Abstract:Objective To analyze the clinical characteristics and peripheral blood lymphocyte subsets of HAdV55 pneumonia in adult patients. Methods 132 adult patients with HAdV55 infection in a hospital from December 2016 to May 2018 were retrospectively analyzed, including 38 patients with pneumonia (pneumonia group) and 94 patients with upper respiratory tract infection (URTI group), clinical and imaging characteristics of two groups of patients were compared. Flow cytometry was used to analyze the distribution of peripheral blood lymphocyte subsets in 31 patients with pneumonia, 38 patients with URTI and 10 healthy controls, dynamic changes in peripheral blood T lymphocyte subsets in 5 patients with pneumonia and 3 patients with URTI were observed. Results Compared with URTI group, patients in pneumonia group had higher proportion of expectoration, longer fever days and hospitalization time, decreased peripheral blood white blood cell and neutrophil count, as well as increased lymphocyte proportion and absolute count (all P < 0.05), chest CT showed that the lung lesions mainly focused on the right lung (21/38, 5.3%). Lymphocyte subsets analysis showed that proportions of CD4⁺T cells, CD8⁺T cells, NK cells and B cells in patients with pneumonia were both higher than those in healthy controls, there was no significant difference compared with patients in URTI group (P>0.05). The dynamic analysis of T lymphocyte subsets showed that CD3⁺ T lymphocyte count of 5 pneumonia patients decreased on the 3rd day of disease course, then increased gradually, and returned to normal on the 18th day. Conclusion Expectoration is more common in patients with HAdV55 adult pneumonia, right lung is easy to be affected, host cell immune function is disordered, dynamic monitoring on peripheral blood lymphocyte subsets is helpful to assess the disease condition.

Abstract:Objective To analyze the epidemiological characteristics of Human adenovirus(HAdV) infection in Chinese army in recent years, and explore the epidemic trend, so as to provide theoretical basis for the disposal of military epidemic outbreaks. Methods Literatures on epidemic outbreak of HAdV in Chinese army published from June 1999 to August 2019 were collected from China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Database. Virus typing, outbreak time (including year and month), regional distribution, population structure and clinical characteristics were analyzed statistically. Results A total of 44 available literatures on HAdV epidemic outbreaks in Chinese army were retrieved, including 46 events of epidemic outbreaks involving 8 710 cases of infection. The types of HAdV causing the epidemic included type 3 (1 event), type 5 (2 events), type 7 (19 events), type 11 (1 event), type 55 (16 events) and unclassified type (7 events); type 7 and type 55 accounted for 41.3% (19 events) and 34.8% (16 events) respectively; the number of infection accounted for 49.5% (4 312 cases) and 35. 9% (3 129 cases) respectively. The outbreaks in January, February and December accounted for 76.1% (35 events) of the total outbreaks, and the number of infection cases accounted for 91.8% (7 999 cases); the main population with infection were recruits or cadets, accounting for 89.2% (2 504/2 807) of the total population; the main clinical manifestations were fever, cough, sore throat and pharyngeal congestion; type 7 and type 55 HAdV infection were the most common, which was prone to be severe. Conclusion Type 7 and type 55 are the most common types of HAdV infection in Chinese army, during training of recruits or cadets in winter and spring, prevention and control of HAdV infection should be strengthened to prevent the outbreak of HAdV infection.

Abstract:Objective To explore the dynamic changes and influencing factors of CD4 cells in HIV-infected/AIDS patients aged≥50 years who received national free antiretroviral therapy(ART) within 60 months in Changde City. Methods HIV-infected/AIDS patients aged≥50 years who were diagnosed and registered in Changde City from January 1, 2005 to December 31, 2017 were selected, data of CD4 cell counts before therapy as well as 3, 6, 12, 24, 36, 48, and 60 months after therapy were collected, according to baseline CD4 cell count, three groups (< 200 cells/μL, 200-cells/μL and ≥350 cells/μL) were divided. Changes and influencing factors of CD4 cell counts with therapeutic time in patients aged ≥50 years with different baseline CD4 cell levels were analyzed. Results A total of 497 patients were included in study. CD4 cell counts of patients with baseline CD4 cell count < 200/μL and 200-/μL showed a continuous growth trend after therapy, while those with baseline CD4 cell count ≥ 350/μL showed a wavy growth trend. The results of growth model showed that patients with high baseline CD4 cell count had relatively high CD4 cell count after therapy, patients with homosexual transmission had higher CD4 cell count after therapy than those with heterosexual transmission and other infection transmission. Conclusion Changes of CD4 cells in HIV-infected/AIDS patients ≥50 years with baseline CD4 cell count ≥350/μL fluctuate greatly after therapy, but patients with higher baseline level have relatively higher CD4 cell count after therapy, which indicates that the baseline level of CD4 cells is always a crucial factor for the growth of CD4 cell count after ART.

Abstract:Objective To explore the indwelling time of needle-free infusion connectors of peripherally inserted central venous catheter (PICC). Methods Tumor patients with chemotherapy who underwent PICC maintenance in a tertiary first-class hospital from April to October 2019 were selected and divided into group A and B according to the types of PICC needle-free infusion connectors. Group A used opaque metal spring mechanical valve needle-free infusion connectors (infusion connector A), group B used transparent silica gel mechanical valve needle-free infusion connectors (infusion connector B), needle-free infusion connectors were collected for qualitative and quantitative bacterial culture, positive culture rates of infusion connectors were compared between two groups when PICC was retained for 4-, 8-, 15-, and >21 days. Results A total of 174 patients were included in the study, quantitative bacterial culture of 11 patients with PICC needle-free infusion connectors was positive, positive rate was 6.32%, positive rates of group A and group B were 8.70% (8/92) and 3.66% (3/82) respectively. There was significant difference in the positive rate of quantitative culture of needle-free infusion connectors with different indwelling time in group A (P < 0.05), but there was no significant difference in group B (P>0.05); positive rates of qualitative culture of needle-free infusion connectors with different indwelling time were not significantly different in both group A and group B (P>0.05). There was no significant difference in the positive rates of both quantitative and qualitative culture of needle-free infusion connectors with the same indwelling time between group A and group B (both P>0.05). Positive rate of culture was 0 for 8-14 indwelling days in group A and for 15-21 indwelling days in group B. 11 strains of 5 species of bacteria were isolated, Bacillus cereus (4 strains) was most common specie. Conclusion Quantitative bacterial culture of infusion connectors in group A with different indwelling time are diffe-rent, there is no difference in bacterial culture positive rate between transfusion connectors A and B with the same indwelling time.

Abstract:Objective To evaluate the effect of evaluation and feedback after comprehensive monitoring on the operation and maintenance of laminar airflow operating rooms. Methods Technical code for construction of hospital clean operating department was used as the monitoring and judgment standard, from February to May 2017, 81 laminar airflow operating rooms in 34 hospitals in Yunnan Province were conducted baseline comprehensive monitoring, monitoring results and rectification suggestions after evaluation were fed back to each hospital, comprehensive monitoring was carried out again from November 2017 to March 2018, the baseline monitoring results were compared with the monitoring results after evaluation and feedback. Results Compared with the baseline level, the monitoring results of dust particle with particle diameter ≥0.5 μm and ≥5.0 μm as well as planktonic bacteria in laminar airflow operating rooms in secondary and tertiary hospitals were not significantly different (both P>0.05). After evaluation and feedback, the qualified rates of monitoring on cross-section wind speed, non-uniformity of wind speed β and blind zone of wind speed were all higher than those of baseline monitoring results, differences were all statistically significant (all P < 0.05); the qualified rates of temperature, relative humidity, air change times, static pressure difference, noise and illumination before and after evaluation and feedback were all not significantly different (all P>0.05). The proportion of obstacle to rectification of "unprofessional maintenance personnel" in laminar airflow operating rooms in secondary hospitals was higher than that in tertiary hospitals, difference was significant (P=0.014). Conclusion The evaluation and feedback after comprehensive monitoring on laminar airflow operating rooms can improve the effect of operation and maintenance of laminar airflow operating rooms, comprehensive monitoring on laminar airflow operating rooms should be carried out regularly, and professional maintenance personnel should be equipped to take charge of the normal operation and maintenance of laminar airflow operating rooms.

Abstract:Objective To explore the promotion of informationized quality traceability management(QTM) in hospital central sterile supply departments (CSSDs) in China. Methods According to the basic requirements of information system in Central sterile supply department (CSSD)-Part 1: Management standard WS 310.1-2016, informationized QTM of CSSDs was investigated through sampling survey method by Disinfection and Supply Professional Committee of Chinese Nursing Association, a series of management measures were taken. The baseline and the second survey was conducted in July 2018 and July 2019 respectively. Implementation of informationized QTM in 2018 and 2019 was compared. Results In 2018, 1 972 hospitals participated in the survey, CSSDs in 1 633 (82.81%) of hospitals implemented QTM for centralized processing of sterile items; in 2019, 2 728 hospitals participated in the survey, CSSDs in 2 606 (95.53%) hospitals implemented QTM for centralized processing of sterile items. There was significant difference in the proportion of quality traceability methods used by the investigated hospitals in the past two years (χ²=43.339, P < 0.001), difference among different levels of hospitals was significant (all P < 0.001). Distribution of quality traceability function and management function in different levels of hospitals during two years was significantly different (all P < 0.001). Of the 919 hospitals that implemented informationized QTM, 572 (62.24%) hospitals all achieved traceability (all centralized processed items were included in informationized QTM), and 471 (82.34%) hospitals mainly used each sterilization package as the traceability granularity. Conclusion informationized QTM in domestic hospitals needs to be improved, rational selection of label technology, development of information system function and improvement of traceability granularity can further improve the quality and efficiency of CSSDs with the help of information development.

Abstract:Objective To establish a risk assessment system for respiratory tract infection in health care workers (HCWs) in outpatient settings of medical institutions. Methods Brainstorming method and literature Meta-analysis method were used to identify risk points, risk points were classified and evaluated by scatter plot of risk, weight of risk points was calculated by analytic hierarchy process. Results The risk assessment system included four risk categories: "diagnosis and treatment process", "environment and layout", "personnel protection" and "emergency disposal", involving a total of 18 risk points. Conclusion The risk assessment system constructed in this study is helpful for the classification management for respiratory tract infection risk in HCWs in outpatient settings.

Abstract:Objective To analyze the effect of different antimicrobial exposure on infection or colonization of carbapenem-resistant Klebsiella pneumoniae (CRKP), explore the effect of different control groups on the results of observational study of antimicrobial exposure as a risk factor. Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other databases were retrieved, studies that met the inclusion criteria published in the past 10 years were searched. Group 1: control group was the study of carbapenem-susceptible Klebsiella pneumoniae (CSKP); group 2: control group was the study of non-infection or colonization. Revman 5.3 software was used for Meta-analysis and sensitivity analysis. Results A total of 40 studies were included, 32 in group 1 and 8 in group 2. Meta-analysis showed that exposure to carbapenems, quinolones, cephalosporins, β-lactam/β-lactamase inhibitors and other antimicrobial agents increased the risk of CRKP infection. Conclusion Antimicrobial exposure increases the risk of microbial resistance, so rational and standardized use of antimicrobial agents should be strengthened. In the observational study of antimicrobial agents as a risk factor for microbial resistance, the selection of control group has a certain impact on study results, which should be carefully selected according to the purpose of study.

Abstract:Objective To investigate the clinical characteristics of infectious mononucleosis (IM) combined with Mycoplasma (MP) infection in children in different age period. Methods Data of children with IM who were admitted to the department of infectious diseases of a children's hospital between 2016 and 2018 were collected and divided into simple IM group and IM+MP infection group according to whether MP infection was complicated. Demographic characteristics were divided into infancy period (< 1 year old), early childhood period (1-3 years old), pre-school period (4-6 years old) and school-age period (7-13 years old) according to children's age. Clinical characteristics and laboratory data of two groups of children were analyzed. Results Among 750 hospitalized children with IM, 410(54.7%) were simply with IM and 340(45.3%) were with IM+MP, 44.8% (n=336) were in early childhood period, and 34.4% (n=258) were in pre-school period. The proportion of children in infancy period in IM+MP group was higher in spring and summer (41.7% for each) and lower in autumn and winter (8.3% for each); proportion of children in school-age period in IM+MP group in autumn was higher (42.3%). Compared with simple IM group, children in IM+MP group were more likely to develop blood system complication in infancy period, respiratory system diseases in early childhood period, and circulatory system diseases in pre-school period; occurrence rates of eyelid edema in infancy period, occurrence rates of pharyngeal secretion and hepatomegaly in early childhood period, occurrence rates of high fever and eyelid edema in pre-school period, as well as occurrence rates of high fever and splenomegaly in school-age period were all higher; In IM+MP group, alanine aminotransferase(ALT) in infancy period, white blood cell(WBC) in early childhood period, creatine kinase isoenzyme(CK-MB) in pre-school period, as well as WBC, ALT and Epstein-Barr virus DNA (EB-DNA) in school-age period were all higher than those in simple IM group; CD4⁺/CD8⁺ of two groups of children decreased gradually with the increase of age, which was more obvious in the pre-school and school-age IM+MP group, differences were all statistically significant (all P < 0.05). Conclusion Proportion of children with IM+MP in different age period is varied with different seasons. Compared with simple IM children, IM+MP group is different in complications, clinical characteristics and laboratory indicators, understanding the disease characteristics of different age groups is conducive to early diagnosis and rational treatment.

Abstract:Objective Fever clinic is the first threshold to prevent and control infectious diseases, based on the summary and analysis on the problems and difficulties in the operation of fever clinics in Wuhan City during epidemic of coronavirus disease 2019 (COVID-19), operation mechanism of fever clinics as well as prevention and control improvement direction of epidemic in China were evaluated. Methods Daily visit data in all fever clinics in medical institutions in Wuhan were surveyed from January 15, 2020 to March 15, combined with the information related to notification, policy and document about prevention and treatment for COVID-19 epidemic issued by China, Hubei Province and Wuhan, visits and operation in fever clinics in Wuhan during COVID-19 epidemic period was retrospectively reviewed and evaluated. Results During the survey period, a total of 76 secondary and above medical institutions in Wuhan opened fever clinics to receive and cure fever patients. From January 15 to March 15, 2020, the average daily number of visits in fever clinics in Wuhan was 6 070 person-time. The number of visits in fever clinics was 1 625 person-time on January 15 and peaked on January 24 (14 486 person-time). From January 30 to February 6, the number of visits in fever clinics in Wuhan was almost saturated. Since February 6, the number of visits showed a gradual downward trend, and dropped to 585 person-time on March 15. Except Hongshan Region, the average daily numbers of visits in the other 6 administrative regions in downtown area of Wuhan were all more than 1 000, the number of visits in fever clinics in Wuchang Region was generally higher than other regions. Conclusion During the epidemic period, fever clinics in Wuhan failed to give full play to the role of early warning, and there were problems in equipment of personnel, materials and facilities. Medical institutions should optimize the construction and management of fever clinics from the following four aspects: establishing a public health early warning feedback mechanism, building scientific one-stop fever clinic, establishing medical emergency supply guarantee system and setting up compound public health emergency team, so as to formulate scientific and effective epidemic prevention and control strategies.

Abstract:Objective To evaluate the application efficacy of infection control observer(ICO) system in operating rooms during coronavirus disease 2019 (COVID-19) epidemic period. Methods ICO system was applied to the diagnosis and treatment activities in operating rooms, epidemic-relevant procedures and guidelines of operating rooms were formulated, on the first day (February 17) after one week of work and the first day (February 24) after one week of the implementation of ICO management system during epidemic period, anxiety as well as qualified putting on and taking off personal protective equipment(PPE) of health care workers (HCWs) in operating rooms were investigated by self-rating anxiety scale (SAS) and rating scale of putting on and taking off PPE, difference before and after the implementation of ICO system were compared. Results A total of 60 HCWs were surveyed and 120 questionnaires were issued twice, 100% of questionnaires were available. Before the implementation (February 17), anxiety score of HCWs was (56.96±9.45), after the implementation (February 24), anxiety score of HCWs was (35.02±6.21), difference was significant (t=14.878, P < 0.001). Before and after the implementation of ICO system, anxiety scores of HCWs with different professional titles were all significantly different (all P < 0.05). Before the implementation of system, anxiety score of HCWs with junior professional title was lower than that of HCWs with intermediate and senior professional titles, differences were both significant (both P < 0.05). Anxiety scores of HCWs with different professional titles before and after the implementation of ICO system were all significantly different (all P < 0.001). 50 nurses in the department were grouped to evaluate putting on and taking off PPE, qualified rate of putting on and taking off PPE in group A (without the supervision and guidance of ICOs) was 40.00% (10/25), while that in group B (with the supervision and guidance of ICOs) was 100.00% (25/25), group B was higher than that in group A, difference was significant (χ²=21.429, P < 0.001). Conclusion ICO system can effectively reduce the psychological anxiety of HCWs during diagnosis and treatment activities and improve the qualified rate of putting on and taking off PPE.

Abstract:Objective To evaluate the effect of different types of ballast on radiation intensity of ultraviolet (UV) lamp. Methods UV lamps were installed on the lamp frames of electronic ballast and inductance ballast respectively, the radiation intensity of UV lamp was monitored and analyzed by ultraviolet radiation intensity monitor. Results In August 2018, at the same temperature, humidity and voltage, the average radiation intensity of 27 new UV lamps using electronic ballast and inductance ballast in a new department were (67.85±6.51) μW/cm² and (109.07±7.43) μW/cm² respectively, with the qualification rates of 0 and 100% respectively; there were significant differences in average radiation intensity and qualified rate between two groups (both P < 0.05). In October 2018, 282 UV lamps used in each ward of a hospital were all electronic ballast, with a total of 8 manufacturers; the average radiation intensity of 92 UV lamps was (103.14±22.35) μW/cm², and the average radiation intensity was (123.50±13.80) μW/cm² after replacing with inductance ballasts; difference was statistically significant before and after replacement. Conclusion The types of ballast has an effect on the radiation intensity of UV lamp, inductance ballast should be selected for UV lamp in hospital to improve the radiation intensity of UV lamp.

Abstract:Objective To study microbial killing efficacy of slightly acidic electrolyzed water (SAEW) in laboratory. Methods SAEW produced by hypochlorous acid water generator was selected to determine the microbial killing efficacy of different available chlorine concentration and different action time on bacterial propagules, spores and fungi. Results When the available chlorine concentration in SAEW was 34.3-118 mg/L, concentration of organic interfering substance bovine serum albumin(BSA) were 3.0% and 0.3%, the average killing logarithm values for Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were all >5.00 after 1.0, 3.0, 5.0, 10.0 minute contact time respectively, the average killing logarithm values for Candida albicans were all >4.00; when available chlorine concentration was 101-118 mg/L and concentration of BSA was 0.3%, the average killing loga-rithm values for spores of Bacillus subtilis var.niger were all >5.00 after 5.0, 10.0 and 30.0 minute contact time respectively. Conclusion Under specific experimental conditions, SAEW can meet the disinfection qualified stan-dard of disinfectant for bacterial propagules, spores and fungi.

Abstract:Objective To observe the difference in microbial monitoring results of dialysis water in different sampling points, and explore high-risk links of microbial contamination in water supply pipeline. Methods According to the requirements of YY 0572—2015 "Water for hemodialysis and related therapies", 57 dialysis centers were sampled at multiple points, including water treatment system water outlet, water return outlet, connection of water inlet hose and dialysis machine, the total number of bacterial colonies and endotoxin index of dialysis water were detected. Results The qualified rates of total bacterial colonies and endotoxin in dialysis water at water outlet of water treatment system were the highest, both were 100%, followed by 96.88% and 95.31% at the water return outlet, qualified rate at the connection of water inlet hose and dialysis machine were 80.86% and 77.03% respectively, qualified rate of total bacterial colonies and endotoxin in water storage tank and liquid preparation barrel were the lowest, which were 66.67% and 83.33% respectively. Conclusion Connection of hose and dialysis machine, water storage tank and liquid preparation barrel are the main links of contamination of dialysis water, clinical disinfection should pay attention to these disinfection blind area, sampling of connection at hose and dialysis machine and other high-risk points in daily monitoring should be strengthened.

Abstract:Prosthetic joint infection (PJI) is a serious complication after joint arthroplasty. Aggregatibacter aphrophilus (A. aphrophilus) is a fastidious bacteria, which was detected from hip joint puncture fluid after total hip arthroplasty of a patient in a hospital by both metagenomic next-generation sequencing(mNGS) and 16S polymerase chain reaction (16S PCR) detection, the optimal culture of intraoperative specimen was performed according to the detection results, A. aphrophilus was cultured finally and antimicrobial susceptibility testing was performed. After two-stage revision of hip arthroplasty and susceptible antimicrobial treatment, the patient was successfully cured. This paper reports and conducts literature review on a rare case of A. aphrophilus infection after total hip arthroplasty.

Abstract:One case of early diagnosis of pulmonary cryptococcosis by detecting cryptococcal capsular polysaccharide antigen in bronchoalveolar lavage fluid (BALF) with lateral flow immunochromatographic assay(LFA) was reported, so as to provide reference for the diagnosis of pulmonary cryptococcosis. This patient only had Cryptococcus pulmonary infection, LFA was negative for detection of serum capsular polysaccharide antigen on admission, but positive for detection of BALF capsular polysaccharide antigen. Compared with serum, the detectable capsular polysaccharide antigen in BALF appeared positive earlier. Therefore, LFA detection of BALF capsular polysaccharide antigen is more significant for the early diagnosis of pulmonary cryptococcosis.

Abstract:Viral respiratory tract infection is a serious threat to human health, causing significant morbidity and mortality worldwide. Many viral respiratory tract infections exhibit similar clinical symptoms, so the rapid detection and identification of pathogens is of great significance to the rational use of drugs, disease diagnosis and treatment, as well as reducing of patients pressure and social economy. Compared with routine clinical laboratory testing, point-of-care testing(POCT) is more conducive to identifying pathogens rapidly, improving detection rate of respiratory viruses, reducing unnecessary use of antimicrobial agents, and using antiviral agents rationally. This paper mainly describes the current situation of viral respiratory tract infection, clinical application of POCT and detection methods of viral respiratory tract infection, focusing on the advantages and potentiality of real-time detection of emerging FilmArray respiratory tract molecules in pathogen identification.

Abstract:Science is changing with each passing day, artificial intelligence, high-speed network, precision control and automation technology are developing continously, the application of intelligent robot has become more and more mature and gradually entered all areas of our daily life. Since December 2019, 2019-nCoV has been raging around the world, human beings have been fighting against the epidemic, facing various challenges such as high infectivity of the virus, high mortality after infection, and social panic. With the development of science and technology as well as the change of medical needs, the application of intelligent robot in medical field was found to be able to reduce the workload of medical staff and reduce the risk of cross infection; it can also increase the whole social awareness of diseases and reduce social panic through science popularization as well as prevention and control propaganda. The effective combination of intelligent robot and medical technology can achieve the effect of "one plus one is greater than two" for scientific anti-epidemic, which has great application prospect and can meet the needs of society.