Abstract:

医院感染直接影响医疗质量和患者安全，是现代医院管理的难题和面临的重要挑战。20世纪80年代中期我国开始重视医院感染管理工作，并加快推进医院感染管理事业的发展。近30年来，医院感染管理方面发生了翻天覆地的变化，取得了丰硕的成果，这在医院感染管理法律、法规、标准等建立方面有充分的体现。但目前,医院感染防控方面仍存在一些问题，如相关法律、法规等文件的落实，各项防控措施的执行等仍需加强。因此,为进一步加强我国医院感染预防与控制工作，加大医院感染防控措施的落实，提升医院感染管理工作水平，为患者提供安全的就医环境，中国医院协会于2012年5月启动“医院感染预防与控制能力建设”合作项目。旨在通过“宏观政策和微观管理相统一，理论与实践相转化”的方式，推动我国医院感染防控工作。

Abstract:

ObjectiveThrough the implementation of competence building project of healthcareassociated infection(HAI) prevention and control, strengthen the competence for HAI prevention and control in China, promote the implementation of HAI prevention and control measures, and improve HAI management level.MethodsThe whole project included 7 subprogrammes for prevention and control of HAI :  ventilatorassociated pneumonia (VAP),  central lineassociated bloodstream infection (CLABSI),  catheterassociated urinary tract infection (CAUTI), surgical site infection (SSI),neonatal ward and neonatal intensive care unit (NICU), hemodialysis center, and multidrugresistant organism (MDRO). Through the convening, baseline survey, and unified training, the participated hospitals started the project in accordance with the requirements, methods and contents. The project was initiated from October 2013; from October 2013 to March 2014, the investigation on HAI epidemiology, and implementation of prevention and control measures were carried out; from April to September 2014, various prevention and control intervention measures were conducted, and compliance to intervention measures were monitored .ResultsA total of 52 hospitals participated in the project, 49 hospitals reported the data.  Of deviceassociated infection (DAI) in ICUs, incidences of VAP, CLABSI , and CAUTI per 1 000 devicedays were 8.89‰, 1.32‰ and 2.02‰ respectively, in general ICUs were 9.6‰,1.4‰, and 2.2‰ respectively. Incidences of VAP and CAUTI between before and after intervention were both significantly different(both  P＜0.05). Hand hygiene compliance rate in ICUs was 76.33%（29 361/ 38 267）. Through taking intervention measures, overall compliance to  intervention measures and  hand hygiene among health care workers  all improved significantly, the differences between before and after intervention were all significantly different(all P＜0.05).ConclusionThe project effectively improved the implementation of prevention and control measures for HAI, reduced the incidence of HAI,  and is  worthy to be popularized.

Abstract:

ObjectiveTo evaluate the effect of comprehensive intervention measures on improving hand hygiene(HH) compliance of health care workers(HCWs) in intensive care units (ICUs) by multicenter study. MethodsA total of 47 hospitals in 12 provinces and cities were enrolled in the study, from October 2013 to September 2014,  HH compliance among HCWs in ICUs was investigated according to World Health Organization HH investigation method, HH compliance rates before and after intervention were compared. ResultsHH compliance rate of HCWs  in ICUs increased from 73.70%(11 155/15 135) before intervention to 78.70%(18 206/23 132) after intervention（χ2=128.16，P＜0.01）; except northeast region , HH compliance of HCWs in the other provinces increased significantly after intervention（all P＜0.05）; among all departments, HH compliance of HCWs in general ICUs, respiratory ICUs, emergency ICUs, and surgical ICUs increased significantly（all P＜0.05）; HH compliance of HCWs of all kinds of occupations  increased significantly（all P＜0.05）; HH compliance rates before touching a patient，before clean/aseptic procedure，after touching a patient，and after touching patient surroundings increased significantly after intervention（all P＜0.01）. ConclusionComprehensive interventions are helpful for improving HH compliance of HCWs in ICUs.

Abstract:

ObjectiveTo investigate the epidemiological characteristics of vancomycinresistant Enterococcus (VRE) infections in intensive care units (ICUs) of general hospitals in China，and provide scientific basis for infection prevention and control. MethodsA multicentre study was conducted, 46 hospitals of 12 provinces and cities in China were studied, VRE infection in ICU patients who were hospitalized from October 2013  to September 2014 was investigated prospectively according to  unified diagnostic criteria and methods.ResultsA  total of 33 443 patients in 58 ICUs were included in study，936 infection/colonization Enterococcus strains were isolated，of which 36  (3.85%) were VRE. 26 infection cases were hospitalonset infection(HOI) caused by VRE ,the incidence was 0.78‰, and 0.09/1 000 patientdays.  Nine infection cases were VRE communityonset infection (COI) ,incidence was 0.27‰. The main type of VRE infection specimen was urine (42.86%)，the main infection site and HOI site was urinary tract (45.71%, 50.00%,respectively). Of different ICUs, respiratory ICUs had the highest VRE isolation rate (20.00%), VRE HOI rate (8.04‰) and HOI incidence per 1 000 patientdays (0.47‰); Of different regions, southwest region had the highest VRE isolation rate (9.74%),  VRE HOI rate (3.68‰) and HOI incidence per 1 000 patientdays (0.35‰).ConclusionIsolation and infection rate of VRE in China are at low levels，but there are difference among different ICUs/regions，monitoring should be intensified continuously，rational use of antimicrobial agents and prevention and control measures should be implemented according to infection characteristics.

Abstract:

ObjectiveTo evaluate the effectiveness of intervention measures in reducing infection caused by multidrugresistant organisms (MDROs).MethodsFrom October 2013 to September 2014, a survey was conducted among 46 hospitals of 12 provinces and cities in China, from October 2013 to March 2014 was baseline investigation stage(before intervention), from April 2014 to September 2014 was intervention stage(after intervention), the occurrence of MDRO infection and compliance to prevention and control measures before and after intervention were compared.ResultsA total of 34 081 cases were monitored, the overall patientdays were 302 818 d, there were 1 122 episodes of hospitalonset infection(HOI), HOI case rate was 3.71‰ . Of various MDROs, infection case rate caused by carbapenemresistant Acinetobacter baumannii per 1 000 patientdays was  highest (2.47‰);  Of different intensive care units(ICUs),  incidence of HOI per 1 000 patientdays was highest in surgical ICUs ( 5.55‰). The overall MDRO HOI case rate decreased from 3.96/ 1 000 patientdays before intervention to 3.53 / 1 000 patientdays after intervention, the difference was significant (P=0.03). HOI case rate per 1 000 patientdays in respiratory and emergency ICUs decreased significantly after intervention(both P＜0.05).The compliance to prevention and control measures (isolation,  hanging isolation signs, hand hygiene, wearing gloves, item exclusive use), as well as doctors, nurses, and cleaning staff awareness enhanced significantly after intervention (all P＜0.05).ConclusionBy carrying out prevention and control measures on MDROs and monitoring the compliance to various measures, compliance to various measures can be improved, and MDRO HOI can decrease effectively.

Abstract:

ObjectiveTo investigate the epidemiological characteristics of deviceassociated infection (DAI) in neonatal intensive care units（NICUs）of tertiary firstclass hospitals in China,  and provide scientific evidence for the prevention and control of neonatal DAI.MethodsNeonates in NICUs at 17 hospitals of 9 provinces from October 2013 to September 2014 were selected for multicenter study, DAI was surveyed prospectively according to the uniform diagnostic criteria and methods.ResultsA total of 12 998 neonates were monitored, the total patientdays were 126 125 d, 13 cases of central lineassociated bloodstream infection (CLABSI) and 70 cases of ventilatorassociated pneumonia (VAP) occurred, central line utilization rate was 15.56%, incidence of  CLABSI was 0.66/1 000 devicedays; ventilator utilization rate was 7.67%, incidence of VAP was 7.23/1 000 devicedays. Utilization rates of central line and respirator in neonates with body weight ≤1 000 g was the highest, which were 61.06% and 29.91% respectively; In NICUs with 2030 beds, utilization rate of central line was the highest(16.67%),and respirator was the lowest(4.11%);of  hospitals in different regions, central line and respirator utilization rate in southwest China was the highest. Of different sizes  of ICUs, VAP per 1 000 devicedays was the lowest in NICUs with 2030 beds(2.36 ‰) . Difference in incidence of CLABSI and VAP per 1 000 devicedays in neonates at NICUs of different regions were  significantly different; incidence of CLABSI and VAP per 1 000 devicedays was highest in southern China(2.68 ‰ and 31.06‰ respectively),followed by southwest region. Of different quarters, incidence of CLABSI, and VAP per 1 000 devicedays were not significantly different(all P>0.05).ConclusionDevice utilization rate and incidence of DAI in China are both high, and are different in neonates of  different birth weight, at different sizes of NICUs, as well as different regions, monitoring should be intensified, prevention and control measures should be implemented according to infection characteristics.
［Key words］neonatal intensive care unit; central lineassociated bloodstream infection; ventilatorassociated pneumonia; epidemiology; multicenter study

Abstract:

ObjectiveTo evaluate the effect of evidencebased bundle intervention strategy on reducing the incidence of central lineassociated bloodstream infection (CLABSI).MethodsProspective and multicenter study was adopted, patients admitted to 54 intensive care units(ICUs) of 41 hospitals and with central venous catheters(CVCs) between October 1, 2013 and September 30,2014 were monitored . Baseline data between October 2013 and March 2014 were collected as preintervention data; from April to September 2014, the participated hospitals performed intervention strategy, postintervention data were compared with preintervention data.ResultsThe usage rate of CVCs before and after intervention was significantly different (44.18% vs 44.63%,χ2=5.526, P=0.019). Incidence of CLABSI before and after intervention was not significantly different(RR ，0.82［ 95%CI, 0.59-1.13］，P=0.10). Constituent ratio of catheter insertion sites between pre and postintervention was significantly different (χ2=76.264, P<0.001), femoral vein catheterization rate as well as proportion of two and above catheter insertion sites after intervention decreased（17.25% VS 13.72%; 2.27% VS 1.44%,respectively）; hand hygiene implementation rate and accuracy rate after intervention were both higher than before intervention (79.73% vs 76.14%, P<0.001; 91.47% vs 74.26%, P<0.001,  respectively); constituent ratio of skin disinfectant application before and after intervention was significantly different(χ2=3.861, P<0.001),  proportion of chlorhexidine ethanol increased (29.62% VS 50.56%); except daily assessment and record, compliance to other prevention and control measures before and after intervention were all significantly different(all P<0.001); utilization rate of maximal sterile barrier, qualified rate of dressing of operators,and port disinfection were all significantly enhanced.ConclusionBundle intervention in intubation and maintenance are implemented effectively, but intervention effect on CLABSI needs further study.

Abstract:

ObjectiveTo explore the incidences of ventilatorassociated pneumonia (VAP) in intensive care units(ICUs) in China. MethodsFrom October 2013 to September 2014, 46 hospitals in 12 provinces and cities were selected to participate in the study, all patients admitted to ICUs were included, the incidences of VAP were surveyed and compared with data from the U.S. National Healthcare Safety Network (NHSN).ResultsA total of 17 358 patients were surveyed, the total patientdays were 176 096 d, the total catheterdays were 91 448 d, 813 patients developed VAP, the incidence of VAP was 8.89/1 000 catheterdays, VAP mainly occurred in general ICUs (76.74%); the incidences of VAP were varied with patients in different types of ICUs,ranging from 4.50/1 000 catheterdays to 32.79/ 1 000 catheterdays.ConclusionThe incidence of VAP in patients in ICUs at 46 hospitals in China is significantly higher than that reported by NHSN, even higher than the P90.

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ObjectiveTo investigate the status and risk factors of surgical site infection (SSI) in  hospitals in China, so as to provide theoretical basis for the prevention and treatment of SSI. MethodsFour types of surgeries (colorectal surgery, abdominal hysterectomy, femoral neck repair surgery, and vascular surgery) in 29 hospitals were monitored prospectively, risk factors for SSI were analyzed.ResultsA total of 6 309 surgical procedures were investigated, incidence of SSI was 1.60%. Incidences of SSI in patients receiving colorectal surgery, abdominal hysterectomy, femoral neck repair surgery, and vascular surgery were 4.47%（74/1 655）,1.03%（22/2 139）,0.21%（5/2 372）,and  0.00%（0/143） respectively. The incidences of SSI were different among different regions(χ2= 114.213,P<0.05). The most common SSI was superficial incisional infection, the next was deep incisional infection. The major pathogens causing SSI were Escherichia coli, Enterococcus spp., coagulase negative staphylococcus, Staphylococcus aureus,and Klebsiella pneumoniae.The independent risk factors for SSI were male patients, long duration of surgery, and high NNIS score.ConclusionThe risk of SSI is varied with different types of surgeries. Male, long duration of surgery, and high NNIS score can increase the risk of postoperative SSI.

Abstract:

ObjectiveTo improve health care workers’ （HCWs） infection prevention and control consciousness through carrying out catheterassociated urinary tract infection(CAUTI) prevention and control project,and implement prevention and control measures in practical work.MethodsDiagnostic criteria of CAUTI issued by the U.S. Centers for Disease Prevention and Control / National Healthcare Safety Network were adopted, from October 2013 to September 2014, monitoring was conducted on CAUTI in patients with indwelling urinary catheters for ＞2 consecutive days at different types of ICUs in hospitals participated in the project .ResultsA total of 14 124 CAUTI cases were collected, 410 patients developed  CAUTI, urinary catheter usage rate was 79.33%(203 114/256 042), incidence of CAUTI was 2.02‰(410/203 114), urine specimen detection rate was 46.52%(6 570 /14 124). The detection rate of urine specimens increased from 37.24% (the fourth quarter of 2013) to 49.76% (the third quarter of 2014). Of prevention measures, the difference in the indication of catheterization was significantly different(P<0.01).ConclusionThrough  the development of competence building project of healthcareassociated infection prevention and control, prevention and control of CAUTI  has achieved good intervention effect.

Abstract:

ObjectiveTo evaluate the effectiveness of comprehensive intervention measures in reducing the incidences of multidrugresistant organism (MDRO) healthcareassociated infection(HAI) in intensive care units (ICUs). MethodsPatients admitted to 6 adult ICUs between January and December 2014 were chosen, and divided into two groups, patients admitted to ICUs between January and June  2014 (without taking special intervention measures) were as control group, between July and December 2014 (taking comprehensive MORO prevention and control measures) were as comprehensive intervention group. Incidences of MDRO HAI of two groups were compared.ResultsOf 1 030 patients in comprehensive intervention group, 391 were detected MDROs,105 developed  MORO HAI, incidence of HAI was 7.63/1 000 patientdays(105/13 753); of 1 230 patients in control group, 596 were detected MDROs, 133 developed  MORO HAI, incidence of HAI was 27.12/1 000 patientdays( 133/4 905),incidence of HAI in comprehensive intervention group was significantly  lower than control group(RR，0.28［95%CI，0.220.37］，P＜0.001）.ConclusionComprehensive intervention measures can effectively reduce the incidence of MORO HAI in ICUs.

Abstract:

ObjectiveTo improve hand hygiene (HH) compliance of health care workers (HCWs) in neonatal intensive care units(NICUs) in China through a series of intervention measures.MethodsA multicenter study was conducted, 17 tertiary first class hospitals in 9 provinces and cities were selected, HH compliance of HCWs in these hospitals were investigated every month according to HH investigation method of World Health Organization.From October 1 ，2013 to March 31，2014 was preintervention stage； from April 1, 2014 to September 30,2014 was postintervention stage, timely feedback and intensified training were conducted at postintervention stage. ResultsHH compliance rates of HCWs before and after intervention were 80.29% and 80.85% respectively, there was no significant difference (P＞0.05). HH compliance rates of  HCWs in different sizes of ICUs were significantly different before and after intervention (all P<0.05), in NICUs with<20 beds and  20-30 beds after the intervention were both significantly higher than before intervention (both P<0.05), while ＞30 beds were significantly lower than before intervention(P<0.001); HH compliance rate of cleaners increased from 58.82% before intervention to 68.09% after intervention (P<0.05); Of different hand hygiene indications, except before clean/aseptic task, compliance to the other HH indications were significantly different between before and after intervention(all P<0.05).ConclusionHH compliance is high among HCWs in NICUs in China, intervention measures, such as intensified training and timely feedback have certain influence in compliance to HH among HCWs at different sizes of ICUs, of different occupations, and at different HH indications.

Abstract:

手术部位感染（surgical site infection, SSI）是最常见的医院感染类型之一。美国每年发生160 000～300 000起SSI事件，占所有医院感染的20%。SSI会增加患者住院时间、再住院率和病死率；发生SSI的患者死亡风险是未感染患者的2～11倍。此外，SSI还会带来严重的经济负担，据报道［1］每例SSI患者额外支出费用为3 000～29 000美元，美国每年因SSI的经济损失高达100亿美元。因此，如何预防SSI的发生是医院感染防控的重点。现将国内外最新SSI防控研究进展综述如下。

Abstract:

血液透析是目前终末期肾病患者最有效和最广泛的治疗方法之一，但因其具有长期性和侵袭性的特点，加之患者的基础疾病及营养不良、免疫功能受损等情况，增加了其罹患感染的风险［12］。血液透析患者发生感染不仅加重本身的疾病，而且增加抗菌药物的使用率、住院日数，治疗费用及病死率［35］。因此，如何预防和控制血液透析患者并发感染，已成为近年来医院感染管理关注的重点。监测是防控的先决条件［610］。国外学者针对血液透析患者的血液透析事件进行了多方面的研究，但我国的相关研究极少。为使我国同行更好地了解血液透析事件监测，开展相关研究及工作，本文将从血液透析事件监测的重要性、发展过程、监测定义和内容、监测的现状及优劣势5个方面进行综述。

Abstract:

多重耐药菌（multidrugresistant organism, MDRO）是指对临床使用的3类或3类以上抗菌药物同时呈现耐药的细菌。常见的革兰阴性MDRO有产超广谱β内酰胺酶（ESBLs）的大肠埃希菌，耐碳青霉烯类鲍曼不动杆菌、多重耐药肺炎克雷伯菌、多重耐药铜绿假单胞菌等；革兰阳性MDRO主要包括耐甲氧西林金黄色葡萄球菌（MRSA）、多重耐药凝固酶阴性葡萄球菌、耐万古霉素肠球菌（VRE）等。