Abstract:Objective To analyze characteristics of clinical trials of coronavirus disease 2019 (COVID-19) in China, find out possible problems, and provide reference for clinical trial designers and policy makers. Methods Clinical trial data for CONID-19 registered at official website of China Clinical Trial Registry and U. S. ClinicalTrials.gov before 24:00 on February 23, 2020 were collected, data were cleaned by Ducati Data Analyzer (DDA) software, and characteristic variables of clinical trials were described by SPSS 18.0. Results The first COVID-19 clinical trial registration date was on January 23, 2020, by the end of 24:00 of February 23, 2020, China has registered 240 COVID-19 clinical trials, including 62(25.83%) multi-center studies. A total of 157 institutions participated in the clinical trials, with the largest number of medical institutions (n=122), and the top five geographical distribution of participating institutions were in Beijing, Hubei, Guangdong, Zhejiang and Shanghai. The main age of patients recruited in the clinical trial were adults (15-64 years old) / the elderly (≥65 years old) (63.75%), the main type of research was intervention study (75.42%), the main intervention measure was drugs (68.51%), the main source of funding was self-financing (25.00%). 181 intervention studies were at stage 0 (n=70) and Ⅳ (n=49). Conclusion At present, there are a large number of clinical trials in China, but there are few institutional cooperation, the types of intervention measures and trial drugs are not focused, the number of recruits is irrational, and the participating institutions and funding sources are diversified.

Abstract:Objective To explore epidemiological and clinical characteristics of patients with coronavirus disease 2019(COVID-19) outside Wuhan. Methods Data of confirmed COVID-19 patients who were admitted to a hospital from January 22 to February 28, 2020 were collected, contact history of patients was inquired in detail, clinical characteristics, laboratory test results and imaging findings of imported and local cases were compared. Results A total of 32 confirmed COVID-19 patients were studied, including 14 cases (43.75%) of imported cases and 18 cases (56.25%) of local cases. 27 patients (84.38%) had definite contact history, 5 (15.62%) patients' contact history was unknown. Family clustering (66.67%) was the main transmission route. The median age of patients was 42 (32.5, 50.5) years old, 19 (59.37%) were female. The first symptoms were dry cough (n=23, 71.88%), fever (n=16, 50.00%) and expectoration (n=13, 40.63%). The median of incubation period was 6.5 (0, 9) days, the median from onset of first symptom to confirming diagnosis was 7 (4.5, 9) days, the median from confirming diagnosis to discharge was 12 (9, 16) days. The abnormal laboratory test indicator included the decrease in leukocyte count, absolute lymphocyte count, albumin, CD4⁺ and CD8⁺ T lymphocyte count, as well as increase of C-reactive protein, D-dimer and fibrinogen. 81.25% (n=26) of patients had bilateral lung involvement. Difference in absolute lymphocyte count between imported cases and local cases was statistically significant (P=0.044), there was no significant difference in other laboratory test results (all P>0.05). 32 patients were all cured and discharged. Conclusion Epidemic of COVID-19 is in a low prevalence in this city, mainly manifested by transmission through familial clustering, there is no significant difference in clinical characteristics between imported cases and local cases.

Abstract:Objective To explore clinical characteristics and causes of death of coronavirus disease 2019 (COVID-19) death cases, enhance the cognition on COVID-19. Methods Clinical data of death cases of confirmed COVID-19 in intensive care unit (ICU) of East Branch of Renmin Hospital of Wuhan University from February 1, 2020 to March 21, 2020 were collected and analyzed. Results A total of 28 death cases of COVID-19 were included in analy-sis, the average age was (69.14±14.70) years old, the ratio of male to female was 2.5:1; 19 cases (67.86%) had underlying diseases, mainly hypertension and diabetes, the mean sequential organ failure assessment score (SOFA) on the day of admission was 6.00(4.00-9.00), compared with the survival cases during the same period, difference was statistically significant (Z=-3.86,P<0.05). Receiver operating characteristic curve (ROC)showed that the area under the curve was 0.90(0.79-1.00). The mean time from onset to confirmed diagnosis of COVID-19 was 6.50 (3.00-12.00) days, respiratory and circulatory system were mainly involved, all patients had dyspnea. The mean time from onset to death was 21.50 (15.25-29.00) days, all patients had severe acute respiratory distress syndrome (ARDS),19 cases (67.86%) developed multiple organ dysfunction syndrome (MODS), 6 cases(21.43%) combined with other infection, mainly infection with Gram-negative bacilli. Conclusion ARDS and MODS are the important causes of death of COVID-19, and combined bacterial infection is also the promoting factor for death, it is necessary to screen critical cases and optimize treatment in time through clinical manifestations and SOFA score.

Abstract:Objective To explore strategies on sanitary quality management on coronavirus disease 2019(COVID-19) buffer rooms of intensive isolation wards. Methods Self-made inspection forms were used from February 8 to March 6, 2020, sanitary quality management of buffer rooms of COVID-19 intensive isolation wards in a hospital were selected randomly before implementation and at day 15, day 21, and day 28 after implementation of intervention measures. There was 2 points for each item in the form, 10 items in total, effect of intervention measures was evaluated according to scores. Results Before the implementation of intervention measures, score of sanitary quality management in buffer rooms was (9.15±1.80), on the 15th, 21st and 28th day after the implementation of intervention measures, scores were (16.57±2.71), (17.07±2.10) and (19.27±1.13) respectively, difference was statistically significant before and after implementation (P<0.05). Scores in implementing emergency power supply and emergency lighting, as well as automatically switching on power system in case of emergency before and after implementation of intervention measures was not significantly different (P=0.11). scores of implementation of other sanitary quality management measures in buffer rooms were all higher than those before implementation, differences were all statistically significant (all P<0.05). Conclusion During COVID-19 epidemic period, implementation of standardized cleaning process, rational arrangement of commuter time, adequate supplies, good facilities, and strengthened training of personnel are effective measures to improve the sanitary quality of buffer rooms, which is essential to ensure the safety of patients and health care workers.

Abstract:Objective To analyze the epidemiological characteristics of coronavirus disease 2019(COVID-19) cases of health care workers(HCWs) and family-related cases in a hospital, and provide reference for formulating prevention and control strategies. Methods The three-dimensional distribution, clinical characteristics and contact history of 4 clustered epidemics in a hospital were analyzed by descriptive epidemiological method. Results There were 14 COVID-19 cases of HCWs in the hospital, and 11 cases of family members were involved, the median age of all cases was 38 (23-76) years old, ratio of male to female was 0.79:1. The median of shortest and longest incubation period of all cases was 4 (0-9) and 7 (3-14) days respectively. Interval from the disease onset to medical consultation of all cases was 2 (0-9) days, among which HCWs cases was 1.5 (0-8) days, family member cases was 3 (1-9) days. The first cases of 4 COVID-19 clustering epidemics were all related to Wuhan. Conclusion This event was composed of 4 COVID-19 clustering epidemics, 3 of which were spread by family members, 1 was spread by colleagues in hospital mixed with family members.

Abstract:Objective To understand contamination of SARS-CoV-2 in isolation wards, and provide evidence for precise monitoring on healthcare-associated infection(HAI). Methods Object surface specimens were taken from clean area, potentially contaminated area and contaminated area in the SARS-CoV-2 isolation wards in The First Hospital of Changsha before disinfection, referring to pharyngeal swab test method, specimens were performed SARS-CoV-2 nucleic acid test, test results were analyzed statistically. Results A total of 191 specimens of various object surface in isolation wards were collected, 9 of which were positive for SARS-CoV-2 test, positive rate was 4.71%. Positive specimens were all from contaminated areas of SARS-CoV-2 isolation wards, ventilator panel, probe and outer surface of B-ultrasound machine, foot pedal of medical waste bin, patient's quilt cover, bedside lamp switch, hands of health care workers(HCWs), bedside table, toilet door handle, patient's mobile phone were detected one positive specimen respectively. Specimens of object surface of potentially contaminated area and clean area was not found SARS-CoV-2. In contaminated areas, positive rate of SARS-CoV-2 nucleic acid test of surroun-ding of patients with cough was higher than that of patients without cough (10.81% vs 1.43%, P<0.05); there was no statistical difference among positive rates of patients' personal belongings, patients' daily necessities, medical facilities and equipment, as well as hands of HCWs and patients (P>0.05). Conclusion Contaminated area in isolation wards is contaminated seriously by SARS-CoV-2, especially surrounding of patients with cough. Strict disinfection and isolation measures should be taken to effectively reduce the HAI risk of COVID-19.

Abstract:The epidemic of coronavirus disease 2019 (COVID-19) has brought about a great impact on society and economy, and also seriously affects the daily medical running of non-frontline departments in the fight against epidemic. This paper summarizes the relevant experience of the running of gynecological ward in Xiangya Hospital of Central South University since the outbreak of COVID-19, medical protection measures required for each link in the process of admission and treatment of patients in the gynecological ward as well as discussion and suggestion on how to apply network platform to manage the whole disease course for patients, with a view to achieving precise management for patients under the premise of medical personnel safety protection.

Abstract:Objective To explore the risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) healthcare-associated infection(HAI) after organ transplantation, and provide evidence for prevention and control of CRKP. Methods 54 hospitalized patients who were diagnosed with CRKP HAI in organ transplantation ward of a hospital from January 1, 2014 to July 31, 2018 were selected as the case group, and 27 hospitalized patients diagnosed with carbapenem-susceptible Klebsiella pneumoniae (CSKP) HAI during the same period were selected as the control group, retrospective case-control study was conducted. Results Infection sites of two groups of patients were mainly lower respiratory tract(42.59% and 48.15%) and surgical site (44.44% and 25.93%); except for cefazolin, resistance rates of Klebsiella pneumoniae to other 20 kinds of antimicrobial agents in two groups of patients were all statistically different (all P<0.05). Univariate analysis showed that patients' age, antimicrobial use≥3 type, carbapenem use, and antifungal use before specimen detection were all associated with CRKP HAI in patients after organ transplantation(all P<0.05); multivariate analysis showed that patients' age, antimicrobial use≥3 type, and carbapenem use before specimen detection were independent risk factors for CRKP HAI in patients after organ transplantation. Conclusion Prevention and control measures of HAI in patients after organ transplantation should be strengthened according to risk factors, especially the rational use of carbapenems.

Abstract:Objective To evaluate the advantages and disadvantages of first-line empirical anti-infective therapy for patients with chemotherapy-induced febrile neutropenia of hematological malignancy. Methods Infection sites and distribution of pathogens of patients with chemotherapy-induced febrile neutropenia of hematological malignancy in a hospital from August 2017 to December 2018 were retrospectively analyzed, according to first-line anti-infective therapy scheme, patients were divided into carbapenem-based agents group(carbapenem group) and β-lactamase inhibitor compounds-based agents group(β-lactamase group), therapeutic efficacy, total hospitalization cost and length of hospital stay between two groups were compared. Results A total of 103 cases with chemotherapy-induced febrile neutropenia of hematological malignancy were collected, including 71 cases in carbapenem group and 32 cases in β-lactamase group. The most common infection site was respiratory tract, followed by bloodstream and gastrointestinal tract. 47 strains of pathogens were isolated, Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 68.1%, 12.8% and 19.1% respectively, Klebsiella pneumoniae accounted for the highest proportion (25.5%), followed by Escherichia coli (21.3%) and Pseudomonas aeruginosa (8.5%). The effective therapeutic rates of carbapenem group and β-lactamase group were 90.1% and 71.9% respectively, the total hospitalization cost were (59 529.7±39 771.3) Yuan and (49 546.9±31 641.1) Yuan respectively, length of hospital stay were (28.7±7.9) and (26.2±6.3) days respectively, differences in therapeutic rate between two group of patients was statistically significant(P=0.038), differences in total hospitalization cost and length of hospital stay between two group of patients were not statistically significant (both P>0.05). Conclusion For patients with chemotherapy-induced febrile neutropenia of hematological malignancy, first-line empirical application of carbapenems as the main anti-infective therapy is better than β-lactamase agents, the total hospitalization cost and length of hospital stay of two groups have no significant difference.

Abstract:Objective To investigate the diagnosis and treatment of Acinetobacter baumannii (AB) lower respiratory tract infection (LRTI) in intensive care unit(ICU), and provide reference for the prevention and treatment. Methods Clinical data of patients who were isolated AB in a general ICU of a tertiary first class hospital from September 2017 to August 2018 were collected, isolation of AB, antimicrobial susceptibility testing results, colonization of AB in lower respiratory tract (LRT), as well as diagnosis and treatment were retrospectively analyzed, efficacy of anti-AB infection treatment (treatment group) and non-anti-AB infection treatment (control group) in patients with AB LRTI were compared. Results A total of 106 strains of AB were isolated, 51.89% (55 strains) were colonized strains, healthcare-associated strains accounted for 43.40% (46 strains), 92.45% (98 strains) were isolated from LRT. Susceptibility rates of AB to 15 kinds of antimictrobial agents were all lower than 30%, susceptibility rates to polymyxin and tigecycline were 96.23% and 66.98% respectively. There were significant differences in white blood cell(WBC)/squamous cell, sputum culture, symptoms and signs of pneumonia, infection indicators and lung imaging between patients with AB colonization and LRTI (all P<0.05). Of 47 patients with AB LRTI, the total therapeutic effective rates were 88.00% in treatment group and 81.82% in control group, there was no significant difference in therapeutic efficacy between two groups of patients(P>0.05). Conclusion AB in general ICU mainly comes from LRT, most are colonized bacteria and can cause healthcare-associated infection, and only susceptible to polymyxin and tigecycline. LRT AB sputum smear, sputum culture, symptoms and signs of pneumonia, infection indicators and lung imaging are helpful to determine infection or colonization, clinical efficacy of treatment group is no better than that of control group.

Abstract:Objective To understand the implementation status of Regulation of disinfection technique in healthcare settings (WS/T367) (hereinafter referred to as regulation of disinfection), find out the main problems and weak links in the disinfection management, and provide scientific basis for further strengthening the disinfection management of healthcare settings. Methods A multi-stage stratified sampling method was adopted to determine the surveyed subjects, formulation and revision of hospital disinfection management system, management of disinfection products, supervision of disinfection work, disinfection-related training, cleaning and disinfection process were investigated. Results A total of 256 healthcare settings were investigated, after the issuing of regulation of disinfection, 94.14% (n=241) of healthcare settings formulated or revised disinfection management system according to the actual situation; 93.75% (n=240) of healthcare settings reviewed, backuped and stored relevant certificates of disinfection products; 91.41% (n=234) of healthcare settings regularly supervised the disinfection work, as well as summarized, analyzed and fed back in time; 93.75% (n=240) of healthcare settings carried out disinfection-related training, and 88.67% (n=227) of healthcare settings carried out the correct routine reuse process of medical instruments. Conclusion The issuing of regulation of disinfection standardized the disinfection management of healthcare settings. Disinfection process of reusable instruments in healthcare settings has been basically standardized, correct rate of cleaning and disinfection process in primary healthcare settings is obviously lower than that in hospitals, which is the focus of disinfection management in the future.

Abstract:Objective To explore the clinical characteristics and risk factors of nosocomial invasive pulmonary mycosis(IPM) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods Clinical data of HBV-ACLF patients who were admitted to a hospital between November 2013 and August 2019 were collected, according to whether patients had IPM, they were divided into HBV-ACLF nosocomial IPM group (study group) and HBV-ACLF non-nosocomial IPM group (control group), clinical characteristics, pathogenic bacteria and risk factors of nosocomial IPM were analyzed. Results A total of 119 patients were included in study, 50 in study group and 69 in control group. In study group, 50 patients all had cough and expectoration, 29 had fever, 12 had obvious chest tightness, shortness of breath and hypoxemia, 28 had moist rales through lung auscultation; chest CT of 50 patients showed changes in different degrees, positive rates of serum 1-3-β-D-glucan antigen and galactomannan antigen were 72.00% and 36.00% respectively. A total of 30 strains of fungi were isolated, the most common fungi were Candida albicans (43.33%) and Aspergillus spp. (33.33%), the 28-day mortality was 76.00%. Long-term use of broad-spectrum antimicrobial agents, decrease of absolute neutrophil count, invasive procedure, proportion of 28-day mortality, total bilirubin level, international standardized ratio, score in model for end-stage liver disease, and length of hospital stay in study group were all higher than those in control group (all P<0.05). Conclusion Clinical manifestations of HBV-ACLF patients with nosocomial IPM have no obvious specificity, the main infection fungus is Candida spp., which is related to the long-term use of broad-spectrum antimicrobial agents, decrease of absolute neutrophil count and invasive procedure, prognosis is poor.

Abstract:Objective To investigate the management and maintenance status of dialysis water treatment system in hemodialysis center of hospitals in a province, analyze the relationship between the relevant factors such as reverse osmosis membrane, pipeline disinfection and the total bacterial colony count and endotoxin level detected in dialysis water, identify risk factors and explore improvement measures. Methods Dialysis water from outlet of reverse osmosis unit and backwater inlet of water pipeline in 18 hospitals was collected and enriched by membrane filtration method,specimens were cultured on tryptone glucose extract agar (TGEA) for 168 hours at 20℃, bacterial colony counting were conducted and endotoxin of parallel water specimens was detected. Questionnaire was designed to investigate the management and maintenance information of dialysis water system. Results The interval length between sampling time and reverse osmosis film replacement was positively correlated with the total number of bacterial colonies at the backwater inlet, as well as endotoxin at backwater inlet and outlet of reverse osmosis unit. Interval length between sampling time and the last time pipeline disinfection was negatively correlated with endoto-xin at backward inlet and outlet of reverse osmosis unit, allocation of professional engineers was negatively correlated with the total number of bacterial colonies at backwater inlet and endotoxin at outlet, while the length of the hose was positively correlated with endotoxin at backwater inlet. Regression analysis showed that the duration of using, the number of dialyzers and the number of dialysis patients also affected the microbial indicators of dialysis water. Conclusion Maintenance and replacement of reverse osmosis membrane, disinfection of water pipeline, allocation of professional engineers, scale of dialysis center and length of pipeline are the main influencing factors of microbial indicators of dialysis water. There are differences in the management and maintenance of water treatment system in different hospitals, so it should be promoted by quality control to achieve homogeneity.

Abstract:Objective To evaluate the protective effect of patient's protective mask on oral spray during periodontal scaling. Methods Ultrasonic scaling was simulated by simulated human in dental clinic to test the protective effect of a new protective mask for patients. The test was divided into six groups according to the teeth position and protective methods(group 1: Upper right anterior teeth + low volume saliva ejector; group 2: Upper right anterior teeth + low volume saliva ejector+ high volume saliva ejector; group 3: Upper right anterior teeth + low volume saliva ejector + new protective mask; group 4: Lower right anterior teeth + low volume saliva ejector; group 5: Lower right anterior teeth + low volume saliva ejector+ high volume saliva ejector; group 6: Lower right anterior teeth + low volume saliva ejector + new protective mask). The spattering range and percentage of spattering area during simulated ultrasonic scaling among groups were compared. Results The spattering range and the percentage of spattering area on white paper were both 0 in group 3 and group 6 (using low volume saliva ejector + new protective mask, whether it was upper right anterior teeth or lower right anterior teeth), while group 1, 2, 4 and 5 (only use low volume saliva ejector or combined with high volume saliva ejector) produced spatter of certain range, and percentage of spattering area were (1.34±0.56)%-(24.48±7.43)%. Conclusion The new protective mask can effectively stop oral spattering during ultrasonic scaling.

Abstract:Objective To investigate the contamination status of dental unit waterlines (DUWLs), and explore influencing factors for DUWLs contamination. Methods The stratified random sampling method was used to collect water specimens from different brands of dental chair unit (DCU) in various outpatient departments of a stomatologi-cal hospital in Beijing from June 22, 2017 to February 23, 2018, bacterial culture and counting was performed, univariate and multivariate analysis of variance was adopted to analyze the differences in bacterial colony of water specimens from DUWLs of different brands, service years, used clinics and sampling sites. Results A total of 464 DCU water specimens were collected, the median of colony forming unit of DUWLs water specimens was 2.6×10³(17-5.2×10⁵)CFU/mL. Univariate analysis of variance showed that there were significant differences in colony forming unit of water specimens from DUWLs of different service years, different diagnosis and treatment specialties and different brands (all P<0.05), but there was no significant difference in colony forming unit of water specimens at different outlet of DCU (P=0.067). Multivariate analysis of variance showed that service years and brands of DCU, as well as diagnosis and treatment specialties all influenced the change of DUWLs bacterial colony (P<0.001), and there was an interaction between DCU brands and diagnosis and treatment specialties, DCU brands and service years (both P<0.001). Conclusion At present, DUWLs are seriously contaminated and are jointly affected by various factors such as DCU service years, brands, as well as diagnosis and treatment specialties.

Abstract:Objective To investigate routine maintenance of eye washer and emergency shower and the proficiency in operation process of health care workers(HCWs) in key departments of a hospital, so as to provide countermeasures for effective management. Methods From October 16 to 17, 2019, self-designed inspection form was used to investigate the integrity of eye washer and emergency shower in key departments of the hospital, HCWs were randomly selected to assess the operation process of eye washer and emergency shower, intervention measures were taken to solve the existing problems, investigation and assessment were conducted again one month later, results of two surveys and assessment were compared. Results There were 30 eye washers and 5 emergency showers in the whole hospital. After the implementation of intervention measures, the proportion of eye washer and emergency shower with low water pressure, high water pressure, facility damage, water leakage of sewer pipe, dirty facilities decreased compared with before the implementation of intervention measures, differences were all statistically signifi-cant (all P<0.05). The qualification rate of HCWs on the correct operation process of eye washer and emergency shower increased from 53.13% to 89.42% (P<0.05). Conclusion Effective management can improve the maintenance status and integrity rate of eye washer and emergency shower, and improve the emergency protection ability of HCWs in key departments.

Abstract:Objective To analyze risk factors and constituent pattern of pathogenic bacteria of urinary tract infection(UTI) after transurethral resection of prostate (TURP). Methods Clinical data of patients with benign prosta-tic hyperplasia undergoing TURP in department of urological surgery of a hospital were retrospectively analyzed,univariate and multivariate logistic regression analysis was used to analyze the risk factors for UTI after TURP, constituent of pathogenic bacteria in urine specimens was analyzed. Results Of 155 patients receiving TURP, 24 (15.5%) developed post-operative UTI. Univariate analysis showed that patients with UTI and patients without infection were significantly different in age, prostate size, pre-operative urinary catheterization, previous urological intervention, history of diabetes mellitus, size of resectoscope sheath, duration of operation, and temperature of irrigation fluid (all P<0.05); multivariate logistic regression analysis revealed that patients' age>65 years (OR=4.18, 95% CI: 1.19-14.75, P=0.026), prostate weight>55 g (OR=3.92, 95% CI: 1.11-13.83, P=0.034), pre-operative urinary catheterization (OR=0.28, 95% CI: 0.11-0.70, P=0.006), previous urological intervention (OR=4.70, 95% CI: 1.85-11.94, P=0.001), history of diabetes mellitus (OR=2.54, 95% CI: 1.00-6.48, P=0.050), resectoscope sheath size=26F(OR=9.05, 95% CI: 1.18-69.48, P=0.034), duration of operation>60 minutes (OR=10.48, 95% CI: 1.37-80.25, P=0.024), and temperature of irrigation fluid<37℃ (OR=4.06, 95% CI: 1.57-10.50, P=0.004) were independent risk factors for UTI after TURP. A total of 23 strains of pathogenic bacteria were isolated from urine specimens of infected patients, mainly Gram-negative bacteria (78.26%), Escherichia coli accounted for 52.17% (n=12). Conclusion UTI after TURP is associated with duration of operation, size of resectoscope sheath, previous urological intervention, and prostate size, Escherichia coli is the main pathogen of infection, effective prevention of high-risk factors and rational use of antimicrobial agents can reduce the occurrence of UTI after TURP.

Abstract:

Abstract:With the emergence of home care in recent years, the problem of medical waste disposal caused by home care has gradually attracted attention. At present, national and local governments have not yet issued relevant documents on the collection, transportation and disposal of medical waste generated by home care. In this paper, the domestic and foreign literatures on the treatment of medical waste in home care are reviewed, so as to provide reference for the development of medical waste treatment standards in home care.