Abstract:Objective To investigate the incidence of healthcare-associated infection (HAI) in patients undergoing radical pancreatoduodenectomy (RPD), assess the economic burden caused by HAIs in these patients, and provide health and economic support for infection prevention and control. Methods Clinical data of patients who underwent RPD in a general surgery ward of a tertiary teaching hospital in Shandong Province from January 2020 to December 2022 were collected retrospectively. The incidences of HAIs in these patients were investigated. Patients were divided into the infection group and the non-infection group based on whether they developed postoperative HAI. A 1 ∶1 propensity score matching method was adopted to construct a covariate balanced database. The hospitalization expenses and length of hospital stay were compared between the two groups of patients, and the economic burden caused by HAIs was calculated. Results A total of 287 patients undergoing RPD were included in the analysis, of whom 35 developed HAI, with a HAI incidence of 12.20%. Propensity score matching method successfully matched 33 pairs. After matching, the median total hospitalization expenses for patients in the infection and non-infection groups were 120 722.0 Yuan and 100 367.0 Yuan, respectively, with the infection group incurring an additional total hospitalization expenses of 20 355.0 Yuan (P<0.05); the median length of hospital stay were 28 and 19 days, respectively, and the infection group had an extended length of hospital stay of 9 days (P<0.05). The analysis of individual costs for the two groups showed that, except for the expenses of surgical costs and hygiene mate-rials costs, all other medical expenditures were significantly higher in the infection group than in the non-infection group (all P<0.05). The economic burden caused by Western medicine costs was the highest, reaching 11 427.0 Yuan, followed by treatment costs (3 228.0 Yuan) and examination costs (2 304.0 Yuan). Except for the expenses of surgery and hygiene material costs, the constituent ratio of all other costs increased in the infection group, with the largest increase being in Western medicine costs, which rose by 2.66 %. Conclusion HAIs in patients under-going RPD can increase hospitalization expenses and prolong length of hospital stay. Prevention of postoperative HAIs is beneficial for reducing the economic burden on patients and hospitals.

Abstract:Objective To investigate the infection status and changing trend of hepatitis C virus (HCV) infection in hospitalized patients in medical institutions, and provide reference for formulating HCV infection prevention and control strategies. Methods HCV infection surveillance results from cross-sectional survey data reported to China Healthcare-associated Infection (HAI) Surveillance System in 2020 were summarized and analyzed, HCV positive was serum anti-HCV positive or HCV RNA positive, survey result was compared with the survey results from 2003. Results In 2020, 1 071 368 inpatients in 1 573 hospitals were surveyed, 738 535 of whom underwent HCV test, 4 014 patients were infected with HCV, with a detection rate of 68.93% and a HCV positive rate of 0.54%. The positive rate of HCV in male and female patients were 0.60% and 0.48%, respectively, with a statistically significant difference(χ2=47.18, P < 0.001). The HCV positive rate in the 50- < 60 age group was the highest (0.76%), followed by the 40- < 50 age group (0.71%). Difference among all age groups was statistically significant (χ2=696.74, P < 0.001). In 2003, 91 113 inpatients were surveyed, 35 145 of whom underwent HCV test, resulting in a detection rate of 38.57%; 775 patients were infected with HCV, with a positive rate of 2.21%. In 2020, HCV positive rates in hospitals of different scales were 0.46%-0.63%, with the highest in hospital with bed numbers ranging 600-899. Patients HCV positive rates in hospitals of different scales was statistically significant (χ2=35.34, P < 0.001). In 2020, 12 provinces/municipalities had over 10 000 patients underwent HCV-rela-ted test, and HCV positive rates ranged 0.19%-0.81%, with the highest rate from Hainan Province. HCV positive rates in different departments were 0.06%-0.82%, with the lowest positive rate in the department of pedia-trics and the highest in the department of internal medicine. In 2003 and 2020, HCV positive rates in the department of infectious diseases were the highest, being 7.95% and 3.48%, respectively. Followed by departments of orthopedics (7.72%), gastroenterology (3.77%), nephrology (3.57%) and general intensive care unit (ICU, 3.10%) in 2003, as well as departments of gastroenterology (1.35%), nephrology (1.18%), endocrinology (0.91%), and general intensive care unit (ICU, 0.79%) in 2020. Conclusion Compared with 2003, HCV positive rate decreased significantly in 2020. HCV infected patients were mainly from the department of infectious diseases, followed by departments of gastroenterology, nephrology and general ICU. HCV infection positive rate varies with gender, age, and region.

Abstract:Objective To observe the effect of multi-modal hand hygiene (HH) intervention on HH compliance, as well as the relationship between HH compliance and the healthcare-associated (HA) case infection incidence. Methods From 2014 to 2022, the infection control team in a tertiary first-class hospital implemented multi-modal HH intervention for health care workers (HCWs). The changing trend of HH monitoring data, the correlation between HH compliance rate and HA case infection incidence were analyzed retrospectively. Results The consumption of HH products in the wards showed a stable upward trend; HH compliance rate increased from 64.98% in 2014 to 85.01% in 2022 (P<0.001), and HA case infection incidence decreased from 1.21% to 0.83% (P<0.05). HH compliance rate was negatively correlated with HA case infection incidence (r=-0.369, P=0.027). HH compliance rates in different regions and job posts in each quarter were increased (P<0.001). For 5 different HH moments in each quarter, HH compliance rate fluctuated slightly before sterile manipulation and after touching patient; presented rising trend after touching surroundings around patient, and decreased before touching patient and after touching patients body fluid since 2020 (P<0.001). Conclusion Multi-modal HH intervention can improve the HH compliance of HCWs, improving their HH awareness is conducive to reducing HA case infection incidence.

Abstract:Objective To summarize the distribution characteristics of healthcare-associated infection (HAI) after esophageal cancer surgery, analyze the relevant risk factors for HAI, provide reference for reducing HAI after esophageal cancer surgery, and improve patients life quality. Methods Clinical data of patients with esophageal cancer who underwent surgery in a hospital from January to December 2022 were analyzed retrospectively. Postope-rative HAI sites and distribution were summarized. Chi-square test, univariate analysis and multivariate analysis were adopted to conduct correlation analysis on the basic characteristics, surgery-related influencing factors, antimicrobial use, risk factors and the occurrence of HAI in patients during hospitalization period. Results A total of 404 patients underwent esophageal cancer surgery were included in the analysis, among which 102 cases had 118 episodes of HAI, leading to an incidence and a case incidence of HAI of 25.25% and 29.21% respectively. The major infection sites were lower respiratory tract (n=57, 48.31%), pleural cavity (n=31, 26.27%), and organ space (n=16, 13.56%). Multivariate logistic regression analysis showed that age ≥60 years (OR=2.115, 95%CI: 1.150-3.890), length of hospital stay ≥25 days (OR=8.388, 95%CI: 4.491-15.667) and duration of postope-rative antimicrobial use ≥10 days (OR=2.885, 95%CI: 1.506-5.527) were independent risk factors for the occurrence of postoperative HAI (all P<0.05). Conclusion The major HAI in patients after esophageal cancer surgery is lower respiratory tract infection, and is caused by multiple factors. Patients aged ≥60 years, with a length of hospital stay ≥25 days, and duration of postoperative antimicrobial use ≥10 days are more likely to develop postoperative HAI. In order to improve the life quality of patients underwent esophageal cancer surgery, it is recommended to further strengthen perioperative management, optimize the nursing quality for patients during hospitalization, and use antimicrobial agents rationally to reduce the occurrence of HAI.

Abstract:Objective To study the application of the trinity model and trinity forecasting method in predicting the incidence trend of pulmonary tuberculosis (PTB). Methods By applying the monthly PTB incidence data in Zhejiang Province from 2011 to 2021, a prediction model was constructed based on the trinity model and trinity forecasting method. Predictive performance of the model was evaluated. Results The mean relative prediction errors of model 1 and model 2 based on trinity model and trinity forecasting method were 7.94% and 8.43%, respectively. The mean relative prediction error obtained by adopting autoregressive integrated moving average (ARIMA) model was 8.87%, and the above mean relative prediction error were all in the range of 7.9%-8.9%, which presented an excellent performance of the forecasting model. Conclusion The trinity model is an excellent time series forecasting model, and the trinity forecasting method is an excellent time series forecasting method, with high application value.

Abstract:Objective To analyze the spatial-temporal distribution characteristics and influencing factors of the incidence of tuberculosis (TB) in Chinese mainland, and provide scientific basis for relevant departments to formulate policies and guidelines. Methods TB incidence in Chinese mainland from 2017 to 2022 was as the research object, and data of relevant influencing factors were collected. The spatial autocorrelation analysis method was adopted to establish a spatial lag model to explore the spatial-temporal distribution characteristics of TB incidence, and the important influencing factors of TB incidence were screened. Results From 2017 to 2022, TB incidence reported in 31 provinces and cities in Chinese mainland were 60.53/100 000, 59.27/100 000, 55.55/100 000, 47.76/100 000, 45.37/100 000 and 39.76/100 000, respectively, showing a yearly downward trend. Global Morans Ⅰ analysis showed that TB incidence presented spatial-temporal aggregation. The spatial distribution map and the local indicators of spatial association (LISA) aggregation diagram analysis results for the incidence of reported TB showed a decreasing trend from west to east in TB incidence. In the spatial lag model, the coefficients of 6 insignificant factors shrank to 0, and 6 important factors were screened out: gross domestic product (GDP) per capita (coefficient -0.259), urban unemployment rate (coefficient -0.198), annual sunshine duration (coefficient -0.332), annual mean relative humidity (coefficient -0.433), annual mean NO2 concentration (coefficient -0.263), and annual mean PM10 concentration (coefficient -0.336). Conclusion From 2017 to 2022, TB incidences in Chinese mainland declined year by year, and presented spatial difference and spatial aggregation: high in the east, low in the west, and stable in the middle area. Social economy, climate and air pollution have strong effects on the incidence of TB. Relevant departments should pay more attention to the prevention and treatment of TB in the western region and take targeted preventive measures.

Abstract:Objective To evaluate healthcare-associated infection (HAI) status and influencing factors in coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI) treatment, and construct a risk prediction model. Methods CHD patients who underwent PCI in a hospital from May 2019 to October 2023 were retrospectively selected as the research subjects. Infection status of the CHD patients was analyzed. Patients were randomly divided into a modeling set and a testing set in a 7 ∶3 ratio. Univariate and multivariate logistic regression analyses were performed to analyze the data in the modeling set and determine the influencing factors for HAI in patients. R software was used to construct and validate a nomogram model. Results A total of 858 CHD patients were included in the analysis, 601 in the modeling set and 257 in the testing set. In the modeling set, 41 cases were in the infected group and 560 cases in the non-infected group. The incidence of HAI in CHD patients after PCI treatment was 6.88% (59/858). Infection site were mainly upper respiratory tract and urinary tract. A total of 74 pathogens were isolated, including Gram-positive bacteria, Gram-negative bacteria, and fungi being 39, 31, and 4 strains, respectively. Multivariate analysis showed that old age, combined diabetes, high grade of New York Heart Association (NYHA) classification, and invasive procedures were all risk factors for HAI in CHD patients after PCI treatment (all P<0.05), while high mini-nutritional assessment short-form (MNA-SF) score was a protective factor (P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram prediction model constructed based on the above five indicators was 0.894 (95%CI: 0.815-0.931), with a sensitivity of 89.0% and a specificity of 82.5%. The testing set data validation showed an AUC value of 0.879 (95%CI: 0.801-0.923), with a sensitivity of 87.5% and a specificity of 81.3%, which were comparable to the modeling set and presented the stability of the model. The H-L goodness of fit test showed no statistical significance (P>0.05), indicating that the model didn’t exhibit overfitting. Calibration curve analysis showed that the model had good consistency. Decision curve analysis confirmed that the model had practical value in clinical practice. Conclusion The nomogram model has a good predictive ability for HAI in CHD patients after PCI treatment, and can provide a simple and effective evaluation tool for medical staff to identify HAI high-risk individuals.

Abstract:In recent years, the reported incidence of human brucellosis has been increasing year by year, and the epidemic range has been spread continuously. It has gradually spread from animal husbandry areas with high incidence to world wide, and become an important public health problem in China. Research on the epidemiological characteristics of brucellosis is of great significance for the effective prevention and control of brucellosis epidemic. This paper systematically reviews brucellosis at home and abroad, especially the domestic epidemic situation and hotspots of brucellosis, understands the incidence situation in various regions, and analyzes the causes of brucellosis based on literature research, so as to provide a theoretical basis for the early warning, monitoring, as well as adjustment of prevention and control policy of brucellosis.

Abstract:Objective To evaluate the effect of targeted monitoring and multi-modular improvement strategy on the prevention and control of catheter-associated urinary tract infection (CAUTI). Methods Patients with indwe-lling urinary catheter in a tertiary first-class hospital from January 2018 to December 2022 were selected as the research subjects. Targeted monitoring results and distribution of pathogenic bacteria in 5 consecutive years were analyzed, and a multi-modular improvement strategy based on the targeted monitoring results was implemented. The occurrence of CAUTI before and after implementation, status and effectiveness of training in prevention and control measures were compared respectively. Results Before and after the implementation of the multi-modular improvement strategy, health care workers compliance rate of hand hygiene, awareness rate of prevention and control measures, and implementation rate of prevention and control measures all increased significantly (all P < 0.001). Targeted monitoring results showed that daily test rates of urine culture and routine urine from patients with indwelling catheters have been on the rise in 5 consecutive years (P < 0.05). A total of 397 cases of CAUTI occurred in the past 5 years. Incidences of CAUTI in general intensive care unit(ICU) and surgical ICU showed decreasing trends in 5 consecutive years (all P < 0.05). Incidence of CAUTI in general wards showed no statistically significant difference in 5 years (P=0.088). A total of 431 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria. Daily incidence of multidrug-resistant organism infection in patients with indwelling catheters was 0.12‰. After the implementation of the multi-modular improvement strategy, incidence of CAUTI in all departments reduced significantly (P < 0.05). Conclusion Targeted monitoring can help identify departments with high-risk of CAUTI, multi-modular improvement strategy can raise the quality of prevention and control of CAUTI in all occasions, reduce the incidence of CAUTI, and is worthy of clinical promotion and application.

Abstract:Objective To understand the changes in occurrence and etiology of hand-foot-and-mouth disease (HFMD) before and after enterovirus 71 (EV-71) vaccination in Jining City from 2012 to 2021. Methods Occurrence and etiology of HFMD in Jining City were analyzed by descriptive epidemiological methods. Changes in incidence and pathogens of HFMD before and after EV-71 vaccination were compared. Results From 2012 to 2021, incidence of HFMD among children aged 6 months-5 years in Jining City was 658.93/100 000, the highest incidence was 1 094.63/100 000 in 2018, and the lowest incidence was 247.23/100 000 in 2021. In laboratory diagnosis cases, EV-71, coxsackievirus A16 (CV-A16), and non-EV-71 non-CV-A16 accounted for 27.89%, 34.59%, and 37.52% respectively. Among children aged 6 months to 5 years, the estimated incidence of EV-71 was 131.04/100 000, the highest estimated incidence was in 2017 (322.13/100 000), and the lowest estimated incidence was in 2021 (7.71/100 000). EV-71 was the main type of severe cases, accounting for 76.25%. The estimated vaccination rate of EV-71 vaccine in Jining City from 2016 to 2021 was 7.98% on average. After EV-71 vaccination, the proportion of EV-71 HFMD was lower than that before vaccination, with a decrease of 4.80%. The dominant strain in 2013 and 2017 was EV-71, the proportion of EV-71 began to decrease in 2018, and the lowest was 5.16% in 2021. Conclusion Vaccination rate of EV-71 vaccine in Jining City is relatively low. After inoculation of EV-71 vaccine, the estimated incidence of EV-71 reached the peak in 2017, but then showed a downward trend. The majority of virus strains were CV-A16 and non-EV-71 non-CV-A16, it is necessary to further carry out typing of non-EV-71 non-CV-A16, and develop multivalent HFMD vaccine.