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ObjectiveTo realize the status in the implementation of three industry standards of central sterile supply department (CSSD), and provide a scientific basis for carrying out of the standards.MethodsAccording to three standards, investigation forms were designed by specialists, written survey on 365 hospitals in 9 provinces and field investigation on 15 hospitals in 3 provinces were performed,the implementation of three standards were investigated.ResultsOf 365 hospitals, the number of provincial and ministerial level, municipal level, and county level hospitals were 90,87 and 188 respectively. More than 94% of hospitals established CSSD management system and regulations,>90% of hospitals met the requirements of CSSD layout; All hospitals were equipped with pressure steam sterilizer, all levels of hospitals basically equipped with the necessary equipments and facilities; CSSD responsible officers of 94.52% (345/365) of hospitals participated in training on standards; 69.61% （252/362） of hospitals were using or developing CSSD information systems;>92% of the CSSD responsible officers considered that three standards played an important role in facilitating centralized management, and improving the quality of cleaning, disinfection and sterilization.ConclusionHospitals need to strengthen the management and training on standards of CSSD, management of loaner instruments and development of information system need to be standardized.

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ObjectiveTo realize the status, effectiveness and existed problems in the implementation of three industry standards of central sterile supply departments (CSSDs), and provide a scientific basis for the revision and execution of standards by public health authorities.MethodsIn December 2012, CSSDs and administration sections in 39 different level hospitals in Jilin Province were investigated by unified method of National Institute of Hospital Administration.ResultsA total of 39 hospitals, including 10 hospitals of provincial and ministerial level, 9 municipal level, and 20 county level,were investigated. After April 1,2009, the overall expansion or reconstruction of 28 hospitals and their CSSDs based on the three standards have been finished. 38(97.44%) hospitals were included in the medical quality management, 4 hospitals established CSSDs quality management and traceability system by adopting information technology, and 18 were being developed; the average area of CSSDs was about 542 m2, average number of staff was about 14.37, and the ratio of staff to beds was 1.75:100; 25 hospitals met the standard requirements for temperature in checking,packaging and sterilization area, qualified rate was 64.10%, and 23 hospitals met the humidity standard, qualified rate was 58.97%; 79.48% of hospitals had cleaning and disinfection equipments; 51.28% with purified water for end rinsing; 28.21% had ethylene oxide sterilizer, 56.41% had hydrogen peroxide plasma sterilizer; 39 hospitals used cotton cloth for packaging materials; 89.74% of hospitals performed biological monitoring on pressure steam sterilizer in accordance with the standard frequency.ConclusionAfter the release of CSSD industry standard, hospitals in Jilin Province paid high attention, the CSSD constrution layout, use of space, staffing, personal protective equipment, cleaning and disinfection equipment and cleaning consumables are greatly improved.

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ObjectiveTo realize the current status of central sterile supply departments(CSSDs) in hospitals, and provide the basis for making improvement measures.MethodsField investigation was adopted to study the resource distribution, personnel structure, and the quality of medical instrument cleaning in 78 hospitals in Chongqing.ResultsQualified results of 78 hospitals was 24.36%(19/78),basically qualified rate 52.56%(41/78), unqualified rate 23.08%(18/78)；inspection results of different types of hospitals were significantly different（Hc=16.643，P=0.002）, qualified hospitals mainly concentrated on city and countylevel hospitals.Unqualified rate of CSSD construction area was 78.21%（n=61）, unqualified rate of personal allocation was 75.64%（n=59）,concentrated management of operating rooms and CSSDs was 52.56%（n=41）, mainly concentrated on city and countylevel hospitals; decentralized management accounted for 47.44%（n=37）,58（74.36%）hospitals used repeated cleaning stainless steel tables for receiving, 50% didn’t install automated cleaning machine and drying cabinet, 42.31%（33/78）performed manual cleaning，40（51.28%）didn’t equip with water treatment system;12（15.38%）hospitals used patched or worn clothing for packing, 47 didn’t equip with hard metal container, 37（47.44%）had no heat sealing machine, 21(26.92%) had no detection equipment for cleaning quality, 41（52.56%）had no low temperature sterilization instruments;52（66.67%）hospitals performed biological monitoring on high pressure steam sterilizer.ConclusionClean and disinfection equipments in CSSDs in city and countylevel hospitals are wellappointed, procedures of clean and disinfection are standard, and can achieve the standard of clean quality; while hospitals affiliated to factories and private hospitals are not wellappointed, procedures of clean and disinfection are not standard. Construction of CSSD should be standard,so as to ensure the effectiveness of clean, disinfection and sterilization of surgical instruments.

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ObjectiveTo study the incidence of ventilatorassociated pneumonia(VAP)and antimicrobial resistance of pathogens in an intensive care unit(ICU).MethodsThe occurrence of VAP in hospitalized patients with mechanical ventilation >48 hours between January 2011 and December 2012 were investigated, species and antimicrobial resistance of pathogens causing early onsetVAP (EVAP, mechanical ventilation≤4 d）and lateonset VAP（LVAP，mechanical ventilation ＞4 d） were compared.ResultsA total of 176 patients were investigated,incidence of VAP was 44.32%（78 cases）；With the prolongation of mechical ventilation，incidence of VAP increased gradually (χ2=52.561，P＜0.001）.The incidence of LVAP was significantly higher than EVAP (58.33% ［70/120］ vs 14.29% ［8/56］）（χ2=30.02，P＜0.001）.A total of 178 pathogens were isolated, gramnegative bacteria,grampositive bacteria and fungi were 104（58.43%）,46（25.84%）,and 28（15.73%） isolates respectively； 97(54.49%) multidrugresistance/pandrug resistance organisms (MDRO) were isolated. MDRO isolation rate in LVAP patients was higher than EVAP patients（［58.86%，n=93］ vs ［20.00%，n=4］）,resistance rate of major pathogens causing LVAP was significantly higher than EVAP patients(all P<0.05).Fungi infection only occurred in LVAP patients, the total antimicrobial resistance rate was 12.14%.ConclusionThe prolongation of mechanical ventilation can increase the incidence of VAP, and resistance rate of pathogen in LVAP is high.

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ObjectiveTo realize the incidence of healthcareassociated infection(HAI) in patients after receiving extracorporeal membrane oxygenation(ECMO)procedure, and to evaluate the related factors for HAI.MethodsClinical data of patients receiving ECMO from January 2003 to December 2012 were collected and analyzed retrospectively.ResultsOf 43 patients receiving ECMO, 15 （34.88％）developed 24 times（55.81％） of HAI. The main HAI site was lower respiratory tract（n=12,50.00%）,followed by blood stream（n=6，25.00%）,skin and soft tissue（n=5，20.83%）.A total of 28 isolates of pathogens were detected, gramnegative bacilli were 19（67.86%）isolates， grampositive cocci 7（25.00%）, and fungi 2（7.14%）; pathogens were mainly isolated from specimens of sputum（n=12，42.86%）, blood （n=9，32.14%）and wound secretion（n=6，21.43%）. The incidence of postoperative HAI in ECMO patients was related with patients’ age, duration of ECMO, complication, mechanical ventilation,tracheal intubation or tracheotomy, and indwelling urinary catheter.ConclusionHAI in patients receiving ECMO is high, hospital should take corresponding prevention and control measures targeting to the related risk factors of infection, so as to reduce the incidence of HAI after the ECMO.

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ObjectiveTo explore the risk factors for healthcareassociated infection (HAI) caused by Candida in a hospital.Methods64 patients with healthcareassociated(HA) Candida infection in a hospital between January 2011 and October 2013 were selected as case group, and 64 patients without HA Candida infection during the same period were as control group, clinical data of two groups of patients were analyzed.ResultsThe main Candida causing HAI were Candida albicans（68.75%）,followed by Candida tropicalis（15.62%）, Candida glabrata (9.38%) and Candida krusei （6.25%）.The major infection sites were respiratory tract（67.19%），urinary tract（18.75%） and digestive tract(10.94%）. Univariate analysis showed the risk factors for HA Candida infection were age, length of hospital stay, diabetes, and malignant tumor and so on; multivariate logistic regression analysis showed that important risk factors for HA Candida infection were age（OR 95% CI：2.57-33.67）, length of hospital stay（OR 95% CI：2.17-25.37）,malignant tumor（OR 95% CI：1.04-15.23）,chemotherapy（OR 95% CI：1.76-20.63）, and use of respirator（OR 95% CI：4.67-96.37）.ConclusionRisk factors for HA Candida infection are complicated, in order to reduce the incidence of HA Candida infection,risk factors should be considered, and preventive measures according to risk factors should be made.

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ObjectiveTo realize the clinical and epidemiological characteristics of measles,and explore effective measures to control measles epidemic.MethodsClinical data of 554 hospitalized measles children between January 2009 and December 2013 were analyzed retrospectively.ResultsAll children had fever,cough, and skin rash, 507 (91.52%) had typical clinical manifestations of measles, 47(8.48%) had mild manifestations; the major population were children aged≤6 months（n=176，31.77%）and 7-8 months (n=346，62.45%）;132 (23.83%) children had contact history of confirmed measles, 19(3.43%) measles children’s mothers also developed measles (all were cases of 2013）, 227 (40.97%) children had history of repeated infusion or hospitalization in large medical institutes during the measles incubation period (all were cases of 2013,there were measles children who had infusion or hospitalization in the same hospital during the same period). The peak incidence of measles usually occurs in JanuaryMay.ConclusionIntensive immunization of measles for young women of reproductive age and vaccination with “premeasles vaccine” for early infancy, and strengthening the medical management of fever outpatients are important measures to prevent measles epidemic.

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ObjectiveTo investigate the detection results of HBsAg, antiHCV, antiTreponema pallidum antibody (antiTP)and antiHIV in patients before transfusion and surgery.MethodsFour infection indicators of 28 165 patients were detected by enzymelinked immunosorbent assay from June 2011 to May 2012,results were analyzed statistically.ResultsOf 28 165 patients, total positive rate was 12.15% （n=3 422）,the positive rate of HBsAg, antiHCV, antiTP and antiHIV was 8.69%（n=2 447）,1.31%（n=368）,2.07%（n=583）,and 0.09%(n=24) respectively. The positive rate of HBsAg, antiHCV and antiHIV in male was higher than female (χ2 was 36.64, 28.95,and 4.82，respectively,all P＜0.05）.In different age groups,positive rate of all indicators in <20 age group was lowest,while positive rates of HBsAg, antiHCV, and antiHIV were highest in 20-39 and 40-59 age groups,antiTP was highest in ≥60 age group.ConclusionDetection of bloodborne pathogens before transfusion and surgery is helpful for realizing infection status of patients before transfusion and surgery.

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ObjectiveTo investigate the prevalence of antiHCV positive among volunteer blood donors in Zhoukou city. MethodsA total of 200 950 blood specimens from voluntary blood donors in Zhoukou from 2007 to 2012 were detected for antiHCV by doubleantibody sandwich enzymelinked immunosorbent assay, results were analyzed. ResultsThe total positive rate of antiHCV was 0.21%（416／200 950）, there were significant difference in positive rates of antiHCV among populations of different genders, ages and educational background（χ2=24.01, 142.31,45.8，respectively,all P<0.01）, the positive rate of antiHCV in female was higher than that of male (［0.27%,205/75 658］ vs ［0.17%, 211/125 292］）; the positive rate of antiHCV was the lowest in donors aged 21-30 years (0.06%,38/63 719）, and highest in donors aged >40 years (0.33%,162/48 871）; the lower donors received education, the higher positive rate of antiHCV they had, the positive rate of antiHCV in donors with junior high school education was 0.26%（107/41 154）. The positive rate of antiHCV in blood donors decreased gradually from 2007 to 2012（χ2=14.576，P<0.05）.ConclusionThe positive rate of antiHCV is low in voluntary blood donors in Zhoukou and is significantly different among different populations.

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ObjectiveTo evaluate the effect of antimicrobial management guideline on the daily antimicrobial use rate in a general hospital.MethodsAn oneday pointprevalence survey on antimicrobial use in hospitalized patients was conducted in 2010, 2011,and 2012 by means of crosssectional investigation method.ResultsThe daily utilization rate of antimicrobial agents in 2010, 2011,and 2012 was 65.40%,42.09% and 26.74% respectively，the rate of the submission of specimens for bacterial culture was 22.53%, 35.74% and 41.74% respectively（χ2trend=266.42,29.02，respectively， both P＜0.01）. The utilization rate of single drug was 83.72%,80.27% and 93.41% respectively. the utilization rate of both twodrug and more than threedrug combination kept a downward tendency. The utilization rate of antimicrobial agents in several departments(digestive internal medicine,cardiovascular, hematological tumor,neurology, general surgery,orthopedics, obstetrics, pediatrics,and ophthalmology) showed a decreasing tendency(all P<0.01).ConclusionThe implementation of antimicrobial management guideline has remarkably reduced the daily antimicrobial use rate, and increased etiological detection rate for therapeutic antimicrobial use.

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Objective To investigate the incidence of adverse drug reaction (ADR) in patients in a hospital, and evaluate ADRrelated factors, so as to provide references for the prevention of ADR and reducing of risk factors in drug use. Methods223 clinically reported ADR cases were collected from January 1, 2011 to December 31, 2011, patients' age, types and administration routes of drugs relating to ADR, and ADRinvolved organs and systems were analyzed.ResultsOf 223 patients with ADR, 211（94.62%）received intravenous drip， 3 received intravenous injection， 2 received intramuscular injection，and 7 received oral administration. ADR mainly occurred within 1-30 minutes after taking the medicines， 39（17.49%）occurred within 1-4 minutes，45（20.18%）within 5-9 minutes，80（35.87%）within 15-29 minutes. Of organ or system involved by ADR, skin and its appendage damages were common (93 cases),followed by gastrointestinal tract (62 cases)and systemic damage (45 cases); single organ and systemic damage were most common (184 cases,82.51%). 123 cases (55.16%) of ADR were caused by antimicrobial use, 60 cases (26.91%) were induced by Chinese medicine injection; Of top 10 ADRinducing medicines,7 were antimicrobial agents and 3 were traditional Chinese medicine injections, levofloxacin lactate and sodium chloride injection ranked first(23 cases,10.31%).ConclusionThe occurrence of ADR is related to multiple factors, reporting and surveillance of ADR should be strengthened, the use of antimicrobial agents and traditional Chinese medicine should be rational, thereby reduce the occurrence of ADR.

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ObjectiveTo study the species and drug resistance of Mycobacterium isolated from patients with sputum smear positive for acidfast bacillus in Wujiang city, and provide reference for the prevention and control of tuberculosis. MethodsSputum specimens with positive smear were cultured, isolated bacteria were identified and performed drug susceptibility testing, drug resistance among different species of strains and between patients with initial and repeated treatment were compared.ResultsA total of 103 Mycobacterium isolates were included in the study,13 of which were nontuberculous Mycobacterium, drug resistance rate was 100.00%, multidrug resistance (MDR) rate was 84.62%; 90 isolates were Mycobacterium tuberculosis, 81(90.00%) of which were Mycobacterium hominis. Drug resistance rate of Mycobacterium tuberculosis was 35.56%, MDR rate was 14.44%. Of 70 initially treated tuberculosis patients with positive sputum smear,14(20.00%) were resistant to drugs, MDR rate was 4.28%(3/70); Of 20 repeatedly treated tuberculosis patients with positive sputum smear,18(90.00%)were resistant to drugs, MDR rate was 50.00%(10/20).ConclusionMycobacterium tuberculosis is the major isolated strain from patients with positive sputum smear. Drug resistance and MDR rates of nontuberculous Mycobacterium are very high. Drug resistance and MDR rates of Mycobacterium tuberculosis in repeatedly treated patients are higher than initially treated patients.

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ObjectiveTo investigate the difference in healthcareassociated infection (HAI) status and antimicrobial resistance of Acinetobacter baumannii（A. baumannii） isolated from different wards, so as to provide evidence for effective prevention and therapy for HAI caused by A. baumannii.MethodsClinical data of 446 A. baumannii isolates from hospitalized patients between January 2012 and July 2013 were analyzed retrospectively. ResultsThe majority of 446 A. baumannii isolates were from patients admitted to intensive care unit (ICU, n=236,52.92%), followed by departments of respiratory diseases(n=55,12.33%) and neurosurgery (n=48,10.76%),and the strains were mainly isolated from sputum specimens (94.62%).Antimicrobial susceptibility testing with 13 kinds of commonly used antimicrobial agents showed that antimicrobial resistance of A. baumannii from ICU were highest, susceptibility rates were all <20%, the next were from department of neurosurgery, susceptibility rates were all<30%, while susceptibility rates of A. baumannii from department of respiratory diseases were all >50%.ConclusionThe difference in antimicrobial resistance of A. baumannii from different wards varied significantly, antimicrobial resistance of A. baumannii from ICU is most serious.

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ObjectiveTo realize the characteristics of clinical distribution of multidrugresistant organisms (MDRO) in a hospital,and take specific measures for the prevention and control of infection.MethodsSurveillance data of 891 MDR isolates detected in a hospital between January 1 and December 31, 2012 were analyzed retrospectively.ResultsOf 891 MDR isolates, extendedspectrum βlactamase(ESBL)producing Escherichia coli ranked first（342，38.39%）, followed by ESBLproducing Klebsiella pneumoniae（195，21.89%）,MDR Acinetobacter baumannii（185，20.76%）, methicillinresistant Staphylococcus aureus（138，15.49%）, MDR Pseudomonas aeruginosa（27，3.03%）, ESBLproducing Proteus mirabilis（2，0.22%）,and ESBLproducing Klebsiella oxytoca（2，0.22%）; Bacteria mainly concentrated on general intensive care unit(ICU)(163,18.29%）, department of neurology（136,15.26%），general surgery(103,11.56%),neurosurgery（85,9.54%）, and respiratory diseases department（71,7.97%）.The most common bacteria isolated from sputum was MDR Acinetobacter baumannii (242，50.63%),and mainly concentrated on general ICU; the most common bacteria isolated from urine was ESBLproducing Escherichia coli(141，80.57%), mainly concentrated on the departments of neurology and urology. ConclusionMDRO infection in this hospital mainly concentrate on lower respiratory tract and urinary system. Monitor on highrisk departments and vulnerable patients should be intensified, targeted preventive measures should be stressed to curb MDRO infection and spread.

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ObjectiveTo analyze the distribution and antimicrobial resistance of Pseudomonas aeruginosa(P. aeruginosa) in a countylevel hospital, provide reference for rational antimicrobial use, and promote the control and prevention of healthcareassociated infection (HAI).MethodsData of P. aeruginosa isolated from patients in a hospital between 2010 and 2012 were analyzed statistically.ResultsA total of 369 P. aeruginosa isolates were isolated, strains were mainly from specimens of sputum（n=234，63.41%）,urine（n=41，11.11%）and wound（n=28，7.59%）; most strains were from intensive care unit（n=146，39.56%）,respiratory diseases department（n=51，13.82%）and neurosurgical department（n=37，10.03%）. P. aeruginosa strains were not resistant to polymyxin B;the resistance rates to imipenem, meropenem, cefoperazone / sulbactam, piperacillin / tazobactam and amikacin were all low(6.81%-22.73%); from 2010 to 2012, resistance rates to antimicrobial agents (except polymyxin B) increased with varying degrees, some antimicrobial agents showed statistical difference（P＜0.05）.ConclusionP.aeruginosa is mainly isolated from respiratory specimens, mainly distributed in departments with serious patients; and resistance to most antimicrobial agents is high, resistance tendency is increasing, surveillance should be intensified.

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ObjectiveTo investigate the influence of participation of healthcareassociated infection (HAI) management department in ward round presided over by hospital director on hand hygiene compliance of health care workers (HCWs) in a basiclevel hospital.MethodsImplementation of hand hygiene in JanuaryJune 2012 (control group : HAI management department didn’t participate ward round) and JanuaryJune 2013 (trial group : HAI management department participated ward round) were investigated, the compliance of hand hygiene of two groups of HCWs and consumption of hand hygiene products of each department were compared.ResultsHAI case rate in trail group was significantly lower than control group (1.49% vs 2.01%)（χ2=4.31，P＜0.05）; HCWs’ hand hygiene compliance rate was significantly higher than control group(71.56% ［3 249/4 540］ vs 44.00%［1 914/4 350］）, hand hygiene compliance rates in nurses were higher than doctors of both groups（χ2=151.30, 179.92， respectively，both P＜0.001）, hand hygiene compliance rate in trial group from high to low was department of pediatrics, obstetrics and gynecology, surgery,and internal medicine. The consumption of rapid hand disinfectant of trail group and control group was 5.38mL/bedday and 1.88 mL/bedday respectively, the consumption of hand sanitizer was 11.51 mL/bedday and 7.03 mL/bedday respectively.ConclusionHand hygiene checked during the ward round presided over by hospital director can improve HCWs’ hand hygiene compliance,reduce the incidence of HAI,and ensure medical safety.

Abstract:

目的分析重症监护室（ICU）导尿管相关性泌尿道感染（CAUTI）病原体的变化及耐药特征，为医院感染的控制提供依据。方法回顾性调查分析某院ICU 2011—2012年56例发生CAUTI患者的病历资料。结果56例发生CAUTI的患者分离病原体64株，其中大肠埃希菌居首位，占42.19%；其次是铜绿假单胞菌（21.88%）、肺炎克雷伯菌（14.06%）、鲍曼不动杆菌（7.81%）、屎肠球菌（6.25%）、白假丝酵母菌（4.69%）、凝固酶阴性葡萄球菌（3.12%）。大肠埃希菌、肺炎克雷伯菌对约50%的抗菌药物耐药率>55%，鲍曼不动杆菌出现泛耐药。结论CAUTI主要的病原体是大肠埃希菌；病原体耐药性较高，临床应加强监测。

Abstract:

目的了解某院住院患者医院感染现患情况及存在的问题，为有效预防和控制医院感染提供科学依据。方法2010年7月24日、2011年8月2日、2012年8月15日采用床旁调查与病历调查相结合的方法对该院所有住院患者进行医院感染现患率调查，并对连续3年的资料进行统计学分析。结果2010—2012年医院感染现患率分别为1.75%、0.99%、1.58%，连续3年医院感染现患率比较，差异无统计学意义（χ2=1.56，P=0.46）。医院感染部位主要以下呼吸道（36.11%）为主，其次为胃肠道（25.00%）和上呼吸道（25.00%）。日抗菌药物使用率分别为72.02%、60.93%、59.71%，连续3年比较，差异有统计学意义（χ2=26.85，P＜0.001）；3年抗菌药物的使用均以单一用药为主（54.88%~61.81%）。结论医院感染现患率调查有助于了解医院感染现状，发现存在的问题，从而有针对性地采取干预措施，加强管理，减少医院感染的发生。