，Slit蛋白在抗炎领域的研究将为炎性疾病提供更广阔的治疗策略。