Abstract:Objective To analyze the influencing factors for recurrent pulmonary infection in coma patients in intensive rehabilitation unit. Methods Clinical data of hospitalized patients in the intensive rehabilitation unit of rehabilitation medicine department of a hospital from January 2016 to December 2019 were retrospectively analyzed, basic condition, injury, underlying diseases, laboratory tests and rehabilitation intervention were compared between patients in recurrent pulmonary infection group and non-pulmonary infection group in the rehabilitation department. Results A total of 269 patients were investigated, and 167 cases had recurrent pulmonary infection. Logistic regression analysis showed that low serum albumin (95%CI:0.750-0.883, OR=0.814), GCS<8 (95%CI:0.176-0.571, OR=0.317) and coma time ≥ 3 weeks (95%CI:1.637-10.752, OR=4.196) were independent risk factors for recurrent pulmonary infection in coma patients. A total of 245 pathogens were isolated from 269 patients, the top three were Pseudomonas aeruginosa (77 strains, 31.43%), Acinetobacter baumannii (70 strains, 28.57%), and Klebsiella pneumoniae (40 strains, 16.32%); the main multidrug-resistant organisms were Acinetobacter baumannii (63 strains, 49.22%), Pseudomonas aeruginosa (29 strains, 22.66%), and Klebsiella pneumoniae (20 strains, 15.62%). Conclusion For coma patients in intensive rehabilitation unit, improving their consciousness, correcting and preventing hypoalbuminemia and shortening hospital stay as far as possible are conducive to reducing the incidence of pulmonary infection.

Abstract:Objective To analyze the characteristics of occupational exposure to blood-borne pathogens among health care workers(HCWs), and provide basis for formulating targeted occupational protection strategies. Methods Data of occupational exposure reported by HCWs in a hospital in Southwest China from 2015 to 2019 were retrospectively investigated, the causes, types, sources, disposal and follow-up of occupational exposure were analyzed. Results A total of 411 cases of occupational exposure were reported. Most of the exposed persons were nurses (47.44%), the main exposure departments were internal medicine system (39.41%), surgical system (22.63%) and emergency department (12.41%). The main type of exposure was sharp injury (78.10%, mainly occurred during handling diagnosis and treatment device/medical waste, collecting blood), contacting with skin and mucosa (19.71%), and others (2.19%, mainly caused by scratch and bite). Occupational exposure with unknown source was mainly distributed in emergency department (33.38%), outpatient department (13.89%) and logistics department (8.33%), which was mainly caused during handling of diagnosis and treatment device/medical waste (44.44%), outpatient and emergency injection and transfusion (27.78%), and outpatient blood collection (13.89%). The main sources of blood-borne pathogens were hepatitis B virus, human immunodeficiency virus (HIV) and Treponema pallidum, 70.67% of exposure were treated with drug prophylaxis. Conclusion In the prevention of occupational exposure, more attention should be paid to sharp injury, and training of occupational protection and management of medical waste disposal should be strengthened.

Abstract:Objective To understand current situation and existed problems of cleaning and disinfection of ultrasound probes of digestive endoscopes in China. Methods Cleaning, disinfection, and sterilization of ultrasound probes of digestive endoscopes at 37 hospitals in China were investigated through questionnaire. Results 70.27% of the hospitals had 1-3 endoscopic ultrasound probes, most were Olympus brand (72.97%), the number of patients who used probes were 0-5 in 48.65% of the endoscopy centers every day; 83.78% of the hospitals cleaned and disinfected endoscopic ultrasound probes by specially-assigned persons, mainly were nurses (51.35%); the main cleaning method was enzyme washing-scrubbing-drying (89.19%), most cleaning time was more than 1 minutes (62.16%); 83.78% of the hospitals disinfected endoscopic ultrasound probes through chemical disinfectant immersion, most of which were O-phthalaldehyde immersion (70.27%) and total immersion (48.65%); most disinfection time was ≥ 5 minutes (56.76%); 27.03% of the hospitals sterilized the endoscopic ultrasound probes, 21.62% of which sterilized probe each time after one patient used and 10.81% of which adopted peracetic acid immersion for 10 minutes; 56.76% of the hospitals placed disinfected and sterilized endoscopic ultrasound probes in endoscopic sto-rage cabinet; 78.38% of the hospitals re-disinfected endoscopic ultrasound probes on the day to be used; 56.76% of the hospitals had never monitored the disinfection efficacy of the disinfected probes. Conclusion There are some differences in the cleaning, disinfection, and sterilization of endoscopic probes in 37 hospitals, it is suggested that the national standards for cleaning and disinfection of endoscopic probes should be formulated as soon as possible to standardize the cleaning and disinfection process of endoscopic probes.

Abstract:Objective To investigate the effect of filtration membrane method and smear method on detection of microorganism in hemodialysis-related water, and provide basis for selecting appropriate detection method. Methods A retrospective study was conducted to analyze the results of water microorganism in hemodialysis-related water detected by filtration membrane method and smear method from January to December, 2018. Bacterial isolation rate, colony forming unit(CFU), rate of intervention-exceeding value as well as qualified rate of microorganism detected by filtration membrane method and smear method were compared and analyzed. Results A total of 274 hemodialysis-related water microbial detection results were collected, including 131 dialysate, 39 reverse osmosis water, 14 concentrated solution B (liquid B), 34 replacement fluid and 56 other dialysis water. Bacterial isolation rates of filtration membrane method were all higher than those of smear method, bacterial isolation rates of dialysate, reverse osmosis water, replacement fluid, and other dialysis water specimens detected by two methods were all significantly different (all P<0.05). The CFU of dialysate, liquid B and other dialysis water specimens detected by filtration member method were all lower than that of smear method, CFU of other dialysis water specimens detected by two methods was significantly different (t=-3.011, P=0.004). Detection rate of intervention-exceeding value of other dialysis water detected by filtration membrane method was lower than that smear method, difference was significant (χ²=6.596,P=0.010). Microbial qualified rate of replacement fluid and reverse osmosis water specimens detected by filtration membrane method was less than that of smear method, qualified rate of microbial detection of replacement fluid was significantly different (χ²=18.987,P<0.001). Conclusion The detection ability of filtration membrane method is higher than that of the smear method, but it has certain limitations in the detection of microorganisms in hemodialysis-related water, except for the replacement fluid, effect of filtration membrane method on the microbial detection of other hemodialysis-related water is no better than that of smear method.

Abstract:Objective To explore the direct economic loss and characteristics of postoperative healthcare-associa-ted infection(HAI) in surgical patients, provide scientific basis for decision-making of HAI management department. Methods 100 patients who developed postoperative HAI in a tertiary first-class hospital from January 1, 2016 to December 31, 2018 were selected as case group, a 1:1 matched case-control study was conducted to select 100 patients who didn't develop postoperative HAI were as control group, difference in direct economic loss and hospitalization days between two groups of patients was compared by rank sum test of paired design. Results Compared with control group, hospitalization expenses (median) increased by 19 866.3 Yuan (Z=-8.338, P<0.01) and length of hospital stay (median) increased by 8.0 days (Z=-6.857, P<0.01) in case group; the top three operations with increased hospitalization expenses were renal allograft, nervous system operation and urinary system operation; the top three operations with increased hospitalization days were cholecystectomy, intervertebral disc destruction or resection and urinary system operation, differences between two groups were both significant (both P<0.05); the top three infection with increased hospitalization expenses were multi-site infection, lower respiratory tract infection and intra-abdominal infection, the top three infection with increased hospitalization days were multi-site infection, deep incision infection and superficial incision infection, differences between two groups were both significant (both P<0.05). Conclusion HAI in surgical patients after operation can lead to huge direct economic loss, HAI control department should take effective prevention and control measures to reduce the occurrence of infection, such as surgical multi-site infection, lower respiratory tract infection and surgical site infection, so as to reduce the economic burden of patients.

Abstract:Objective To understand the current situation of human resource allocation in healthcare-associated infection(HAI) management departments in different levels of designated medical institutions for COVID-19 in Anhui Province, analyze the existing problems and weak links, and provide basis for improving the construction of infection control talent team. Methods In April 2020, questionnaire survey was adopted to investigate the basic condition of HAI management departments and distribution of full-time HAI management staff in different levels of designated medical institutions for COVID-19 in Anhui Province, results were analyzed. Results A total of 68 medical institutions were investigated, including 6 provincial-, 19 municipal- and 43 county-level hospitals. The proportion of hospitals which met the standard allocation of full-time HAI management staff in provincial-, municipal- and county-level medical institutions accounted for 16.67%, 26.32% and 51.16% respectively. 84.82% of the full-time HAI management personnel in the whole province were female; HAI management team is mainly nursing, accounting for 59.53%; persons with senior profession title only account for 21.01%. There were significant differences in specialty, educational background and working years of HAI management professionals among different levels of medical institutions (all P<0.05). Conclusion HAI management departments of different levels of designated medical institutions for COVID-19 in Anhui Province have shortage of insufficient allocation of full-time staff, single profession, low academic qualifications, and difficult promotion of professional title, human resource allocation needs to be further optimized, medical institutions and relevant management departments should strengthen HAI control team, promote the effective implementation of HAI control under the normalization of epidemic prevention and control.

Abstract:Objective To understand occupational exposure of health care workers(HCWs) in designated medical institutions for coronavirus disease 2019(COVID-19) treatment in Hunan Province. Methods According to the documents issued by Health Commission of Hunan Province, occupational exposure of HCWs in fever clinics and isolation wards at 365 medical institutions in Hunan Province was reported every Tuesday and Friday, data were collec-ted by Hunan Provincial Healthcare-associated Infection Quality Control Center, HCWs' occupational exposure related to COVID-19 treatment were analyzed. Results From January 27 to March 3, 2020, a total of 29 HCWs with occupational exposure related to COVID-19 treatment were reported, 5(17.24%) were males and 24 (82.76%) were females; the average age was (32.39±6.95) years old; 22 were nurses and 4 were doctors, 24 of whom were aid HCWs in fever clinics and isolation wards. The main exposure location was COVID-19 isolation wards (n=26). High-, medium-, and low-risk exposure were 12 (41.38%), 14 (48.28%), and 3 cases (10.34%) respectively; the main type of exposure was sharp injury (n=18, 62.07%); the most common manipulations were venous blood collection(n=5, 17.24%) and arterial blood gas analysis (n=4, 13.79%); the main exposure sites were hands or fingers (n=18, 62.07%); among HCWs who had occupational exposure related to COVID-19, 27(93.10%)had second-level protection when exposed. 19 occupational exposure sources were patients, 7 of whom were with confirmed COVID-19. 29 HCWs with occupational exposure were all reported to department of HAI control or health care department of the hospital in time, by March 17, they all exceeded more than 14-day isolation observation period, 1 occupational exposure HCW developed COVID-19. Conclusion During COVID-19 epidemic period, HCWs' personal protection consciousness has been greatly improved, but new occupational exposure risk links can result in post-exposure infection, occurrence of occupational exposure can be effectively reduced by improving manipulation level of HCWs under the second-level protection, providing high-quality protective equipment and complying with the manipulation regulations.

Abstract:Objective To evaluate problems in health education during coronavirus disease 2019 (COVID-19) epidemic period, and provide basis for hospitals to strengthen patient health education under regular status of epidemic prevention and control. Methods From April 1, to May 10, 2020, patients with confirmed COVID-19 in COVID-19 wards of Mudanjiang area were randomly selected and investigated by trained investigators, basic characteristics of the respondents,implementation of health education on hand hygiene(HH), wearing masks, opening windows for ventilation, closing doors, keeping wards clean, cough etiquette were recorded and filled in questionnaire. Results A total of 173 valid questionnaires were collected, COVID-19 patients who participated in the survey all received health education before admission, 73.41% (n=127) of whom received health education on cough etiquette, 98.27% (n=170) wore masks(94.12%[n=160] wore surgical masks); among isolation wards of 173 COVID-19 patients, the ratio of fully equipped HH facilities was 22.54% (n=39), 77.46% (n=134) were without fully equipped HH facilities, equipping rate of paper towels was the lowest (n=48, 27.75%). COIVID-19 patients who had fully equipped HH facilities performed HH more frequently per day(χ²=15.93,P<0.001);compared with only equipped with alcohol-based hand rub or not, when equipped with alcohol-based hand rub and other HH facilities, patients wash their hands more frequently per day(χ²=4.16,P=0.040);compared with not equipped with paper towels, when equipped with paper towels, patients wash their hands more frequently per day (χ²=15.03, P<0.001). The proportion of implementation of keeping indoor clean was the highest (n=166, 95.95%), and that of cough etiquette was the worst (n=107, 61.85%). With the increase of patients' age, proportion of poor implementation of cough etiquette was higher(χ²=19.66,P<0.001), implementation of cough etiquette in patients in general wards was better than that in critical care wards(χ²=15.82,P<0.001), correct rate of cough etiquette in patients receiving health education on cough etiquette was higher than that in patients without receiving health education on cough etiquette (χ²=94.57,P<0.001). Conclusion During the COVID-19 epidemic, health education level of patients is improved, but there are still some deficiencies, hospital should continue to strengthen the propaganda and education on respiratory tract hygiene and cough etiquette, improve self-protection awareness of patients as well as reduce infection risk of patients and health care workers.

Abstract:Objective To survey the enviromental contamination of carbapenem-resistant Klebsiella pneumoniae(CRKP) in intensive care unit (ICU) and carriage of drug resistance genes of CRKP. Methods Specimens collected from high-touch object surface, object surface in public area, wall and drain holes of sink in 5 surgical ICUs were performed microbial isolation by mSuper CARBA chromogenic medium, targeted strains were identified by MALDI-TOF mass spectrometry, carbapenemase phenotype of CRKP was identified by double-disk synergy method, KPC and NDM resistance genes were detected by polymerase chain reaction (PCR). Results The isolation proportion of CRKP from high-touch object surface (1/73), object surface in public area (1/89), attendants' clothing (1/24) were very low, but from drain hole of sink was higher (25/29). Identification of carbapenemase phenotype showed that 5 strains produced class A enzyme and 11 strains produced class B metalloenzyme; PCR results showed that 2 strains carried KPC resistance genes and 3 strains carried NDM resistance genes. Conclusion Colonization rate of CRKP on high-touch object surface in ICU is low, but contamination rate of drain hole of sink is high. The results of resis-tance phenotype enzyme identification and PCR revealed that cross transmission of CRKP in ICU may be low if environmental cleaning and disinfection measures are strictly implemented.

Abstract:Objective To explore risk factors for neonatal carbapenem-resistant Enterobacteriaceae (CRE) infection, and provide evidence for prevention and control of neonatal CRE infection and rational use of antimicrobial agents. Methods 68 neonates with CRE infection in a neonatal ward of Wuhan Children's Hospital from 2016 to 2018 were chosen as CRE group, 50 neonates with carbapenem-sensitive Enterobacteriaceae (CSE) infection in the same ward during the same period were randomly selected as CSE group, retrospective case-control study was conducted, risk factors for CRE infection were analyzed. Results There were 68 neonates in CRE group, including 60 cases (88.24%) of Klebsiella pneumoniae infection, 7 cases (10.29%) of Escherichia coli infection and 1 case (1.47%) of Klebsiella oxytoca infection. There were 38 cases (55.88%) of healthcare-associated infection(HAI) in CRE group and 6 cases (12.00%) of HAI in CSE group, difference between two groups of neonates was significant (P<0.05). Lower respiratory tract was the main infection site in both groups. Univariate analysis showed that small gestational age, low birth weight, neonatal respiratory distress syndrome, endotracheal intubation, mechanical ventilation time, peripherally inserted central catheterization (PICC), antimicrobial use time, types of used antimicrobial agents ≥ 3 kinds, use history of carbapenems, use history of glucocorticoid, long hospital stay were all risk factors for neonatal CRE infection. Multivariate regression analysis showed that low birth weight, duration of mechanical ventilation and history of carbapenem use were independent risk factors for CRE infection. Conclusion The main neonatal CRE infection is HAI, comprehensive prevention and control measures should be formulated according to the risk factors of neonatal CRE infection, so as to reduce the occurrence and spread of CRE infection.

Abstract:Objective To understand Hawthorne effect on compliance rate of hand hygiene(HH) of staff of diffe-rent occupations, different departments and five HH opportunities, so as to provide basis for rational use of Hawthorne effect and improve HH compliance rate. Methods The direct observation method was adopted to investigate HH compliance of the same kind of population in different departments through routine survey method and concealed survey method, results were analyzed, the consumption of hand sanitizer and hand disinfectant used at the same period was investigated. Results Consumption of HH products in routine survey group and concealed survey group were 26.9 mL/bed-day and 27.5 mL/bed-day respectively, there was no significant difference between two groups (P>0.05). HH compliance rates in routine survey group and concealed survey group were 79.7% (985/1 236) and 49.8% (646/1 298) respectively, difference was statistically significant (χ²=247.166, P<0.01). Nurses had the highest HH compliance rate, HH compliance rate of doctors in concealed survey group and routine survey group were 31.6% and 82.6% respectively, routine survey group increased by 161.4%. HH compliance rates were the highest in routine survey group before aseptic manipulation and in internal medicine group (86.5% and 88.7% respectively), HH compliance rates of concealed survey group after touching patient's blood and body fluid were both higher (69.2% and 78.5% respectively). Compared with concealed survey group, HH compliance rates before touching patients in routine survey group increased by 127.0% (81.5% and 35.9% respectively). Except for touching patients' blood and body fluid, there were significant differences in compliance rates of the other four HH indicators and different departments between two groups (all P<0.05). Conclusion Concealed survey combined with the consumption of hand sanitizer and hand disinfectant can truly reflect HH compliance rate of staff in different departments and staff with different occupations, Hawthorne effect on HH compliance in routine survey group is higher, continuous stimulation through Hawthorne effect on practical work can be used to improve HH compliance rate of health care workers.

Abstract:Objective To analyze the epidemiological characteristics of a suspected outbreak of carbapenem-resis-tant Klebsiella pneumoniae (CRKP) healthcare-associated infection(HAI), provide evidence for prevention and control of HAI. Methods Field epidemiological and environmental hygiene detection methods were adopted to investigate patients with CRKP during hospitalization in pediatric intensive care unit(PICU) of a children's hospital from June 19 to July 10, 2019, the causes were analyzed and appropriate prevention and control measures were taken. Results Epidemiological investigation showed that 6 patients were isolated CRKP, and 5 of whom had HAI (3 cases of lower respiratory tract infection, 1 case of bacteremia, 1 case of catheter-related bloodstream infection), 1 case was colonization. A total of 177 environmental hygiene specimens were collected, 2 specimens (hanging tower and floor towel) were isolated CRKP, the remaining specimens were not found CRKP. After taking control mea-sures, no similar new cases occurred in the PICU until the end of July 2019. Conclusion The suspected outbreak of CRKP HAI may be transmitted through the surface of PICU environment and hands of health care workers, strengthening hand hygiene of HCWs and taking strict disinfection measures can effectively control the further pre-valence of CRKP.

Abstract:Objective To analyze the pathogen detection results of patients with acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) in a hospital in Hainan area, so as to provide basis for diagnosis and treatment of AE-IPF patients. Methods Patients who were with AE-IPF and admitted to a hospital in Hainan Province from January 2016 to December 2019 were retrospectively analyzed, detection results of IgM antibody of respiratory virus, sputum bacterial culture, and atypical pathogen nucleic acid were analyzed, difference in clinical data between pathogen-positive group and pathogen-negative group were compared. Results A total of 52 patients with AE-IPF were analyzed, including 23 cases in pathogen-positive group and 29 in pathogen-negative group. The proportion of patients with fever, purulent sputum and anti-infection treatment, as well as white blood cells, neutrophils and procalcitonin were higher in pathogen-positive group, proportion of patients receiving glucocorticoid treatment was higher in pathogen-negative group, differences were all statistically significant (all P<0.05). There was no significant diffe-rence in mortality between two groups of patients (P>0.05). In patients in pathogen-positive group, 15, 10, and 9 cases were with positive sputum culture, virus IgM, and atypical pathogen nucleic acid respectively, Pseudomonas aeruginosa was most frequently detected pathogen in sputum culture (n=5, 14.7%), respiratory syncytial virus (RSV) and adenovirus (ADV) were the most common virus in positive IgM detection (n=3, both 8.8%), Mycoplasma pneumoniae was the most common pathogen in positire detection of atypical pathogen nucleic acid (n=6, 17.7%). Conclusion Infection may be an important cause of patients with AE-IPF in this hospital in Hainan area, clinical manifestations and inflammatory markers is conductive to indicating the cause of infection in AE-IPF patients.

Abstract:Objective To analyze the molecular characteristics and virulence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP), strengthen the clinical staff's understanding on this bacteria. Methods One strain of CR-HvKP isolated from respiratory tract specimen of a patient with severe pneumonia was performed antimicrobial susceptibility testing, resistance mechanism to carbapenems was studied. The molecular and virulence characteristics of the strain were analyzed through string test, virulence gene detection, virulence-related capsular antigen gene detection, multilocus sequence typing, Galleria mellonella infection model, and clinical manifestation of patient. Results CR-HvKP caused severe pneumonia in patient, patient received bronchoscopy, bronchoalveolar lavage fluid (BALF) specimen was taken for pathogenic culture and isolation, patient's condition was under control after adjusting antimicrobial use according antimicrobial susceptibility testing result. The strain was multidrug-resistant, expressed IMP-4 carbapenemase, negative for string test, ST2928 type, positive for prmpA₂ virulence gene, positive for K54 capsular antigen gene, and in vitro high virulence in Galleria mellonella model test. Conclusion The isolated CR-HvKP strain with ST2928, positive K54 capsular antigen gene and producing IMP-4 carbapenemase is reported for the first time, CR-HvKP can cause more complicated and severe infection due to its combination of high drug resistance and high virulence, and its molecular characteristics are diverse.

Abstract:Nokardia cyriacigeorgica (N. cyriacigeorgica) belongs to the Nocardia spp., Nocardia distributes widely in soil and water, it does not belong to the normal flora of human body, mainly invades human body through respiratory tract inhalation and damaged skin. Nocardiosis is caused by Nocardia infection, Nocardia infection is common in the lung and skin, there are few reports of eye infection, reports of eye infection caused by N. cyriacigeorgica is even fewer. This paper reports a case of eye infection with N. cyriacigeorgica, and reviews the literature at home and abroad, so as to improve clinical diagnosis and treatment of nocardiosis.

Abstract:One case of melioidosis associated with rare brain lesion and secondary epilepsy was reported, patient was admitted to a hospital twice because of "right hip pain for 10 days" and "epileptic seizure", Burkholderia pseudomallei was isolated through blood culture,and was diagnosed as melioidosis, antimicrobial susceptibility testing showed that it was susceptible to imipenem and compound sulfamethoxazole, magnetic resonance imaging (MRI) of brain proved that it was multiple brain lesions in right centrum ovale, corpus callosum, and posterior cingulate gyrus. After 6 months of symptomatic medical treatment, including anti-infective treatment and organ function support, patient recovered well. Therefore, relevant examination should be conducted in time for melioidosis complicated with central nervous system diseases, including cranial MRI, active bacterial culture and antimicrobial susceptibility testing, as well as long-term standardized anti-infective treatment, so as to avoid recurrence.

Abstract:Highly pathogenic coronavirus(HPC) is characterized by high incidence, high mortality and global pandemic, it seriously threatens human health and poses great challenge to social economy. At present, the pathogenic mechanism of HPC is mainly discussed from two aspects:the direct cytopathic effect and indirect immunopathological damage, but the study of specific acting genes still needs further in-depth research. In this paper, the relationship between gene structure characteristics and pathogenic mechanism of HPC is reviewed, so as to provide refe-rence for the prevention and treatment of HPC infection.

Abstract:Hepatitis C virus(HCV) infection can cause a variety of diseases, and the outbreak of HCV infection event in hemodialysis room has been reported by many countries, the main factors for infection is that there are loopholes in infection prevention and control. Literatures of HCV infection outbreak event are reviewed and relevant management documents with great influence at home and abroad are analyzed, which will help to prevent and control the spread of HCV in hemodialysis room more scientifically and reduce the risk of infection outbreak to the minimum.