Abstract:

丙型肝炎病毒（hepatitis C virus，HCV）的慢性感染已成为备受全球关注的重要公共健康问题。据世界卫生组织（WHO）估计，全世界HCV的感染率约为2.8%，共1.85亿例，由其导致的死亡病例约35万/年。我国2006年全国血清流行病学调查统计显示，中国大陆约有560万慢性HCV感染者。然而，考虑到高危人群和高发地区的更多感染者，中国慢性HCV的感染人数预估可能为1 000万例。在慢性HCV感染的情况下，每年肝细胞癌（hepatocellular carcinoma，HCC）的发病率随着肝纤维化的进程而显著升高，未经治疗的肝硬化患者HCC的发病率为2%~8%［1］。而HCV阳性患者20年内发生肝硬化风险至少为10%~20%［2］。因此，对于慢性丙型肝炎患者而言，抗病毒治疗十分关键，可以减少并发症，提高患者生存率。

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ObjectiveTo understand epidemiological and etiological characteristics of serogroup C and W135 Neisseria meningitidis(Nm) in Hunan Province.MethodsNm strains isolated from blood or cerebrospinal fluid of patients with epidemic cerebrospinal meningitis, as well as throat swab specimens of close contacts of patients and healthy people in Hunan Province from 2006 to 2016 were collected, strains were performed biochemical testing and serological grouping. Partial strains of serogroup C and serogroup W135 were selected to perform antimicrobial susceptibility testing, and perform genotyping by pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST), epidemiological characteristics were analyzed.ResultsAfter being confirmed by biochemical and serological detection, 22 strains of serogroup C Nm and 9 strains of serogroup W135 Nm were selected to perform antimicrobial susceptibility testing, results showed that all strains were sensitive to most detected antimicrobial agents, but serogroup C Nm were all resistant to compound sulfamethoxazole, resistance rate of serogroup W135 Nm was 55.56%, difference was statistically significant （χ2=7.61，P=0.006）. After PFGE typing, 22 strains of serogroup C Nm were divided into 5 PFGE bands, HNC01 band of 5 strains and HNC02 band of 13 strains were of the same subtype; PFGE band of first isolated strain of serogroup C in Hunan Province in 2006 was HNC02, which was identical with strains isolated from patients and close contacts of patients in 2012 and 2013, there was only one band that was different from band HNC01 in strains isolated from patients in 2008, 2010, and 2013, all were dominant bands. 9 strains of serogroup W135 Nm were divided into 2 band patterns after PFGE typing, the strain from the first patient was the same type as the strains isolated from patients in 2013 and 2016, all were HNW01 type. Dominant strains were selected for MLST, results showed that serogroup C Nm was ST4821 type, serogroup W135 was ST11 type, all were highly pathogenic clones of Nm.ConclusionAfter the first case of serogroup C and serogroup W135 epidemic meningitis appeared in Hunan Province, both became the dominant epidemic clone group of the disease, serogroup C Nm decreased in recent years, but new epidemic types have emerged. Serogroup W135 became new epidemic strain of epidemic cerebrospinal meningitis in this province since 2012, the dominant strain is consistent with the globally invasive serogroup W, which may cause a new pandemic, corresponding prevention and control policy should be formulated timely.

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ObjectiveTo investigate the distribution of 16S rRNA methylase armA and its relationship with drug resistance of gramnegative bacteria from different sources.Methods953 strains of gramnegative bacteria from different sources were analyzed by conventional antimicrobial susceptibility testing, armA gene was detected by quantitative fluorescence polymerase chain reaction, relationship between carrying of armA gene and aminoglycoside susceptibility was analyzed.ResultsA total of 846 clinical gramnegative bacteria and 107 zoonotic Klebsiella spp. strains were collected, resistance rates of Acinetobacter spp. to amikacin and gentamicin were 86.4%(152/176) and 89.8%(158/176) respectively. Carrying rate of armA gene in Acinetobacter spp. was up to 66.5%. Resistance rates of 107 zoonotic Acinetobacter spp. strains to amikacin and gentamicin, as well as carrying rate of armA gene were all higher than clinical Klebsiella spp. strains, which were 74.8%, 79.4%, and 65.4% respectively. Resistance rates of 256 armAcarrying strains to amikacin and gentamicin were 95.7% and 98.4% respectively.ConclusionDifferent species of gramnegative bacteria had different aminoglycoside susceptibility and with different carrying rates of armA gene, but they all show high consistence between carrying of armA gene and aminoglycoside resistance phenotype, which suggest that the detection results of armA in gramnegative bacteria can predict the susceptibility of strains to aminoglycosides.

Abstract:

ObjectiveTo understand medical coping mode and its influencing factors among patients with tuberculosis(TB), and provide evidence for the development of clinical nursing strategies for TB patients.MethodsGeneral questionnaire and medical coping mode questionnaire(MCMQ) were used to investigate 402 TB patients in tuberculosis unit of a tertiary firstclass hospital in Changsha, medical coping mode and its influencing factors among TB patients were analyzed.ResultsThe scores of confrontation, avoidance, and acceptanceresignation dimensions of TB patients were (18.91±3.05), (15.49±2.62), and（10.00±3.01）respectively, score of confrontation dimension was statistically lower than domestic norm(P<0.05), but score of avoidance and acceptanceresignation dimensions were statistically higher than domestic norm(P<0.01). Factors influencing confrontation coping mode of TB patients were residence (city and town residents had a higher score, b=1.01, P=0.036), whether attending lecture on tuberculosis education (participants scored higher, b=1.71, P=0.001), and degree of understanding the disease conditions (the more understanding, the higher the score, b=0.55, P<0.001); factors that had significant influence on the avoidance dimension was the way of living (leading solitary life had a higher score, b=1.19, P=0.004); factors influencing acceptanceresignation of TB patients were course of tuberculosis(long duration scored higher, b=0.53, P=0.008), education degree (higher education level had lower score, b=-0.35, P=0.047), times of hospitalization due to tuberculosis (more hospitalization scored higher, b=0.58, P=0.002) and so on.ConclusionTB patients are prone to take avoidance and acceptanceresignation coping mode. The coping mode of TB patients is influenced by both demographic factors and disease factors such as residence， education level, the course of disease, times of hospitalization due to tuberculosis and so on.

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ObjectiveTo understand status of healthcareassociated infection(HAI) management in private medical institutions in China.MethodsPrivate medical institutions in 29 provinces in China were performed questionnaire survey in 2016, HAI management status in private medical institutions in China was analyzed.ResultsA total of 247 private medical institutions filled out the questionnaire, data of 246 private medical institutions were obtained after data were screened and sorted. 22 (8.94%) private medical institutions were tertiary hospitals, 236 (95.93%) had authorized beds, 132 (53.66%) set up independent HAI management departments, 240(97.56%) carried out training about HAI; among 246 medical institutions, only 17(6.91%) carried out informational monitoring on HAI, 197 (80.08%) conducted monitoring manually, and 32 (13.01%) didn’t carry out HAI monitoring. 240 (97.56%) medical institutions carried out hand hygiene training, 152 (61.79%) carried out occupational exposure monitoring for needlestick injury, among 205 medical institutions that filled out the annual number of training on safe injection, 169 (82.44%) carried out safe injection training, all or part of the fabric in 69 (30.53%) medical institutions were washed by social washing services or other medical institutions. In 223 medical institutions that carried out medical fabric washing management (226 filled out this data), HAI management departments in 67 (30.04%) hospitals participated. 187 (76.02%) medical institutions understood the work of HAI quality control center.ConclusionHAI management systems and organizations have gradually improved in private medical institutions, but attention should be paid to the strengthening of training for basic knowledge about HAI prevention and control, level of hospital information monitoring, and standardized management of medical fabric washing and disinfection. The quality control system of HAI management should be strengthened for private medical institutions.

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amikacin for treatment of patients with bronchiectasis and chronic obstructive pulmonary disease(COPD).MethodsPatients with bronchiectasis and COPD in a hospital from January 1, 2016 to December 31, 2016 were selected. They were randomly divided into trial group and control group. Two groups both received conventional treatment, control group was treated with 0.9% sodium chloride for bronchoalveolar lavage; trial group were given topical use of amikacin solution on the basis of conventional treatment. Efficacy of treatment, laboratory test results, and incidences of adverse reactions were compared between two groups of patients.ResultsA total of 47 patients were included in the study, 24 were in trial group and 23 in control group. After treatment, the total efficacy rate of trial group was significantly higher than that of control group (95.83% vs 69.57%, P<0.05). Pulmonary function (VC, FEV1, FEV1/FVC), peripheral white blood cell count (WBC), neutrophil percentage (N%), highsensitivity Creactive protein (hsCRP), and procalcitonin (PCT) levels in two groups of patients significantly improved after treatment compared with those before treatment, differences were all statistically significant (P<0.05). After treatment, improvement of pulmonary function in trial group was better than that of control group, WBC count, N%, hsCRP, and PCT were lower than control group, differences were all statistically significant (P<0.05); there was no significant difference in the incidence of adverse reactions between two groups（χ2=0.090，P=0.956）.ConclusionTherapeutic efficacy of BAL and topical amikacin in the treatment of patients with bronchiectasis and COPD is superior to 0.9% sodium chloride lavage, it does not increase the incidence of adverse reaction, can shorten length of hospital stay, and is worthy of clinical application.

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ObjectiveTo evaluate the effect of chlorhexidine bathing on reducing ventilatorassociated pneumonia(VAP).MethodsPatients with mechanical ventilation for>48 hours in the neurosurgical intensive care unit(ICU) in a hospital were intervened, chlorhexidine skin rubbing was performed once a day, effective supervision and management mechanism was established, incidence of VAP before intervention (JanuaryDecember, 2013) and after intervention (first stage: JanuaryDecember, 2014; second stage: JanuaryDecember, 2015) was compared.ResultsA total of 1 015 patients were investigated, implementation rate of chlorhexidine skin rubbing before intervention was 0, the first and second stages of postintervention were 55.36% and 88.49% respectively. Incidence of VAP per 1 000 ventilator days before intervention was 9.21‰, the first and second stage after intervention were 7.67‰ and 4.77‰ respectively， correlation analysis on two groups of data showed that there was a negative correlation between incidence of VAP and implementation rate of intervention measures(rs=-1.00, P<0.001).ConclusionDaily bathing with chlorhexidine can effectively reduce the incidence of VAP.

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ObjectiveTo understand isolation of carbapenemresistant Serratia marcescens(CRSM), analyze risk factors for infection and colonization with CRSM.MethodsPatients whose specimens were isolated Serratia marcescens(S. marcescens) in a hospital between January 2014 and December 2016 were recruited in the study. Patients who isolated CRSM were as case group, and those who isolated carbapenemsensitive Serratia marcescens(CSSM) were as control group. Patients’ medical records were surveyed retrospectively, univariate and logistic regression analysis of related factors were performed.ResultsA total of 120 patients were isolated S. marcescens, 38 were in case group, and 82 in control group. 32(84.2%) strains of CRSM and 61(74.4%) strains of CSSM were isolated from sputum respectively. Univariate analysis showed that risk factors for CRSM infection and colonization were patients with hypoproteinemia, respiratory failure, tracheal intubation or tracheotomy, vascular catheterization, history of carbapenem and fluoroquinolone use within two weeks, and history of staying in intensive care unit(all P<0.05). Multivariate analysis showed that hypoproteinemia and carbapenem use within two weeks were independent risk factors for CRSM infection and colonization(P<0.05).ConclusionInfection and colonization with CRSM is related to multiple factors, hypoproteinemia and carbapenem use within two weeks are independent risk factors.

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ObjectiveTo understand status of healthcareassociated infection(HAI) and changing trend of pathogens, evaluate the efficacy of HAI management and control measures, and provide basis for improving HAI management level.MethodsCombination of bedside survey and individual case survey was adopted to investigate the prevalence rates of HAI occurred among all hospitalized patients in a tertiary firstclass hospital at a given day in JulyAugust in each year of 2010-2016.ResultsFrom 2010 to 2016, a total of 8 434 patients were surveyed, 419 patients had 476 cases of HAI, HAI rate and HAI case rate were 4.97% and 5.64% respectively，HAI prevalence rates were 3.77%-6.16%，difference was not significant(χ2=10.98，P＞0.05）, prevalence rate of HAI in intensive care unit was 50.91%, mainly was lower respiratory tract infection(51.47%). The top 5 pathogens causing HAI were Acinetobacter baumannii (14.62%), Pseudomonas aeruginosa (14.62%), Klebsiella pneumoniae (13.08%), Escherichia coli (10.38%), and Staphylococcus aureus(7.31%). Antimicrobial usage rate on the survey day was 33.09%, antimicrobial usage rate and antimicrobial prophylaxis decreased from 47.92% and 49.19% in 2010 to 26.62% and 18.26% in 2016 respectively, bacterial culture rate in patients receiving therapeutic antimicrobial use increased from 5.16% in 2010 to 50.00% in 2016, differences were all statistically significant (χ2 =279.44, 265.21, 246.26, respectively, all P＜0.001）.ConclusionIncidences of HAI didn’t change significantly in recent 7 years, usage of antimicrobial agents has been standardized year by year, but pathogenic detection rate in patients receiving therapeutic antimicrobial use needs to be improved.

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ObjectiveTo analyze risk factors for death in elderly patients with ventilatorassociated pneumonia(VAP).MethodsPatients aged≥60 years and with VAP in a hospital from April 2011 to February 2017 were surveyed, clinical data of patients, including basic condition, infection status, and prognosis were collected, risk factors for death were analyzed.ResultsThere were 682 elderly patients with VAP, 198 (29.03%) died. There were 8 independent risk factors for death in elderly VAP patients: APACHE II score>15 points（OR, 2.482 ［95%CI, 1.473-4.183］）, mechanical ventilation>15 days（OR, 2.526 ［95%CI, 1.661-3.840］）, multidrugresistant organism infection（OR, 3.379 ［95%CI, 2.008-5.686］）, fungal infection（OR, 3.414 ［95%CI, 1.830-6.370］）, glucocorticoid use（OR, 2.075［95%CI, 1.265-3.403］）, serum albumin concentration＜35 g/L（OR, 2.129［95%CI, 1.386-3.268］）, number of organ damage≥3（OR, 3.438［95%CI, 2.165-5.459］）, and blood sugar≥10 mmol/L（OR, 1.744［95%CI, 1.106-2.751］）.ConclusionMortality of elderly patients with VAP is related to multiple factors, comprehensive prevention and control measures should be taken to interfere the main risk factors and reduce the mortality.

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ObjectiveTo conduct risk assessment on clinical departments in a tertiary firstclass general hospital using ranksum ratio(RSR) method, screen out highrisk departments of healthcareassociated infection(HAI), and provide basis for developing HAI control strategies.MethodsRSR method was used to select 7 indexes for conducting a risk assessment on HAI control in clinical departments of a hospital in 2016, a high, medium and low risk rating was defined.ResultsIn 2016, neither complete good nor complete bad results appeared in the completion of each assessed index in 28 clinical departments. There was a high correlation between ranksum value and probability units(correlation coefficient r=0.944，P＜0.01, Linear regression equation RSR=-0.022+0.106Y）. Frequency analysis on RSR values in each department showed that results conformed to normal distribution ( KS test，P=0.873），most departments were at moderate risk, and only a few departments were at high or low risk. Six departments at high risk were neurology, intensive care unit, trauma hand surgery, neurosurgery, joint surgery, and respiratory medicine, RSR values were 0.7165, 0.6763, 0.6652, 0.6406, 0.6317, and 0.6205 respectively.ConclusionRSR method can be used to assess the risk of HAI in a real, objective, and scientific way, define key points of HAI prevention and control, improve resource allocation of high risk departments, and reduce incidence of HAI.

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ObjectiveTo analyze the extra hospitalization expense and length of hospital stay due to healthcareassociated infection(HAI) in patients undergoing clean neurosurgical operation, and evaluate the economic loss caused by HAI.MethodsClinical data of patients who underwent clean operation in a neurosurgical department from January 2014 to December 2016 were collected, according to age frequencymatched case control method, 151 patients with single site HAI was as case group, 151 patients without HAI were randomly selected from the same age group and as a control group, hospitalization expense and length of hospital stay were compared between two groups of patients, economic loss caused by HAI was calculated.ResultsA total of 801 patients underwent clean neurosurgical operation, 194 patients had 245 cases of HAI, HAI rate and HAI case rate were 24.22% and 30.59% respectively，151 (18.85%) cases were single site HAI. Among patients with single site infection, hospitalization expense in patients with respiratory system infection was the highest, length of hospitalization in patients with urinary tract infection was the longest. The median of total hospitalization expense in case group and control group were 110 181 and 60 398 yuan respectively, difference was statistically significant（P＜0.05）；the median length of hospital stay in two groups were 30 days and 18 days respectively, difference was statistically significant (P<0.05); the average economic loss due to HAI was 52 661.64 yuan.ConclusionThere is huge economic loss due to HAI in patients undergoing clean neurosurgical operation, prevention and control of HAI is very important for reducing the economic loss caused by HAI.

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ObjectiveTo compare medical expense of patients with and without  intracranial infection after craniocerebral operation, analyze the costbenefit of prevention and control programme for surgical site infection (SSI) after craniocerebral operation. MethodsAll patients who underwent craniocerebral operation in department of neurosurgery in a hospital between June 2014 and May 2015 were surveyed retrospectively, a 1∶1 matched casecontrol study was adopted to compare medical expenses in patients with and without intracranial infection after craniocerebral operation, economic loss due to SSI after craniocerebral operation was calculated, cost of prevention and control programme for SSI was analyzed, benefit was calculated.ResultsLength of hospital stay in case group was longer than that of control group (25 ［20, 32］ d vs 16 ［12, 19］ d, P<0.001 ). Total hospitalization expense of case group was more than that of control group (96 150.6 ［69 415.0, 153 079.6］ yuan vs 59 438.6 ［50 092.6, 77 336.4］ yuan, P<0.001). The top 5 expenses were fees for medicine, operation, therapy, examination, and laboratory testing, each expense of infected patients was higher than that of uninfected patients. If incidence of SSI decreased by 5% due to the implementation of SSI prevention and control programme in department of neurosurgery, the generated economic benefit was enough to pay the cost of programme; when infection rate decreased by 20%-30%, the ratio of benefit to cost could reach 4-6. ConclusionIntracranial infection after craniocerebral operation can bring a heavy economic burden to patients, implementation of prevention and control programme for SSI in department of neurosurgery can not only reduce the economic burden of patients, but also increase hospital income and improve medical quality.

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ObjectiveTo analyze clinical features of children with measles in the department of infectious disease in a children’s hospital, provide basis for clinical diagnosis and treatment of measles. MethodsA retrospective analysis on demographic data, clinical features, laboratory examination, treatment, and prognosis of children with measles in a children’s hospital from January 1 to June 30, 2016 were analyzed retrospectively. ResultsA total of 248 children with measles were investigated, the average age was 18.2 months; 98 cases were aged ≤9 months, 150 were aged ＞9 months; 242 children with measles didn’t receive measles vaccination. Body temperature of 83.06% of children with measles was >39℃, the average course of fever was 7.8 days; 24 cases had atypical rash. Two groups of children were both mainly complicated with pneumonia, accounting for 93.95%; incidences of hoarseness, cough, laryngitis, and heart failure in children ≤9 months were higher than children>9 months (P<0.05); while typical rash, koplik spots, photophobia, respiratory failure, and severe measles were lower than children>9 months(P<0.05); there was no significant difference in the number of cured cases between two groups of children(P>0.05). Of 248 children with measles, 41 had peripheral white blood cells＞10×109/L；28.26% of children who complicated with pneumonia were isolated Streptococcus pneumoniae from sputum; 93.95% were reported pneumonia by chest Xray examination; 9 cases complicated with respiratory failure and used invasive mechanical ventilator, 6 cases cured, 3 died. ConclusionChildren aged>9 months who don’t receive measles vaccine are more, and they are prone to develop severe measles, and children aged ≤9 months are easily combined with heart failure.

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ObjectiveTo explore distribution and antimicrobial resistance of pathogens causing soft tissue infection (STI) in children. MethodsChildren with STI and had positive bacterial culture in a hospital between January 2010 and January 2017 were analyzed, they were divided into communityassociated STI group(CASTI) and healthcareassociated STI(HASTI) group, pathogens and antimicrobial resistance of pathogens causing STI were analyzed. ResultsA total of 165 STI patients were with positive bacterial culture. There were 98 cases in CASTI group and 67 in HASTI group. 16 kinds of bacteria were isolated. 98 cases of CASTI were single bacterial infection, 92 of which were grampositive bacteria, mainly Staphylococcus aureus (S. aureus, n=85, 86.7%) and Streptococcus pyogenes (n=4, 4.08%); 6 strains were gramnegative bacteria, mainly Escherichia coli(E. coli, n=3, 3.06%) and Klebsiella pneumoniae(n=2, 2.04%). 67 cases were HASTI, 5 cases were mixed infection with two kinds of bacteria, 72 strains of bacteria were isolated, 13 were grampositive bacteria strains, mainly S. aureus (n=9, 12.50%）；59 were gramnegative bacteria, mainly E. coli (n=21, 29.17%）, Pseudomonas aeruginosa (P. aeruginosa, n=15, 20.83%), and Enterobacter cloacae(E. cloacae, n=13, 18.06%). Resistance rates of S. aureus to penicillin, erythromycin, and lincomycin were all＞50%，resistance rates to gentamicin, compound sulfamethoxazole, and rifampicin were all ＜20%，isolation rate of methicillinresistant S. aureus (MRSA) was 43.62%, strains were all sensitive to vancomycin, linezolid, tigecycline, levofloxacin, moxifloxacin, and nitrofurantoin. Resistance rates of E. coli to cefuroxime and sulfamethoxazole were all ＞70%，resistance rates to piperacillin, cefepime, and levofloxacin were all ＜30%, imipenemresistant E. coli and P. aeruginosa were not found. ConclusionS. aureus is the main pathogen causing CASTI in children; the main pathogens of HASTI are E. coli, P. aeruginosa, E. cloacae, and other gramnegative bacteria. Children with STI can choose antimicrobial agents according to types of infection before pathogens are identified.

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ObjectiveTo understand status of occupational exposure of health care workers(HCWs), analyze the causes and risk factors, and provide basis for effective precaution measures.MethodsRetrospective analysis was performed to investigate and analyze the occupational exposure occurred in a hospital from January 1, 2013 to December 31, 2016.ResultsA total of 632 cases of occupational exposure occurred in this hospital, 62.02% (n= 392 cases) occurred among nurses, 61.23%(n=387 cases) occurred among HCWs who worked for less than 2 years. The top three occupational exposure opportunities were needle withdrawal after transfusion, centralized disposal of used sharp objects(including needles), and surgical suturing, accounting for 15.19%, 14.71%, and 12.18% respectively. Among devices causing sharp injury, scalp steel needle accounted for the largest proportion (n=137, 23.42%), the next was suture needle(n=96, 16.41%). Hepatitis B virus was the major bloodborne pathogen causing occupational exposure, accounting for 58.86%, followed by unknown exposure sources(18.04%); general ward was the main location of occupational exposure（38.61%）.ConclusionIt is necessary to strengthen occupational safety precaution education, improve HCWs’ ability of preventing occupational hazard, correct potentially dangerous operation, strengthen classification and management of medical waste, so as to reduce hazard to HCWs induced by occupational exposure.

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ObjectiveTo investigate status and influencing factors of hand hygiene(HH) of hospitalized puerperas while breastfeeding, and take intervention measures to improve HH status of puerperas.MethodsA selfdesigned questionnaire was used to investigate puerperas in the department of obstetrics in a hospital from April to May 2017, training about HH knowledge and skill was carried out, compliance rate and correct rate of HH among puerperas before and after training were observed.ResultsA total of 48 puerperas were included in the investigation. The survey results showed that only 54.17% of puerperas washed their hands before breastfeeding; compliance rate and correct rate of HH before intervention were 44.05% and 45.95% respectively, after intervention were 79.49% and 61.29% respectively, difference in compliance rate was statistically significant before and after intervention (χ2 =21.37, P＜0.01）.ConclusionSystematic and standardized training on HH knowledge and skill for puerperas is helpful for improving their compliance and standardization of HH, which is of great significance for reducing maternal and infant infection.

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ObjectiveTo understand hand hygiene(HH) compliance among nursing staff, and evaluate the effective strategies to improve HH compliance.MethodsHH compliance among 59 nurses in the internal medicine ward of a tertiary comprehensive hospital was investigated between January 2016 and June 2017, HH compliance rates of nursing staff with different professional titles and different working years were compared.ResultsHH compliance rate of 59 nurses was 69.6%, HH compliance rates of five moments for HH were: before touching a patient（59.7%）, before clean/aseptic procedure（96.2%）, after body fluid exposure risk （97.7%）, after touching a patient（56.3%）, after touching patient surroundings（42.0%）. Difference in compliance rate of different HH moments was statistically significant （χ2=220.393，P＜0.001）. HH compliance rates among nurses of different professional titles after touching patient were significantly different（χ2=6.521，P=0.038）. HH compliance rates of nurses with different working years before and after touching patient were significantly different（χ2=8.385,16.123，respectively, P＜0.05）.ConclusionThe overall HH compliance rate among nursing staff is low, management of HH compliance of junior nurses should be strengthened, and implementation of HH before and after touching patient should be emphasized.

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丙型肝炎病毒容易导致慢性感染，是我国慢性肝病主要病因之一。近年来，直接抗病毒药物(directacting antiviral agent,DAA) 的出现，为慢性丙型肝炎的治疗带来了革命性的变化。与传统的干扰素联合利巴韦林的治疗方案相比，DAA抗病毒治疗的效果好，且口服方便、不良反应少，适用范围广［12］。目前，随着国民经济水平的提高和药物购买的方便性，部分慢性丙型肝炎患者可以通过购买仿制或原研新型DAA进行抗病毒治疗。DAA获得持续性病毒学应答（sustained virological response, SVR）的比例较高，给丙型肝炎患者带来了治愈的希望。但是，随着应用病例的增加以及治疗时间的延长,也有少数患者难以获得SVR，或者获得SVR后复发。我们在临床上观察到类似病例，现将相关内容报告如下。

Abstract:

抗菌药物的发现是二十世纪巨大的医学成就。抗菌药物的使用大大降低了传染疾病的病死率，挽救了无数生命，也使以前的一些绝症，如结核病都有了治疗的方法。然而最近六十年，我们开始从抗菌药物的辉煌时代走向抗菌药物耐药性时代［1］。2014年世界卫生组织发布了全球耐药报告［2］，指出抗菌药物耐药细菌正蔓延至全球各地。