Abstract:

ObjectiveTo understand the current situation of hand hygiene(HH) facilities in China.MethodsA multicenter study was conducted to select different levels of hospitals (province, district, and county levels) and army hospitals in 14 provinces (municipalities and autonomous regions). HH facilities in hospital wards were conducted field survey, installation of HH facilities in different sections of different wards in 2010 and 2016 were compared.ResultsThe total installation rate of hand wash sink in hospital increased from 69.30% in 2010 to 77.20% in 2016（χ2=37.68，P<0.01）； in 2016, the faucet switch in hospital wards was mainly inductive (39.39%), follows by handtype and foottype switch, accounting for 29.65% and 17.67% respectively；the main way of hand drying was use of paper towel, accounting for 77.30%. The rate of hand drying by using paper towel increased from 38.45% in 2010 to 77.30% in 2016, rate of hand drying naturally fell from 18.65% to 8.04%. The total equipping rate of alcoholbased hand rub in hospitals increased from 50.47% in 2010 to 75.64% in 2016, difference was statistically significant（χ2=402.46，P<0.01）. In 2016, equipping rate of alcoholbased hand rub in different sections of different wards were all significantly different (department of respiratory disease medicine: χ2=69.49，P<0.01；department of general surgery: χ2=66.97，P<0.01；intensive care unit ［ICU］: χ2=88.52，P<0.01）. The equipping rate of alcoholbased hand rub in treatment room was the highest (treatment rooms in departments of respiratory medicine, general surgery, and ICU were 89.50%, 88.50%, and 88.54% respectively), equipping rate of alcoholbased hand rub in patients’ rooms and corridor of common wards was lowest (about 60%). Except for the corridor equipping rate was 56.25%, equipping rate of alcoholbased hand rub in other sections of ICU were all over 80%.ConclusionCompared with 2010, the equipping of hand washing basin, alcoholbased hand rub, faucet switch, and hand drying method have improved significantly in 2016, but allocation of HH facilities is uneven in different wards, it is necessary to improve HH facilities to meet the requirement of healthcareassociated infection prevention and control.

Abstract:

ObjectiveTo investigate carbapenemase genes and molecular epidemiological characteristics of carbapenemresistant Klebsiella pneumoniae(CRKP), so as to provide laboratory basis for healthcareassociated infection（HAI） control and clinical treatment. Methods13 strains of CRKP isolated from Taian City Central Hospital between January and November 2014 were collected, bacterial identification and antimicrobial susceptibility testing were performed by WalkAway 96 PLUS automatic bacterial analyzer; carbapenemase phenotypes were confirmed by modified Hodge test and EDTAdisk synergy test; carbapenem resistance genes (blaKPC, blaIMP, blaVIM, blaGIM, and blaNDM1) were amplified by polymerase chain reaction (PCR), then sequenced; clone correlation of strains was investigated by pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST), epidemiology comparison was performed. Results13 strains of CRKP were mainly isolated from sputum (n=7, 53.85%) and urine (n=4, 30.77%), resistance rates to compound sulfamethoxazole and tetracycline were all low (all <40%), to the other antimicrobial agents (except amikacin) were all>70%, resistance rates to carbapenems were all 100%; 13 strains were all positive for modified Hodge test, 5 strains were positive for EDTAdisk synergy test; sequencing of PCR confirmed that blaKPC gene was most common among carbapenemase genes (13/13), followed by blaNDM1 gene (5/13), while blaIMP, blaVIM, and blaGIM gene were not found; clustering analysis of PFGE showed that 13 strains of Klebsiella pneumoniae were divided into 5 types, mainly type C (9/13), all belonged to ST11, others were ST37, ST626, ST628, and ST668 respectively. ConclusionCarbapenemase genes blaKPC and blaNDM1 are the main causes of the resistance of Klebsiella pneumoniae to carbapenems in this hospital, ST11 is the main clone type, hospital should strengthen the prevention and control of HAI as soon as possible.

Abstract:

ObjectiveTo establish a quantitative realtime polymerase chain reaction（qPCR） assay for rapid detection of Staphylococcus aureus (SA) and its mecA gene, rapidly and accurately diagnose SA infection as well as preliminarily determine its drug resistance.MethodsSequences of nuc, atl, icaB, fnbA, hla, and srap genes of SA were downloaded from NCBI database for screening of markers, and sequence of mecA gene was used for screening of methicillinresistant SA (MRSA); sequence alignment was conducted by DNA MAN, conserved region of each gene sequence was employed for designing primers and fluorogenic probes. Simplex and duplex qPCR were established, and gene sequences with the best detection performance were screened by clinical and standard strains as markers, a duplex qPCR system for identifying SA and drug resistance was developed and evaluated.ResultsThe atl gene（CP009361.1：1010217-1010341）and mecA gene （KF058908.1：1715-1843）possessed the best detection performance, and were used as detection markers in the duplex qPCR system. qPCR system could amplify both targets in a range of 2.0×1028 copies/mL with a strong linear relationship and lower detection limits for both targets reached 4 copies/PCR. Among 335 positive culture specimens for SA (including 94 MRSA) from patients, 335 and 94 specimens were detected SA and MRSA by duplex qPCR respectively; among 95 negative culture specimens for SA from patients, 17 and 4 specimens were detected SA and MRSA by duplex qPCR respectively, PCR products were sequenced, the homology with standard strain were all≥90%. Time from specimen processing to result reporting was≤2.0 hours by duplex qPCR method.ConclusionqPCR method is simple, rapid, sensitive, and specific, it’s a promising way to improve the diagnostic efficacy of SA infection and achieve the rapid detection, which contributes to the early precision treatmen

Abstract:

ObjectiveTo explore risk factors for catheterassociated urinary tract infection (CAUTI) in hospitalized patients, and provide reference for prevention of CAUTI.MethodsCase control studies about the risk factors for CAUTI in hospitalized patients were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, China Biology Medicine (CBM), and PubMed from 2007 to 2017. After literature screen, data extraction, and quality evaluation were performed, Revman 5.3 software was used to carry out comprehensive quantitative analysis, OR value and 95% confidence interval (CI) for each risk factor was calculated.ResultsA total of 10 literatures were included, with a total of 2 652 patients. Seven risk factors that with predictive value for CAUTI were extracted from literatures, Meta analysis results showed that the combined OR value of each factor and its 95%CI were as follows: urinary catheter indwelling time (OR, 1.57 ［95%CI, 1.33-1.86］), age≥60 years (OR, 2.24 ［95%CI, 1.09-4.59］), gender (OR, 1.21 ［95%CI, 0.54-2.72］), diabetes mellitus (OR, 3.49 ［95%CI, 2.61-4.66］), antimicrobial use (OR, 2.58 ［95%CI, 0.70-9.55］), disturbance of consciousness (OR, 4.51 ［95%CI, 3.33-6.09］), and No. of intubation≥2 times (OR, 2.60 ［95%CI,1.62-4.18］). Two risk factors (gender and antimicrobial use) were not statistically significant(P>0.05), combined results of other factors were statistically significant (all P<0.05).ConclusionUrinary indwelling time≥5 days, patients’ age≥60 years, combined with diabetes mellitus, disturbance of consciousness, and No. of intubation≥2 times are  main risk factors for CAUTI; predictive value of gender and antimicrobial use in CAUTI needs to be further evaluated. Nursing staff should pay more attention to the above factors and take specific preventive measures to reduce the incidence of CAUTI.

Abstract:

ObjectiveTo understand species, distribution, and antimicrobial resistance of common pathogens from patients with sepsis in intensive care unit（ICU），and provide reference for rational application of antimicrobial agents in sepsis patients. MethodsClinical data of sepsis patients who were admitted to the ICU of a hospital from January 2015 to June 2016 were collected retrospectively, pathogenic detection and antimicrobial susceptibility testing results of specimens were analyzed. ResultsA total of 175 sepsis patients were selected, 241 pathogens were isolated, 129 of which were multidrugresistant organisms(MDROs); 139 (57.68%) were gramnegative bacteria, 68 (28.22%) were grampositive bacteria, and 29 (12.03%) were fungi; the top 5 isolated strains were Escherichia coli (E. coli, 20.75%), Klebsiella pneumoniae (K. pneumoniae, 14.11%), Acinetobacter baumannii (A. baumannii, 13.28%), Candida albicans (C. albicans, 12.03%), and Pseudomonas aeruginosa (P. aeruginosa, 9.54%). The top five isolated MDROs were A. baumannii (29/32, 90.63%), Enterococcus faecium (16/20, 80.00%), K. pneumoniae (24/34, 70.59%), Staphylococcus spp. (14/21, 66.67%), and P. aeruginosa (14/23, 60.87%）. The isolation rates of extendedspectrum βlactamases (ESBLs)producing E. coli and K. pneumoniae were 68.00%(34/50) and 17.65%(6/34) respectively, E. coli had low resistance rates to carbapenems and βlactamase inhibitors, K. pneumoniae was only sensitive to tigecycline; A. baumannii was generally resistant to antimicrobial agents, P. aeruginosa was only sensitive to polymyxin; Enterococcus spp. and Staphylococcus spp. were sensitive to glycopeptide, linezolid, and tigecycline; C. albicans was generally sensitive to antifungal agents. ConclusionResistance rate of pathogens isolated from sepsis patients in ICU in this hospital is high, especially A. baumannii. Enzyme inhibitors, carbapenems, and glycopeptide are still effective antimicrobial agents for empirical antiinfection treatment.

Abstract:

ObjectiveTo explore the risk factors for pulmonary infection(PI) in patients with severe craniocerebral injury, and provide basis for clinical prevention and control of PI.Methods418 patients with severe craniocerebral injury and admitted to the Third People’s Hospital of Haikou were selected, they were divided into PI group (n=152) and nonPI group (n=266) according to whether the PI occurred, sputum culture of patients with PI was performed. Univariate and multivariate logistic regression analysis were conducted to analyze the risk factors for PI in patients with severe craniocerebral injury.ResultsIncidence of PI in 418 patients with severe craniocerebral injury was 36.4% (152/418). 168 strains of pathogens were isolated from 152 patients with PI, mainly gramnegative bacteria (66.7%) and grampositive bacteria (25.0%). Univariate and multivariate logistic regression analysis showed that duration of surgery≥4 hours, mechanical ventilation≥7 hours, tracheotomy, drainage tube indwelling, Glasgow Coma Scale (GCS)<5, and acute physiology and chronic health evaluation (APACHE II) score≥18 were independent risk factors for PI in patients with severe craniocerebral injury, OR (95%CI) values were 5.837（3.125-13.168）, 3.172（1.748-5.975）, 5.106（2.683-11.829）, 4.913（2.284-10.716）, 3.625（1.972-7.218）, and 2.618（1.327-4.721）respectively.ConclusionIncidence of PI in patients with severe craniocerebral injury is high, it is necessary to strengthen nursing and early prevention according to risk factors, so as to reduce the incidence of PI.

Abstract:

ObjectiveTo understand microbial contamination and existing problems of B ultrasonic probe with disinfectant coupling agent, and prevent healthcare associated infection caused by B ultrasonic probe.MethodsB ultrasonic probe with disinfectant coupling agent was carried out sampling survey in a large tertiary firstclass hospital in Hubei Province, bacteria from contaminated probe were counted and identified, SPSS 19.0 software was used for statistical analysis.ResultsA total of 95 B ultrasonic probe specimens were collected, 28.42% were isolated bacteria, the qualified rate was 77.89%; of different departments, qualified rate of B ultrasonic probe in department of gynecology and obstetrics was the highest (92.00%), in physical examination center was the lowest (38.46%); of different types of B ultrasonic probe, qualified rate of transvaginal B ultrasonic probe after covering condom/sterile glove, heart B ultrasonic probe, abdominal B ultrasonic probe, and  transvaginal B ultrasonic probe before covering condom/sterile glove were all≥80%，qualified rate of transvaginal B ultrasonic probe after covering condom/sterile glove was the highest(85.71%），highfrequency probe was the lowest（57.14%），there was no significant difference in qualified rate of different types of B ultrasonic probe (χ2=6.91, P=0.141); 4 strains of methicillinresistant Staphylococcus aureus(MRSA) were isolated, carbapenemresistant Acinetobacter baumannii(CRAB) strain was not found.ConclusionMicrobial contamination exists on B ultrasonic probe with disinfectant coupling agent, health care workers’ awareness on disinfection and isolation should be improved, corresponding cleaning and disinfection system should be set up, monitoring and management should be carried out regularly.

Abstract:

ObjectiveTo understand current situation of disinfection management in primary medical institutions, and provide scientific basis for strengthening the prevention and control system of healthcareassociated infection(HAI) in primary medical institutions.MethodsA stratified sampling method was used to select 70 primary medical institutions in Pengjiang District and Jianghai District of Jiangmen City, these institutions performed intravenous injection and/or oral diagnosis and treatment. From April to September 2016, baseline investigation on HAI management status in these medical institutions were performed field trip and questionnaire survey. From February to December 2016, disinfection efficacy in key departments in 70 primary medical institutions and 11 municipal medical institutions was monitored. Brainstorming and expert evaluation were used for risk assessment, risk assessment matrix method was adopted to get the risk level of each risk factor.Results70 primary medical institutions included 7 countylevel hospitals, 12 community health service centers, 14 township health centers/health stations, and 37 private clinics. Of 70 primary medical institutions, only 17.14% (12/70) had adequate HAI management regulations or procedures. Hand hygiene facilities was insufficient, only 55.71% (39/70) of institutions used alcoholbased hand rub. 84.29% (59/70) of institutions installed ultraviolet light, only 17.14% (12/70) of institutions could monitor the intensity of ultraviolet light irradiation regularly. Only 12.86% (9/70) of institutions installed sewage treatment equipment. 2.86% (2/70) and 11.43% (8/70) of institutions respectively had the ability of selfchecking for medical sewage and disinfection efficacy. A total of 816 specimens were conducted disinfection efficacy detection, overall qualified rate was 96.20% (785/816). The qualified rates of indoor air, inuse disinfectant, medical device, and dialysis water all reached 100%; and the lowest rate was medical sewage (61.54%). The qualified rate of object surface disinfection in primary medical institutions was lower than that of municipal medical institutions, difference was statistically significant (P<0.05). Risk assessment results indicated that sterilizer and dialysis water were very high risk projects, hand hygiene, environmental disinfection, and medical devices were high risk projects.ConclusionThere are a lot of deficiencies in the disinfection management of medical institutions in Jiangmen City, risk assessment method can help center for disease prevention and control find the key points of disinfection management of medical institutions, improve the efficiency of surveillance work.

Abstract:

ObjectiveTo improve the balance of each covariate using propensity score matching(PSM), provide a new method for evaluating economic burden of healthcare associated infection(HAI).Methods158 976 patients who were discharged from a large general hospital between January 1, 2015 and December 31, 2016 were selected as the studied subjects, a 1∶1 PSM matching of patients with HAI and without HAI was performed by SPSS 22.0 software, balanced database after matching was analyzed to evaluate the effect of HAI on patients’ length of hospital stay and hospitalization expense.ResultsA total of 2 388 pairs were successfully matched by using PSM, the successful matching rate was 97.75%, there was no statistical difference in covariates between HAI group and nonHAI group after matching (all P>0.05). The median of length of hospital stay in HAI group and nonHAI group were 21 and 10 days respectively, difference in median was 11 days, difference between two groups was statistically significant (P<0.05). The median of total hospitalization expenses in HAI group and nonHAI group were 33 618.38 and 15 004.93 Yuan respectively, difference in median was 18 613.45 Yuan, difference between two groups was statistically significant (P<0.05). Fees for bed, western medicine, traditional Chinese medicine, therapy, examination, laboratory testing, diagnostic check, nursing, blood transfusion, operation, material, and anesthesia in HAI group were all higher than nonHAI group (all P<0.05), difference in expense of western medicine was the largest, which was 6 987.00 Yuan, the other fees were not significantly different.ConclusionPSM results showed that HAI causes serious financial burden, PSM can provide a new method for evaluating the economic burden of HAI.

Abstract:

ObjectiveTo study the costbenefit of disposable medical supplies (disposable urinary catheter package, disposable dressing exchange package, disposable ventilator tube, disposable plastic shoe cover) and reusable medical supplies (urinary catheter package, dressing exchange package, ventilator tube, slipper), evaluate advantages and disadvantages of economic benefits and social benefits of disposable medical supplies and reusable medical supplies.MethodsThe production activities in the central sterile supply department were regard a series of activities by using activitybased costing method and qualitative analysis, completing a task consumed a certain amount of resources, according to producing characteristics of supplies and different requirements of cost management, product cost structure was systematically summarized, the actual cost was calculated. The amount of medical waste produced by reusable medical supplies instead of disposable medical supplies was calculated.ResultsThe cost of reusable and disposable urinary catheter package were 12.15 Yuan/set and 16.00 Yuan/set respectively, cost saving was 3.85 Yuan/set; cost of reusable and disposable dressing exchange package were 6.07 Yuan/set and 5.50 Yuan/set respectively, increase of cost was 0.57 Yuan/set; cost of reusable and disposable ventilator tube were 68.47 Yuan/set and 80.00 Yuan/set respectively, cost saving was 11.53 Yuan/set; cost of reusable slipper and disposable plastic shoe cover were 0.03 Yuan/pair and 0.17 Yuan/pair respectively, cost saving was 0.14 Yuan/pair. Supposing the above medical supplies were reused instead of single used, taking a hospital as an example, cost saving in 2014 was 187 409.50 Yuan, and the amount of medical waste was reduced by 30 839.6 kg; cost saving in 2015 was 133 243.64 Yuan, the amount of medical waste was reduced by 43 517.5 kg.ConclusionThe cost of reusable medical supplies is lower than that of disposable medical supplies, promoting the use of reusable medical supplies can reduce cost of medical treatment, reduce medical expenses of patients, reduce producing of medical waste, and save limited resources of country.

Abstract:

ObjectiveTo explore the application efficacy of visualization labeling management in healthcareassociated infection(HAI) management in department of traditional Chinese medicine of a general hospital.MethodsDepartment of traditional Chinese medicine in a general hospital was selected, May August 2016 was pre intervention group, September December 2016 was postintervention group. Color, logo, flow chart, and other visual labeling management models were applied to the management of the department of traditional Chinese medicine. Quality inspection results and environmental hygiene monitoring of HAI prevention and control before and after intervention was compared.ResultsBefore and after the implementation of visual labeling management model, health care workers’ total scores in testing of theoretical knowledge on HAI prevention and control were （71.90±10.89） and （88.47±5.85）respectively, difference was statistically significant (t=2.08, P<0.05). After the implementation of visual labeling management, the scores in hand hygiene, disinfection and isolation, aseptic manipulation, medical waste, and occupational exposure of HAI prevention and control quality inspection were all higher than those before intervention, difference were all statistically significant (all P<0.05). After the implementation of visual labeling management, the qualified rate of environmental hygiene monitoring was higher than that before intervention, difference was statistically significant (82.43% vs 46.58%, χ2=29.79，P=0.000）, the qualified rate of object surface, hands of doctors and cleaning staff were all higher than those before intervention, differences were all statistically significant(all P<0.05). There was no significant difference in the qualified rate of nurses’ hygiene hand before and after intervention (P>0.05).ConclusionThe adoption of visual label management can improve the quality of HAI management in department of traditional Chinese medicine, enhance health care workers’ awareness on control of HAI, and reduce the risk of occurrence of HAI.

Abstract:

ObjectiveTo explore scientific and effective intervention method for rational use of antimicrobial agents, and provide reference for improving rational rate of antimicrobial prophylaxis.MethodsPatients who received class I incision operation and discharged from hospital in JanuaryDecember 2011(preintervention group) and JanuaryDecember 2016 (postintervention group) were selected as studied subjects. Intervention program was formulated, use rate and rational rate of antimicrobial prophylaxis between two groups of patients receiving class I incision operation were monitored and compared before and after intervention.ResultsBefore and after intervention, 1 027 and 3 820 cases of class I incision operation in two groups of patients were monitored respectively. Since January 2012, comprehensive intervention measures for rational use of antimicrobial prophylaxis has been adopted, after intervention, prophylactic antimicrobial use rate in patients undergoing class I incision operation decreased from 97.18% (998/1 027) to 21.23% (811/3 820), prophylactic antimicrobial use rate in seven types of operation patients dropped from 96.33% (210/218) to 1.88% (25/1 330); rational rate of antimicrobial agent selection rose from 21.14% to 99.38%; rational rate of antimicrobial use time rose from 76.05% to 99.01%; rational rate of treatment course increased from 23.95% to 99.06%; combined antimicrobial use rate decreased from 12.73% to 0; rational rate of supplemental antimicrobial agents during operation increased from 11.72% to 95.18%; difference between two groups before and after intervention were all statistically significant (all P<0.01). Incidence of SSI before and after intervention were 0.32% and 0.61% respectively, difference was not significant（χ2=0.75，P=0.54）.ConclusionEffective intervention can standardize antimicrobial prophylaxis during perioperative period, meets the relevant requirements of national standards.

Abstract:

ObjectiveTo understand the occurrence of totally implantable venous access port（TIVAP）related infection, and explore its risk factors.MethodsA total of 2 098 patients with breast cancer who received TIVAP in a tertiary firstclass hospital in Henan Province between January 2013 and December 2016 were selected as the research subjects. By nested case control study, 26 patients with TIVAPrelated infection during monitoring period were selected as case group, according to the proportion of 1∶2, 52 patients undergoing the same kind of operation during the same period were randomly selected as control group, difference in general data and research indexes between two groups was compared. Logistic regression model was used to analyze the risk factors for TIVAPrelated infection.ResultsDuring monitored period, the total TIVAP day was 274 838 days, 26 patients developed TIVAPrelated infection, incidence of TIVAPrelated infection was 1.24%, infection rate per 1 000 venous access day was 0.09‰; the main pathogen causing infection was Staphylococcus epidermidis (30.77%); independent risk factors for TIVAPrelated infection in patients were history of diabetes mellitus (OR, 3.61 ［95%CI, 1.27-10.11］), duration of venous access≥90 days (OR, 4.71 ［95%CI, 1.65-13.22］), and duration of operation≥40 minutes (OR, 3.60 ［95%CI, 1.34-9.64］). ConclusionIt is necessary to strengthen the monitoring and followup of patients receiving TIVAP, especially for patients with diabetes mellitus, as well as long duration of catheterization and operation, so as to prevent and control TIVAPrelated infection.

Abstract:

ObjectiveTo analyze the application efficacy of acidic electrolyzed oxidizing water (AEOW) in healthcare associated infection(HAI) control in mobile field hospital.MethodsHand hygiene, environmental object surface disinfection, medical instrument cleaning were performed with AEOW as well as different commonly used cleaning and disinfectant agents in mobile field hospital, ATP biological fluorescence detector was used to detect and evaluate the efficacy of cleaning and disinfection.ResultsThe qualified rates of hand washing with running water as well as soap and AEOW were 100.00% and 98.75% respectively, there was no significant difference between two groups (P=1.000). Environmental object surface were disinfected with AEOW, chlorine containing disinfectant, and compound double chain quaternary ammonium salt wipe, the qualified rates were 87.10%, 90.32%, and 90.32% respectively, there was no significant difference in the qualified rates among three methods (P=1.000). The qualified rates of instruments cleaned by AEOW and conventional cleaning were both 100%. The mean value, standard deviation, and standard error of mean value of relative light unit (RLU) of instrument specimens after cleaned by AEOW were all 0, after cleaned by conventional method were 9.70, 8.91, and 1.63 respectively，difference in RLU after cleaned by two methods was statistically significant (t=-5.97, P=0.000).ConclusionCompared with other commonly used disinfectants, AEOW can achieve the desired results in hand washing, object surface disinfection, as well as instrument cleaning. In view of its onsite preparation and convenient use, it shows a effectiveness, compatibility, and superiority in HAI control in mobile field hospital.

Abstract:

ObjectiveTo analyze the change in antimicrobial resistance rate of grampositive bacteria in Shaanxi Provincial Bacterial Resistance Surveillance Network(BRSN) from 2014 to 2016, and provide theoretical basis for treatment of grampositive bacterial infection.MethodsData of grampositive bacteria from participating hospitals in Shaanxi Provincial BRSN between 2014 and 2016 were collected, according to 2016 standards of American Clinical and Laboratory Standards Institute (CLSI), data were analyzed with WHONET 5.6 software.ResultsData of 42 participating hospitals in Shaanxi Provincial BRSN were collected. 43 830, 48 258, and 61 819 strains of bacteria were collected in each year from 2014 to 2016, of which grampositive bacteria were 14 487 (33.1%), 15 303 (31.7%), and 18 613 (30.1%) respectively. The top 5 specimens of grampositive bacteria were sputum (n=14 844, 30.7%), blood (n=8 873, 18.3%), secretion (n=6 271, 13.0%), urine (n=5 225, 10.8%), and wound pus (n=2 449, 5.0%). The top three grampositive bacteria were Staphylococcus spp. (n=28 878, 59.7%), Enterococcus spp. (n=10 207, 21.1%), and Streptococcus spp. (n=8 824, 18.2%). From 2014 to 2016, isolation rates of methicillinresistant Staphylococcus aureus (MRSA) were 36.1%, 45.2%, and 38.6% respectively, isolation rates of methicillinresistant coagulase negative Staphylococcus (MRCNS) were 80.5%, 81.0%, and 83.3% respectively, vancomycin, linezolid, and teicoplaninresistant Staphylococcus spp. were not found; resistance rates of Enterococcus faecalis to vancomycin were 1.7%, 0.8%, and 0.7%, respectively, resistance rates of Enterococcus faecium to vancomycin were 3.1%, 2.0%, and 2.1% respectively; among Streptococcus pneumoniae isolated from noncerebrospinal fluid, isolation rates of penicillinresistant Streptococcus pneumoniae (PRSP) in three years were 11.8%, 6.1%, and 4.7% respectively.ConclusionAntimicrobial resistance of clinically isolated grampositive bacteria is more common in this region, surveillance and management of bacterial resistance should be strengthened, antimicrobial resistance of bacteria should be realized in time, so as to provide basis for rational clinical antimicrobial use.

Abstract:

ObjectiveTo understand detection method and clinical characteristics of bloodstream infection caused by Fusobacterium periodonticum(FP).MethodsClinical manifestation and laboratory examination results of one case of bacteremia caused by FP was analyzed, detection methods of FP were reviewed with relevant literatures.ResultsThis patient has neutropenia with fever, gramnegative bacillus was isolated from blood culture, the strain was identified as FP by gene sequencing, patient was discharged from hospital after received metronidazole combined meropenem for antiinfection treatment. Through literature review, it is found that there was no reported literature on bloodstream infection caused by FP. Identification of FP in 9 literatures showed that FP in 5 literatures were identified by DNDDND hybridization, 3 by PCR method, and 2 by 16S rRNA gene sequence analysis.ConclusionFP can cause bloodstream infection in patient with low immunity, it is difficult to be identified by conventional method, PCR and gene sequencing can be used for identification of septicemia caused by FP.

Abstract:

目的探讨医院感染管理内审员在医院评审工作中的作用，寻求医院感染管理质量控制的新途径。方法通过培训和考核遴选一支院级医院感染管理质控内审员队伍（由部分主任、护士长、感控医生、感控护士组成），按照等级医院评审标准“C”、“B”、“A”条款的要求制定医院感染质量控制路径，由内审员分组、分片对全院进行月度、季度检查，以便医院感染管理工作得到持续质量改进。结果实施内审前消毒隔离项目的合格率最低，为43.9%，实施内审后上升至88.2%；实施内审后各项目的合格率上升至78.7%~92.0%。实施内审后各医院感染管理项目合格率均高于实施内审前，差异均有统计学意义（均P=0.000）。实施内审整改追踪前，医院感染控制处针对检查结果下发整改反馈单后，科室整改措施执行率为78.6%；实施内审整改追踪后，科室整改措施执行率为94.4%，差异均有统计学意义（χ2=4.925，P<0.05)。结论医院感染管理质控内审员队伍的建立进一步完善了医院感染质量管理体系和医院感染质量监督和评价机制，强化了质量管理意识和参与意识，使得质量管理标准在医院感染管理工作中得到充分落实。

Abstract:

人猪链球菌病是由猪链球菌感染人而引起的人畜共患性疾病，世界动物卫生组织将猪链球菌病列为B类疫病［12］，我国将其列为二类动物疫病［3］。人颅内猪链球菌感染通常表现为化脓性脑膜炎，伴有耳聋、运动功能紊乱，重症患者发生中毒性休克综合征，导致多脏器衰竭及死亡［14］。猪链球菌是重要的人畜共患病原菌，其感染病例在世界范围内广泛分布。自20世纪50年代以来，由猪链球菌引发的猪链球菌病在所有养猪业发达的国家均有报道，以北欧和东南亚地区最为突出，该病也已成为我国养猪场最常见的细菌性传染病之一［23］。近几年虽很少发生人群疫情暴发，但仍有散发病例出现。本文对某院2013—2015年收治的经临床和病原学检查确诊的5例猪链球菌脑膜炎患者的临床资料进行分析，以期为该病的早期诊断和治疗提供依据。

Abstract:

随着人们认识的增加，烈性传染性病毒不断被发现和鉴定，高致病性、高传播性的病毒往往由于变异，导致反复流行。如在非洲和阿拉伯半岛多次暴发1931年首次分离到的裂谷热病毒（Rift Valley fever virus，RVFV）［1］；1937年发现于非洲，并于1999年传入美国且在多个州暴发的西尼罗病毒（West Nile virus，WNV）［23］；1944、1956、1965年分别发现于俄国克里米亚、非洲刚果和我国新疆巴楚地区的克里米亚-刚果出血热病毒（CrimeanCongo haemorrhagic fever virus，CCHFV），1967年分离出该病毒，被我国称为新疆出血热病毒（Xinjiang haemorrhagic fever virus，XHFV）［4］。1967年在德国首次发现马尔堡病毒（Marburgvirus，MARV）［5］；1976年发现，随后在非洲反复暴发流行的埃博拉病毒（Ebolavirus，EBOV）［6］；1998—1999年在马来西亚暴发，2001—2009年连续在印度和孟加拉国流行的尼帕病毒（Nipahvirus，NiV）［78］；2002年底出现，2003年在我国暴发流行的SARS冠状病毒（severe acute respiratory syndrome coronavirus，SARSCoV）［9］；2012年出现于沙特阿拉伯，具有高致死率的中东呼吸综合征冠状病毒（Middle East respiratory syndrome coronavirus，MERSCoV）［10］；2013年在我国多地出现的H7N9型流感病毒［11］。自2009年以来，中国加强了急性发热性疾病的监测与管理，发现了一种不明原因的严重发热伴血小板减少综合征（SFTS），该病由一种新型病毒引起，命名为发热伴血小板减少综合征布尼亚病毒，简称新布尼亚病毒（severe fever with thrombocytopenia syndrome visus，SFTSV）［12］。目前，上述病毒感染几乎没有特效药物和疫苗，因此，针对其研制特效药物，对于提高其防治水平、保障我国国民健康，具有非常重要的意义。

Abstract:

目前，牙科综合治疗台（dental chair unit，DCU）已成为口腔科日常诊疗过程中必不可少的设备之一，DCU是一个复杂的集成系统，提供口腔科各种诊疗服务过程中所需的物质（如气、水和电）和设备［1］。牙科手机、超声洁治器、三用枪头等均是DCU常用附属设备，上述设备均需要牙科综合治疗台水路（dental unit waterlines，DUWLs）供水。若水路被污染，会将病原体带入患者口腔，并通过手机、三用枪等的喷雾作用污染空气及周围环境，可导致患者及医护人员发生医院感染［2］。20世纪60年代，英国牙医Blake［3］对牙科临床设备进行取样培养，检出大量细菌，首次报道通过DCU发生交叉感染的可能性。国内相关研究起步较晚，2002年李罡等［4］才对水源在牙科医源性交叉感染中的作用进行总结。本文就DUWLs污染现状、污染原因、影响因素、水质标准、控制措施的研究进展进行综述，旨在为今后展开相关工作提供参考。

Abstract: