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ObjectiveTo understand genetic mutation sites in linezolid (LZD)sensitive and inducible resistant strains of methicillinresistant Staphylococcus aureus(MRSA) using wholegenome sequencing, and realize mutation sites of LZDresistant gene.MethodsMRSAMS4 with explicit genotype and wholegenome sequences was induced by LZD of different concentration gradients, LZDresistant strain MRSAMS4LZD100 was obtained, minimum inhibitory concentration(MIC) was detected, domain V of 23S rRNA and ribosomal proteins L3/L4 gene in MRSAMS4LZD100 were amplified by polymerase chain reaction (PCR), the sequenced products obtained the corresponding mutation site in contrast with the wildtype strain; Illumina PE library was constructed through pairedend sequencing by Illumina HiSeq 2000 technique, and whole genome sequencing was completed based on bioinformatics.ResultsMRASMS4LZD100 strain was induced after 32 passages, MIC of LZD was 96 μg/mL. Sequencing of PCR products indicated the genetic variations were G2447T mutation in multiple copies of domain V of 23S rRNA gene, and Gly113Val mutation in L3 protein respectively; the whole genome of MRSAMS4LZD100 contained 2 744 315 bp, annotation of the whole genome found a total of 2 509 genes, 11 tRNAencoding genes and 2 entire rRNAencoding operons. The data were submitted to the PubMed, and the GeneBank accession number JXMJ00000000 was assigned; a total of 101 SNPs and 6 Small indels were found, 16 of 101SNP mutations occurred in exon, of which the variant proteins with anmino acid sequence alterations included IstB ATP binding domaincontaining protein, clumping factor A, IS1272 transposase and so on; 3 of 6 Small indel mutations occurred in exon, of which the variant proteins with anmino acid sequence alterations included hypothetical protein, 30S ribosomal protein S1, and clumping factor A.ConclusionLZDresistant strain MRSAMS4LZD100 was successfully induced by LZD; beside 23S rRNA V domain and ribosomal L3 protein, the other mutant site exist in this resistant strain, which provide some direction for subsequent study of recessive LZD resistance mechanism.

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ObjectiveTo investigate the characteristics of healthcareassociated infection(HAI) in elderly hospitalized patients, and analyze the risk factors for HAI.MethodsIncidences of HAI in elderly(elderly group) and nonelderly hospitalized patients (control) in a tertiary firstclass hospital were investigated, the underlying diseases, infection sites, department distribution and so on between two groups of patients were compared.ResultsThe incidence of HAI in elderly group was higher than that in control group（3.38% vs 1.45%, P＜0.05）；the proportions of hypertension and diabetes mellitus in elderly group was higher than control group, while cerebrovascular disease was lower than control group. The proportion of lower respiratory tract infection, urinary system infection and antimicrobialassociated diarrheal in the elderly were higher than control group（41.62% vs 28.00%, 15.44% vs 12.02%, 6.03% vs 3.15%, respectively）. The incidence of catheterassociated urinary tract infection in the elderly group was higher than that in control group（6.85‰ vs 3.95‰, RR95%CI=1.209-2.485, P＜0.05）. The proportion of HAI in the elderly group in internal medicine departments was higher than that in control group（52.71% vs 40.03%），while in intensive care unit was lower than control group(33.52% vs 41.19%）.ConclusionThe characteristics of HAI in elderly patients are closely related to their demographic characteristics, early prevention of HAI in key sites should be carried out according to its characteristics.

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ObjectiveTo investigate the effect of Dectin1 on the release of inflammatory factors interleukin10(IL10) and tumor necrosis factorα (TNFα) in rat tracheal epithelial cells (RTECs) stimulated with heattreated Candida glabrata(C. glabrata).MethodsRTECs cultivated in vitro were randomly divided into three groups, including control group(RTECs +sterile normal saline), fungal stimulation group(RTECs + heattreated C. glabrata), and inhibitor intervention group(RTECs + laminarin + heattreated C. glabrata), cells were harvested after incubation for 0, 2, 4, 6 hours respectively, cell survival rate was determined by MTT method, expression of Dectin1 was analyzed by Western Blot, expression of IL10 and TNFα were detected by enzymelinked immunosorbent assay (ELISA).ResultsHeattreated C. glabrata destroyed cell structure and reduced cell survival rate. At the beginning of the culture (0 h), cell survival rate, expressions of Dectin1, IL10 and TNFα among three groups were all not significantly different(all P>0.05). After incubation for 2, 4, 6 hours, expressions of Dectin1, IL10 and TNFα in fungal stimulation group and inhibitor intervention group were both significantly higher than control group; expressions of Dectin1, IL10,and TNFα in inhibitor intervention group was lower than fungal stimulation group(all P<0.05). The expressions of IL10 in inhibitor intervention group at 0 h and 2 h was not significantly different, expressions of Dectin1, IL10, and TNFα in fungal stimulation group and inhibitor intervention group at different incubation periods were significantly different(all P<0.05).ConclusionDectin1 is an important receptor for RTECs to recognize the heattreated C. glabrata, it induces the release of IL10 and TNFα, and mediate the occurrence of inflammation.

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ObjectiveSurgical site infection (SSI) is associated with morbidity, increased healthcare costs and in some cases poor outcomes in patients. The purpose of this study was to identify the burden of SSI and the risk factors among hospitalized patients undergoing spinal surgery in a Chinese hospital.MethodsA prospective cohort study was performed in patients who underwent spinal surgery in a hospital of traditional Chinese medicine (TCM) in China from June 26 to November 30 in 2014. SSI was diagnosed according to the Centers for Disease Control and Prevention (CDC) criteria of the U.S., and was identified by bedside surveillance and postdischarge follow up. The detailed characteristics of pre, intra and postoperative patients were recorded with a standardized data collection form.ResultsA total of 192 patients with spinal surgery were included in the study, 7(3.6%) of these patients developed SSI. Contaminated and dirty/infected wound, surgical drainage, and blood transfusion were associated with increased Odds of SSI by bivariate analysis. Intravenous antimicrobial prophylaxis (AMP) was given in 120 of 192 (62.5%) spinal surgery. The average duration of AMP administered was 2.2 days (range, 1-9), 139 (72.4%) of 192 patients were prescribed TCM after spinal surgery.ConclusionThe incidence of SSI among patients after spinal surgery in a hospital of TCM in China was identified. This study is served as a reference for studying SSI in spinal surgery in future, and also provides the valuable information to formulate SSI prevention programs.

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ObjectiveTo investigate the current status of healthcareassociated infection (HAI), communityassociated infection（CAI）, and antimicrobial use in hospitalized patients in medical institutions of Guizhou Province.MethodsIn September 2014, infection status of hospitalized patients in 174 second level hospitals and above in Guizhou Province were performed crosssectional survey.ResultsA total of 68 419 patients were surveyed, the actual survey rate was 99.65%. 1 581 patients developed 1 684 cases of HAI, HAI prevalence rate and HAI case prevalence rate were 2.31％ and 2.46％ respectively, 18 571 patients developed 19 191 cases of HAI, CAI prevalence rate and CAI case prevalence rate were 27.14％ and 28.05％ respectively; patients in general intensive care unit(ICU) and pediatric department(nonneonatal group) had the highest HAI and CAI prevalence rates respectively. Constituent ratios of HAI and CAI sites was significantly different(χ2=17 325.44，P＜0.01）；Escherichia coli was the main pathogen causing HAI and CAI. Utilization rate of antimicrobial agents on the survey day was 39.82%, ICU (80.47%) and pediatric department(76.67%) were the highest. Therapeutic antimicrobial use accounted for 67.48%(n=18 386), single antimicrobial use accounted for 79.55% (n=21 672). Pathogenic detection rate of specimens from patients receiving therapeutic antimicrobial agents was 31.76%.ConclusionThis survey is helpful for understanding the high risk departments and sites of HAI and CAI in Guizhou Province, as well as pathogenic detection rate of specimens from patients receiving therapeutic antimicrobial agents, which provides basis for further prevention and control of HAI.

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ObjectiveTo monitor ventilatorassociated event (VAE) for the first time in an intensive care unit (ICU) in China, understand the applicability, incidence，and clinical significance of VAE in China.MethodsTargeted monitoring on VAE was performed among patients ≥18 years and with mechanical ventilation (MV)>2 days in the ICU of a hospital between January 2014 and September 2015, incidence of VAE was calculated, and patients were grouped according to whether or not they had VAE, prognostic factors were analyzed statistically.ResultsA total of 1 004 patients were monitored, the total hospital stay was 13 795 days in patients who used ventilator, 307 (30.58%) cases of VAE occurred, incidence of VAE per 1 000 ventilatordays was 22.25. Univariate analysis showed that patients with VAE had longer length of ICU stay and MV, and higher mortality rate than patients without VAE when they moved out of ICU (all P<0.05). Multivariate logistic regression analysis showed that VAE was independent risk factor for length of ICU stay, duration of MV, as well as mortality when patients moved out of ICU(all P<0.05).ConclusionJudgment of VAE is based on MV parameters, it is more objective and accurate. There is a high incidence of VAE among ICU patients, it may lead to poor clinical outcomes, and has good values for the targeted monitoring on ICU patients in large comprehensive hospitals of China.

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ObjectiveTo evaluate the prophylactic efficacy and safety of posaconazole against invasive fungal disease（IFD）in hematologic patients with neutropenia.MethodsMedical records of 18 hematologic patients with neutropenia received posaconazole for preventing IFD in a Beijing hospital between 2014 and 2015, the efficacy and safety was evaluated.ResultsThere was no clinical diagnosis or confirmed diagnosis of IFD among 18 patients during posaconazole prophylaxis period, none of patients stopped posaconazole due to severe adverse reaction. Two patients with acute myeloid leukemia(AML) died of pulmonary infection, 1 of whom isolated Stenotrophomonas maltophilia from sputum culture on the 12th day of posaconazole prophylaxis, the other isolated Escherichia coli from sputum culture on the 14th day of posaconazole prophylaxis. Other patients all adherence to posaconazole prophylaxis until granulocyte count recovered, patients were followed up until 100 days medication, no death occurred. The lowest peripheral neutrophil count was(0.00-0.27)×109/L during posaconazole prophylaxis period, with the median of 0.02×109/L；the duration of posaconazole prophylaxis was 8-27days, with the median of 16 days; among patients without IFD breakthrough or received systemic use of other antifungal agents, there were 2 (11.1%) allcause death within 100 days; there were no adverse reaction, such as liver function abnormalities≥grade 2 and kidney function abnormalities≥grade 2, as well as QTc prolongation.ConclusionPosaconazole is effective for preventing IFD in hematologic patients with neutropenia, adverse reaction is rare.

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ObjectiveTo explore the effect of antimicrobial use density (AUD) on the detection rate of methicillinresistant Staphylococcus aureus (MRSA) and antimicrobial resistance rate of healthcareassociated Staphylococcus aureus (HASA) half a year later.MethodsFrom 2012 to 2015, all types of AUD, detection rate of MRSA, and antimicrobial resistance rate of HASA were calculated semiannually, correlation between antimicrobial resistance rate of HASA and all types of AUD in the same first half of year were analyzed with correlation analysis and multiple linear regression.ResultsFrom the first half of 2012 to the latter half of 2015, the total AUD declined from 128.2 to 49.0, except the AUD of carbapenems rose, AUD of other antimicrobial agents declined. From the latter half of 2012 to the latter half of 2015, 104 249 patients were admitted to the hospital, and 1 008 strains of SA were isolated from 40 884 specimens, 857 (85.02%) of which were communityassociated SA(CASA) and 151 (14.98%) were HASA. Isolation rate of HAMRSA declined from 31.25% in the latter half of 2012 to 12.50% in the latter half of 2015；isolation rate of CAMRSA rose from 7.08% to 16.08%, resistance rate of HASA was generally higher than that of CASA. Antimicrobial resistance rate of HASA to ciprofloxacin remained the same, to levofloxacin increased, to 8 other antimicrobial agents all declined; resistance rates of CASA to oxacillin, ciprofloxacin, clindamycin, gentamicin, and levofloxacin increased, but to other antimicrobial agents declined;  no SA strains was found to be resistant to vancomycin and linezolid. The resistance rate of HASA to azithromycin and erythrocin was correlated with the AUD of macrolides, resistance rate of HASA to clindamycin was correlated with the AUD of aminoglycosides, to gentamicin was correlated with the AUD of macrolides and the total AUD. ConclusionThe selective pressure of antimicrobial agents is still the important cause of the occurrence of antimicrobial resistance, decreasing the AUD of antimicrobial agents will help for reducing the detection rate of HAMRSA and drug resistance rate of HASA.

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ObjectiveTo investigate the bactericidal mechanism of electrolyzed oxidizing water (EOW) against Pseudomona aeruginosa(P. aeruginosa).MethodsBactericidal mechanism of EOW against P. aeruginosa was studied through intracellular protein leakage, nucleic acid,and cell membrane calcium ion permeability, 2% glutaraldehyde was used as positive control group, and normal saline (NS) was used as negative control group.ResultsThe killing rates of EOW and 2% glutaraldehyde to P. aeruginosa were both>99.99% with 30second contact time, and 100.00% with 60second contact time. After 60second contact with EOW, NS, and 2% glutaraldehyde，the protein leakage of P. aeruginosa detected by bicinchoninic acid (BCA) were （96.00±7.42）,（94.15±7.49）, and （216.97±10.35）μg/mL, respectively, difference was significant（F=613.20，P＜0.01），2% glutaraldehyde group was higher than EOW group and NS group; protein leakage did not change with the increase of contact time(all P>0.05). Electrophoretogram of random amplified polymorphic DNA showed high intensity dense band between 500-1000 Kb in EOW group and NS group, while 2% glutaraldehyde group was without amplified bands. The fluorescence intensity of calcium ion of EOW group and 2% glutaraldehyde group were both lower than that of NS group.ConclusionBactericidal mechanism of EOW may be due to the damage of membrane permeability of P. aeruginosa, which causes Ca2+ leakage, but fails to cause protein leakage, the damage to nucleic acid is not obvious, DNA may not be a bactericidal target of EOW.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit (PICU), provide reference for empirical treatment of bloodstream infection in critically ill children.MethodsPathogenic bacteria isolated from blood culture of children in a PICU in 2011-2015 were identified and performed antimicrobial susceptibility testing.ResultsA total of 180 strains of pathogens were isolated from 3 215 blood specimens, the positive rate was 5.60%, 153（85.00%） of which were grampositive bacteria and 27（15.00%） were gramnegative bacteria. The top five isolated pathogens were Staphylococcus epidermidis(26.67%)， Staphylococcus hominis(25.00%)，Staphylococcus haemolyticus(11.66%)， Escherichia coli(5.55%)，and Staphylococcus aureus(3.89%). The resistance rates of Staphylococcus spp. to linezolid, vancomycin, and quinupristin/dalfopristin were all 0; the detection rates of methicillinresistant coagulasenegative staphylococci (MRCNS) and methicillinresistant Staphylococcus aureus(MRSA) were 70.18% and 42.68% respectively； Escherichia coli had high resistance rates to ampicillin， cefazolin， ceftriaxone， gentamycin, and compound sulfamethoxazole（50.00%-80.00％）.ConclusionCNS and Escherichia coli are the main pathogens in blood culture of children in PICU, differences in antimicrobial resistance exist among different types of CNS.

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ObjectiveTo investigate the status of safe injection practice in primary medical institutions.Methods55 primary medical institutions in Hubei Province were randomly selected, questionnaire survey on status of safe injection in primary medical institutions was conducted.ResultsA total of 55 questionnaires were distributed, 50(90.91%) valid questionnaires were obtained. All valid questionnaires were from primary level medical institutions of Hubei Province, 16 of which were from community health centers, 17 from township health centers, and 17 from village health clinics. None of 50 primary medical institutions repeatedly used syringe and hemostix, all used disposable sterile syringe, only 7(14.00%) medical institutions used retraction type selfdestructing syringe. Only 5 (10.00%) medical institutions were equipped with hand hygiene facilities and sharps containers, 32 (64.00%) medical institutions didn’t provide sharps containers on treatment carts, 21 (42.00%) injection rooms didn’t install handdrying facilities, 18（36.00%）medical institutions didn’t provide alcoholbased hand rub on treatment carts and didn’t install handdrying facilities in treatment rooms. Of sharp injures among health care workers(HCWs) reported in 2015,114 HCWs sustained 117 times of injuries, 74 cases（63.25%） were caused by ampoule. Of medical waste disposal, there existed some problems,such as leakage and repeated use of sharps box, didn’t close sharps box timely, as well as without providing sharp containers in locations where sharps might be produced.ConclusionThere are a variety of hidden risks of unsafe injection in primary medical institutions, like insufficient facilities and unsafe disposal of medical waste.

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ObjectiveTo investigate the change in distribution and antimicrobial resistance of Acinetobacter baumannii(AB) in an intensive care unit(ICU), and provide basis for rational use of antimicrobial agents in the clinical practice.MethodsUsing retrospective investigation study, data about pathogenic bacteria isolated from patients who were hospitalized in ICU in 2010-2014 were collected, distribution and antimicrobial resistance of AB were statistically analyzed.ResultsA total of 3 807 bacterial strains were isolated from ICU patients in 2010-2014, 488(12.82%) of which were AB, isolation rate increased from 6.94% in 2010 to 17.33% in 2014 （χ2=45.58，P＜0.01）. AB was mainly isolated from sputum, accounting for 72.13%, followed by wound secretion, blood, catheter, urine and so on; AB had the lowest resistance rate to amikacin(<30%), resistance rates to imipenem and meropenem increased significantly year by year (value of trend χ2 test were 42.99 and 53.91 respectively, both P＜0.001);  resistance rates of AB to other antimicrobial agents were all>50%.ConclusionDetection rate and antimicrobial resistance rate of AB increased year by year, clinical surveillance on bacterial resistance should be paid more attention, patients should be isolated by effective measures, so as to control and prevent the prevalence of AB in ICU.

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ObjectiveTo understand the status of infection with multidrugresistant organisms (MDROs) in intensive care units(ICUs), and evaluate the intervention efficacy of targeted monitoring.MethodsProspective study was adopted, patients who were admitted to ICUs in 2014-2015 were selected (JanuaryDecember 2014 was as preintervention stage, JanuaryDecember 2015 was as intervention stage), trend of MDRO infection before and after intervention were compared and analyzed.ResultsBefore and after intervention, 297 and 217 strains of MDROs were isolated respectively, except carbapenemresistant Pseudomonas aeruginosa (CRPA), the isolated strains of carbapenemresistant Acinetobacter baumannii (CRAB), carbapenemresistant Enterobacteriaceae (CRE), methicillinresistant Staphylococcus aureus(MRSA), and vancomycinresistant Enterococcus (VRE) declined after intervention. MDRO infection rate declined from 7.17 ‰ before intervention to 3.88‰ after intervention, infection rate of CRAB and CRE after intervention were both lower than before intervention (both P<0.05); MDRO infection rates in general ICU and internal medicine ICU increased from 8.75‰ and 7.84‰ before intervention to 4.39‰ and 2.28‰ after intervention, respectively (both P<0.05). After taking comprehensive intervention measures, compliance to prevention and control measures, such as ordering rate of doctor’s advice on contact isolation for 24 hours, hand hygiene, health care workers’ awareness all enhanced significantly(all P<0.05).ConclusionTargeted monitoring and intervention measures can reduce isolation rate of MDROs in ICUs.

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ObjectiveTo analyze risk factors for surgical site infection(SSI) in cardiac surgery patients, so as to provide basis for making control measures.Methods215 patients who underwent cardiac surgery in a hospital between January 2012 to December 2014 were investigated, univariate analysis and multivariate logistic regression analysis were used to analyze the related risk factors for postoperative SSI.ResultsThe incidence of postoperative SSI in cardiac surgery patients was 16.28%（35/215）. Univariate analysis showed that the incidence of postoperative SSI was relatively higher in patients aged>65 years, duration of operation>5 hours，continuous operation, preoperative hospitalization time >7 days, irrational perioperative antimicrobial use, as well as patients with underlying diseases such as hypertension and diabetes mellitus. Multivariate logistic regression analysis indicated that the age, duration of operation, continuous operation, preoperative hospitalization time, irrational perioperative use of antimicrobial agents, and patients with underlying diseases were independent risk factors for SSI in patients who underwent cardiac surgery.ConclusionIncidence of SSI is higher in patients with cardiac surgery, preventive measures should be taken to control risk factors such as duration of operation, so as to reduce the incidence of SSI.

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ObjectiveTo explore the distribution and antimicrobial resistance of pathogens causing healthcareassociated infection(HAI) in a hospital, and provide theoretical basis for rational use of antimicrobial agents and control of HAI.MethodsHAI occurred in patients in this hospital between 2011 and 2015 were chosen, distribution of major pathogens causing HAI and antimicrobial resistance were analyzed.ResultsA total of 852 pathogenic strains were isolated, including 458 (53.75%) strains of gramnegative bacteria, 259 (30.40%) fungi, and 135(15.85%) grampositive bacteria, the top 4 pathogens were Klebsiella pneumoniae(n=159，18.66%), Candida albicans (n=119，13.97%), Acinetobacter baumannii(n=81，9.51%), and Escherichia coli(n=74，8.69%). Isolation rate of gramnegative bacteria increased from 47.41% in 2012 to 61.57% in 2015, fungi increased from 24.78% in 2011 to 34.45% in 2014 (2015 was 27.95%), grampositive bacteria decreased from 26.55% in 2011 to 10.48% in 2015. Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem and meropenem were 8.11%-12.58%；Acinetobacter baumannii had the lowest resistance rate to cefoperazone/sulbactam(23.46%)，resistance rate of Candida albicans to fluconazole was up to 59.66%，vancomycinresistant grampositive bacteria was not found.ConclusionThe major pathogens causing HAI are opportunistic pathogens, antimicrobial resistance is serious, the species and distribution varies with different years, it is necessary to enhance specimen detection rate, strengthen the monitoring on pathogen resistance, and use antimicrobial agents rationally.

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ObjectiveTo analyze the risk factors for ventilatorassociated pneumonia(VAP) in the intensive care unit(ICU) of a hospital, and provide theoretical reference for preventing and controlling VAP.MethodsICU patients receiving mechanical ventilation for more than 48 hours between October 2013 and December 2014 were monitored by targeted monitoring method, risk factors for the occurrence of VAP were analyzed.ResultsA total of 483 patients received mechanical ventilation for more than 48 hours, 76 (15.73%) of whom developed VAP; the overall ventilator days were 5 347 days，incidence of VAP was 14.21 per 1 000 ventilator days. Univariate analysis showed that groups of gender, age, length of hospital stay, and duration of artificial airway were all significantly different, VAP rate in male patients was higher than that in female patients（χ2 =9.838，P＜0.01）；VAP rate was highest in patients aged 41-70 years（χ2 =10.242，P＜0.01），followed by patients aged≥71 years; VAP rate were relatively higher in patients with longer length of hospital stay and longer duration of artificial airway（χ2 =59.533，P＜0.01；χ2 =74.215，P＜0.01, respectively）.ConclusionIncidence of VAP in the ICU of this hospital is higher, especially in male patients, patients aged 41-70 years, as well as patients with long length of hospital stay and long duration of artificial airway.

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ObjectiveTo investigate cognitive status of medical students of a medical university on laboratory biosafety, and provide basic data for laboratory biosafety management in Chinese universities.Methods900 fulltime undergraduate medical students were chosen by cluster random sampling, questionnaires were filled out in by them.Results900 questionnaires were distributed, 877 (98.21%) valid questionnaires were obtained, 49.03% (n=430) were from sophomores, 50.97%（n=447）from juniors，148（16.88%）students have ever participated in students’ scientific research. The overall awareness rate of laboratory biosafety was 58.72%, only 32.16% of students understood the detailed contents of laboratory biosafety regulations, only 8.21% of students have received training in laboratory biosafety; the awareness rate of laboratory biosafety cabinet was only 14.14%, only 7.75% of students knew which operation should be performed in biosafety cabinet; 28.28% of students could deal with waste according to the rules, 68.19% of students were able to identify warning signs of biological hazard; 92.82% of the students thought that laboratory biosafetyrelated courses should be set up. The overall awareness rate of laboratory biosafety knowledge and safety behavior was low, which were 42.65% and 41.96% respectively, juniors was higher than that of sophomores(P<0.05); in the aspect of chemical hazards and biological hazards, students with scientific research experience scored higher than those who did not participate in scientific research(all P<0.05).ConclusionMedical students’ cognition on knowledge of laboratory biosafety is not optimistic, it is imperative to strengthen the management of education and publicity of laboratory biosafety.

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ObjectiveTo compare the main hygiene indicators before and after clean operating rooms are used, evaluate the influencing factors, and find out the improvement measures.MethodsIn 2015, some cleaning operating rooms in Chengdu were detected, according to different service years and maintenance status, operating rooms were divided into newlybuilt group, replacement group, and nonreplacement group, change in qualified rate of three groups of clean operating room indicators were analyzed.ResultsA total of 111 cleaning operating rooms were detected, including 56 newlybuilt operating rooms, and 55 operating rooms (24 in replacement group,31 in nonreplacement group) which have been used for more than 1 years. The qualified rate of air cleanliness in newlybuilt group, replacement group, and nonreplacement group were 98.21%, 100.00%, and 74.19% respectively, difference among three groups was significantly(P<0.001）, the qualified rate of air cleanliness in newlybuilt group and replacement group were both higher than nonreplacement group, while newlybuilt group and replacement group was not significantly different(P=1.000）；difference in bacterial concentration, static pressure difference, and ventilation frequency of air in operating rooms of three groups were all not statistically significant(all P>0.05).ConclusionAfter clean operating room have been used for one year, air cleanliness declined, there was no significant change in static pressure difference and air exchange frequency, which indicates that when concentration of airborne bacteria is qualified, risk of infection due to unqualified air cleanliness still needs to be paid attention, the replacement of high efficiency particulate air filter in clean operating rooms can significantly improve the cleanliness of operating rooms.

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ObjectiveTo understand hand hygiene(HH) among health care workers(HCWs) in primary medical institutions in Shijiazhuang, and evaluate HH compliance, so as to formulate the strategy for HH management.MethodsIn 2015, one countylevel comprehensive medical institution and two township medical institutions from each of seven counties of Shijiazhuang city were randomly selected, HH qualified rates of HCWs in all divisions of internal medicine before clinical procedures and after HH were analyzed statistically.Results118 HCWs before clinical procedures and 130 HCWs after HH were monitored. The qualified rate of HH of physicians and nurses before clinical procedures were 44.26%(27/61) and 40.35%(23/57) respectively; HH qualified rate of nurses in township hospitals before clinical procedures were higher than countylevel hospitals（χ2=6.447，P=0.011）; the qualified rate of HH of physicians and nurses after HH were 98.41%(62/63) and 98.51%(66/67) respectively; there were significant differences in the qualified rates before clinical procedures as well as after HH in HCWs at different levels and types of medical institutions（all P<0.05）.ConclusionThe qualified rate of HH among HCWs in primary medical institutions in Shijiazhuang before clinical procedures is low, medical institutions should improve the HH compliance among HCWs from various aspects.

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ObjectiveTo evaluate the effectiveness of hospital environmental cleaning practice by fluorescence labeling method.MethodsFrom January to February 2015, 312 ward rooms in 7 hospitals were chosen, high touch object surface were labeled with fluorescence, after object surface being cleaned by cleaners, clearance rates of fluorescence labeling were calculated (as baseline survey data), training and onsite guidance for cleaners were performed(intervention measures), fluorescence labeling clearance effect before and after intervention was compared.ResultsA total of 110 ward rooms were performed baseline survey, the fluorescence labeling clearance rate of 2 856 touched clean surface was only 50.81%, the quantitative evaluation value was 45.70; after intervention, 202 rooms were surveyed, fluorescence labeling clearance rate of 3 992 touched clean surface enhanced to 79.23%, the quantitative evaluation value was 76.30；there was significant difference in fluorescence labeling clearance rate between before and after intervention （χ2=612.14，P<0.05）. In the baseline survey, the clearance rates of fluorescence labeling on touched surface of medical instruments, hospital beds, and toilets were 46.07%, 37.80%, and 25.20% respectively; after intervention , the clearance rates were 80.59%, 75.90%, and 51.70%，respectively. After intervention, fluorescence labeling clearance rates of beepers, toilet seat covers, toilet electrical switches, and chairs were low, the clearance rates of these touched surface in baseline survey were＜30%，after intervention were 47.03%-68.32%；the clearance rates of other high touch surface were all>75%. ConclusionFluorescence labeling method can directly reflect the operation quality of cleaners, and improve the cleanliness of ward environment, it is a simple, inexpensive and objective globally popular method for evaluating hospital environment cleanliness.

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ObjectiveTo understand the occupational exposure among medical laboratorians in a hospital, and put forward prevention and control measures.MethodsOccupational exposure among medical laboratorians in the department of laboratory medicine of a hospital from January 2011 to December 2014 were analyzed statistically.ResultsA total of 72 cases of occupational exposure occurred among 217 laboratorians during 4 years, occupational exposure rate was 33.18%, the occupational exposure rate in interns was 46.23%, and in laboratorians with working seniority< 1 years was 49.56%. Occupational exposure mainly occurred in outpatient blood collection room(accounting for 38.89%），the main occupational exposure types were injuries by blood collection needles, skin contaminated by blood and body fluid(76.39%). Occupational exposure rates in medical laboratorians in this hospital during 2011-2014 were 53.66%（22/41）, 41.67%（20/48）, 26.23%（16/61）, and 20.90%（14/67）, respectively，which presented a declining tendency（χ2 =12.286，P＜0.01）. After occupational exposure, only 23 cases were reported according to the requirements of infection management department, the missing report rate was 68.06% (49/72), correct handling rate was 80.56%（58/72）.ConclusionLaboratorians should strengthen education and training of healthcareassociated infection management, improve safety and prevention consciousness, standardize handling process, improve consciousness of reporting, so as to reduce the occurrence of occupational exposure and post exposure infection.

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艰难梭菌(Clostridium difficile,CD)是一种专性厌氧的革兰阳性芽孢杆菌，1935年首次在新生儿肠道正常菌群中被分离出来。1978年起人们发现该细菌是引起抗生素相关性腹泻、医院性腹泻及假膜性肠炎的主要病原体。有资料显示，25%～30%的抗生素相关性腹泻以及90%以上的假膜性肠炎均是由CD引起的，美国由艰难梭菌感染(Clostridiumdifficile infection,CDI)所致的病死率可达7.1%［1］。但是，不是所有的CD均会产生典型的临床症状，CD致病主要是因为产生A、B两种毒素。有研究认为，毒素B对于CDI感染的发生、发展至关重要［2］。因此，对于CDI的诊断应当基于毒素的检测，而不仅仅是细菌的鉴定。

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