Scenario of Infection Prevention and Control Measures for Tuberculosis in Tuberculosis Inpatient and Outpatient Department in Tertiary Care Hospital

Tuberculosis is one of the most important infectious diseases in our country. Also nosocomial infection by tuberculosis can occur, which can be prevented by implementing simple, effective and affordable tuberculosis infection control measures in health care facilities. To evaluate the effectiveness of infection control measures, such study was planned. Questionnaires were administered to all doctors, healthcare workers and servants working in outdoor and indoor department of tuberculosis at tertiary care hospital to assess the knowledge, attitudes and practices on prevention and control of Tuberculosis infection. A scoring system was devised to grade them. One-time audit was also done in outpatient and inpatient department. The analysis showed scoring of poor for doctors, good for nurses and poor forward aids. There is a need to develop strategies for training of health care workers on regular basis in order to reduce the incidence of nosocomial infections. Audit result shows a good level of environmental control measures. Better knowledge, attitude and practices are helpful for the prevention and control of tuberculosis. Also environmental control measures are helpful to prevent infection.

The strategic framework of tuberculosis control and prevention in the elderly:a scoping review towards End TB targets

With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.

Identification and attribute analysis of key stakeholders who influence multidrug-resistant tuberculosis prevention and control in China

Background There could be various stakeholders who influencing multidrug-resistant tuberculosis(MDR-TB)policy development and implementation,yet their attributes and roles remain unclear in practice.This study aimed to identify key stakeholders in the process of policy-making for MDR-TB control and prevention and to analyse the attributes and relationships of the stakeholders,providing evidence for further policy research on MDR-TB control.Methods This study was conducted from October 2018 to March 2019 and applied the stakeholder analysis guidelines and domestic stakeholder analysis.An initial candidate stakeholder list was developed by policy scanning.Ten experts were invited to identify these candidate stakeholders.The major attribute of these stakeholders were analysed using the Michell scoring method.Based on these results,the intertwined relationships among groups of stakeholders were analysed and mapped through a systematic scan of the policy and literature on MDR-TB control,as well as information obtained from the interviews.Results A list of 21 types of candidate stakeholders was developed after a literature review and policy scanning,of which 11 received 100%approval.After expert evaluation and identification(the total expert authority was 0.80),19 categories of stakeholders were approved and included in the stakeholder analysis.We categorized all of the stakeholders into three groups:(i)definitive stakeholders who are mainly involved in administrative departments and the Provincial Center for Disease Control and Prevention(CDC);(ii)expectant stakeholders who are mainly involved with MDR-TB patients,clinical departments of TB hospitals at different levels,community health care facilities,prefectural CDC and charity organizations;and(iii)latent stakeholders who mainly involved family members and neighbours of MDR-TB patients and TB related products manufacturers.Government departments and higher-level CDCs have strong decision-making power in developing MDR-TB control policies whereas the recommendations from service providers and the concerns of patients should be considered.Conclusions The MDR-TB prevention system was a multistakeholder cooperation system that was mainly led by government stakeholders.Enhancing communications with front-line service providers and patients on their unmet needs and evidence-based suggestions would highly benefit policy-making of MDR-TB prevention and control.

Achievements and challenges of the World Bank Loan/Department for International Development grant-assisted Tuberculosis Control Project in China

In March 2002,the government of China launched the World Bank Loan/ Department for International Development-supported Tuberculosis （TB） Control Project to reduce the prevalence and mortality of TB. The project generated promising results in policy development, strengthening of TB control systems, patient treatment success,funds management, and the introduction of legislation. In light of the global TB epidemic and control environment, it is useful to review the TB control priorities of the project, summarize the achievements and experiences around its implementation.

Demand Analysis and Management Suggestion:Sharing Epidemiological Data Among Medical Institutions in Megacities for Epidemic Prevention and Control

During the prevention of coronavirus disease 2019(COVID-19),epidemiological data is essential for controlling the source of infection,cutting off the route of transmission,and protecting vulnerable populations.Following Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases and other related regulations,medical institutions have been authorized to collect the detailed information of patients,while it is still a formidable task in megacities because of the significant patient mobility and the existing information sharing barrier.As a smart city which strengthens precise epidemic prevention and control,Shanghai has established a multi-department platform named"one-net management"on dynamic information monitoring.By sharing epidemiological data with medical institutions under a safe environment,we believe that the ability to prevent and control epidemics among medical institutions will be effectively and comprehensively improved.

Tuberculosis infection prevention and control:why we need a whole systems approach

Infection prevention and control(IPC)measures to reduce transmission of drug-resistant and drug-sensitive tuberculosis(TB)in health facilities are well described but poorly implemented.The implementation of TB IPC has been assessed primarily through quantitative and structured approaches that treat administrative,environmental,and personal protective measures as discrete entities.We present an on-going project entitled Umoya omuhle(“good air”),conducted in two provinces of South Africa,that adopts an interdisciplinary,‘whole systems’approach to problem analysis and intervention development for reducing nosocomial transmission of Mycobacterium tuberculosis(Mtb)through improved IPC.We suggest that TB IPC represents a complex intervention that is delivered within a dynamic context shaped by policy guidelines,health facility space,infrastructure,organisation of care,and management culture.Methods drawn from epidemiology,anthropology,and health policy and systems research enable rich contextual analysis of how nosocomial Mtb transmission occurs,as well as opportunities to address the problem holistically.A‘whole systems’approach can identify leverage points within the health facility infrastructure and organisation of care that can inform the design of interventions to reduce the risk of nosocomial Mtb transmission.

全国妇幼保健机构医院感染监测与防控实施现状调查报告

目的 了解全国各级妇幼保健机构医院感染监测和防控措施的实施现状,为优化妇幼保健机构医院感染防控工作提供政策依据。方法 从8个省/自治区的省部级、地市级和区县级妇幼保健机构中分层抽样,设计统一的调查问卷,以“问卷星”的形式开展线上调查。结果 123所妇幼保健机构的数据纳入统计分析。90.24%的妇幼保健机构开展了医院感染综合性监测,开展新生儿监护室医院感染目标性监测、手术部位感染目标性监测、多重耐药菌目标性监测和重症监护病房(非新生儿)医院感染目标性监测的妇幼保健机构比率分别为89.66%、85.96%、80.77%和74.19%,51.22%的妇幼保健机构实现了医院感染病例信息化监测。94.31%的妇幼保健机构开展了手卫生依从性监测工作,90%以上的妇幼保健机构中医院感染高风险部门开展了环境卫生学监测,71.54%的妇幼保健机构由消毒供应中心对复用诊疗器械集中清洗、消毒、灭菌和供应。>90%的妇幼保健机构建立了三级预检分诊制度,86.18%的妇幼保健机构设置了过渡病房。妇幼保健机构对建档孕产妇、高危新生儿、保健人群和长期康复患者等特殊就诊人群普遍采取了建立有效沟通机制、全预约就诊和单独分区就诊的管理模式,但开展互联网复诊的妇幼保健机构比率<50%。结论 妇幼保健机构普遍开展了医院感染综合性监测和目标性监测,信息化监测程度有待提高。手卫生和环境卫生学监测在各级妇幼保健机构中普及程度较高,少数妇幼保健机构复用诊疗器械清洗、消毒、灭菌和供应流程不规范。特殊就诊人群得到有效管理,互联网医疗有待进一步推广。

健康体检机构呼吸道传染病疫情防控管理标准化研究

本文根据健康体检机构特点和疫情防控需求,从组织保障、物资配备、场所管理、工作人员管理、受检者管理、消毒隔离、传染病疫情报告、应急处置等方面,提出健康体检机构疫情防控管理标准化要点,明确标准研制思路,并提出进一步建议,以促进健康体检机构呼吸道传染病疫情防控管理的规范化。

基层疾病预防控制机构复合型人才评价指标体系构建

目的 构建基层疾病预防控制机构复合型人才评价指标体系,为基层疾控机构评价复合型人才提供参考。方法 根据冰山模型理论、德尔菲法和层次分析法,对甄选的专家进行咨询和问卷调查,计算各评价指标的权重并排序,建立基层疾控机构复合型人才评价指标体系。结果 共进行两轮专家咨询,协调系数分别为0.633和0.743,建立7个一级指标、17个二级指标在内的基层疾控机构复合型人才评价指标体系,符合一致性检验要求。一级指标分别为人员基本情况、学识水平、专业知识与技能、学习与创新能力、组织力与执行力、沟通协作能力、抗压能力与特殊成就,权重分别为0.083 01、0.089 03、0.093 79、0.125 30、0.223 08、0.205 30和0.180 49。其中二级指标位列前3位为处理疫情及重大事件能力、团队意识及协作能力、现任岗位工作能力。结论 基层疾控机构复合型人才评价工作中评价权重应向组织力与执行力指标倾斜,沟通协作能力指标也应给予重视;研究指标具有一定的科学性和实用性,为基层疾病预防控制机构选拔人才提供参考。

文化教育类校外培训机构传染病防控能力评价指标体系构建

目的:构建文化教育类校外培训机构传染病防控能力评价指标体系,为相关部门提升传染病防控能力和开展管理工作提供参考依据。方法:在日常防控工作经验的基础上,结合既往文献研究和参考幼托机构、中小学校相关传染病管理要求,通过小组讨论和深入个人访谈等方法形成评价指标体系初步框架,通过两轮德尔菲法专家咨询对指标的重要性和可操作性进行判定。结果:邀请19名传染病防控领域专家开展两轮专家咨询,专家积极系数分别为1.00和0.95,专家权威系数为0.87,指标变异系数均<25%;第二轮专家咨询三级指标重要性协调系数为0.22,可操作性协调系数为0.27。从文化教育类校外培训机构基本情况、保障体系、日常防控措施、异常情况应对和防病检查指导5个维度,将机构资质、选址与规模、人员配备、设施设备、制度建设、物资配备、清洁与消毒、健康管理、缺课追踪、现场处置、登记与报告、复课管理和防病检查指导等各方面指标纳入评价指标体系,构建5个一级指标、14个二级指标、44个三级指标的评价指标体系。结论:构建的指标体系具有一定的科学性和合理性,可应用于文化教育类校外培训机构传染病防控能力的评价。

基层疾病预防控制机构2017—2022年政务热线案件特征分析

目的通过分析2017—2022年某基层疾控机构政务热线诉求反映的问题,为基层疾控机构政务热线处理提供参考。方法回顾性对比分析2017—2019年(常态化防控期)与2020—2022年(动态化防控期)受理的市民热线政务工单,通过比较诉求原因分类及受理科室分布,探讨不同时期市民诉求的变化情况。结果该基层疾控机构在动态化防控期(6974件)受理热线工单量较常态化防控期(284件)增加了23.6倍。常态化防控期“公共卫生服务质量”类(7.75%)、“公共卫生服务可及性”类(49.30%)诉求引发的案件占比高于动态化防控期同类型案件占比(3.63%和19.29%)。动态化防控期“管理措施”类(27.37%)案件占比低于常态化防控期同类案件(33.10%),“数据信息化”类案件受理量在动态化防控期间更为突出。结论动态化防控政策直接影响了市民获得公共卫生服务的体验,导致市民诉求原因的变化。基层疾控机构应通过完善公共卫生服务能力建设,以诉求问题为导向,加强沟通培训等措施提高政务热线处理能力。

健康教育在学校结核病防控中的价值研讨

目的研究学校结核病防控中应用健康教育的效果。方法于2021年1月—2022年12月时间段对某高中学校进行调查,选择该校三年级400名进行研究,其中1~5班采用常规校园疾病防控管理(200名),6~10班采用健康教育疾病防控管理模式(200名),观察指标为健康知识水平、防控措施落实情况、新发结核病发生情况。结果6~10班学生结核病防控知识高于1~5班学生,差异有统计学意义(P<0.05);6~10班学生防控措施落实情况高于1~5班学生,差异有统计学意义(P<0.05);6~10班学生新发结核病发生为0,低于1~5班学生3例(1.50%),但差异无统计学意义(P>0.05);6~10班学生结核病主动汇报15例(7.50%),高于1~5班学生4例(2.00%),差异有统计学意义(P<0.05)。结论学校结核病防治过程中采用健康教育模式可以提升学生的健康知识水平,强化结核病防治措施落实效果,有效预防新发结核病发生,并提高其主动汇报率,改善学生预后效果。

我国疾病预防控制机构考核评价政策沿革、问题及对策

通过梳理总结我国针对疾控机构/工作开展考核评价相关的政策文件及文献,总结当前疾控机构考核评价关键点,梳理现存问题,并提出改进的对策建议,为新时代下疾病预防控制中心考核评价相关政策文件的制定提供借鉴。

我国托幼机构儿童传染病防控研究进展

儿童是传染病的高发群体,而托幼机构又是儿童发生传染病传播和流行的主要场所。传染病具有突发性、传染性、流行性和不可预见性等特点,一旦传染病在幼儿园暴发,将严重影响托幼机构的教学秩序,甚至进一步扩大形成某个地区乃至全国或全球的疾病,给孩子、家庭、社会造成较大的影响,成为全国乃至全球性的公共卫生问题。文章通过梳理我国托幼机构儿童传染病的流行现状和研究进展,分别从病原体检测手段、防控法律制度和协同防控体系现状与存在的不足来阐述我国在托幼机构儿童传染病防治研究方面取得的进展,旨在对我国新时期托幼机构儿童传染病防控工作提供参考。

基于财务风险防控的事业单位内控体系构建探讨

以财务风险防控为导向的内控管理工作,能够对事业单位各业务活动进行追踪管控,增强单位整体风险防控能力,实现财政资金的合理使用,满足国家财政管理要求。文章围绕财务风险防控下事业单位内控工作展开研究,简要分析财务风险防控与内控管理的概述及关系,探讨了财务风险防控的内控体系构建意义,最后基于风险防控视角提出几点事业单位内控体系构建思路,旨在发挥财务风险导向价值,优化事业单位内控管理效果,实现稳定发展。

2014-2020年广东省不同年龄段结核病患者耐药特征及应对防治策略

目的 探究2014-2020年广东省期间各年龄段结核病患者的耐药特征与应对防治策略。方法 以2014-2020年广东省32个结核病耐药监测点中,确诊结核病患者的39 048株结核分枝杆菌(mycobacterium tuberculosis, MTB)临床分离株为研究对象,回顾性分析耐药结核病患者及实验室相关资料,并以年龄、地区进行分组,探讨MTB临床分离株对药物的耐药性趋势、耐药结核病(包括单耐药结核病(monodrug-resistant tuberculosis, MR-TB)、多耐药结核病(poly-resistant tuberculosis, PDR-TB)、耐多药结核病(multidrug-resistant tuberculosis, MDR-TB)和广泛耐药结核病(extensively drug-resistant tuberculosis, XDRTB)的发病率差异,以及MTB临床分离株对重点药物(利福平和氧氟沙星)的耐药情况。结果 2014-2020年广东省32个结核病耐药监测点患者MTB临床分离株对9种抗结核药物在不同年度间、不同年龄段间的耐药率差异均无统计学意义(均P> 0.05)。MTB临床分离株的单耐药率、多耐药率、耐多药率、广泛耐药率和总耐药率分别为14.46%、5.16%、4.58%、1.29%。儿童组患者MTB临床分离株单耐药率(15.4%)高于青壮年组及老年组;青壮年组(5.0%)和老年组(5.0%)患者MTB临床分离株耐多药率高于儿童组患者;老年组患者MTB临床分离株广泛耐药率(2.1%)高于儿童组及青壮年组,差异均有统计学意义(P <0.001)。来自珠三角地区的患者MTB临床分离株的单耐药率(14.8%)、多耐药率(5.3%)、耐多药率(4.7%)、广泛耐药率(1.4%)、耐氧氟沙星率(11.33%)和耐利福平率(6.92%)明显高于非珠三角地区,差异均有统计学意义(P <0.001)。结论 根据监测点数据,2014-2020年间,广东省耐药结核病的流行趋势平缓。但在特定人群(如儿童和老年人)中,耐药结核病的发病率较高,且珠三角地区的耐药结核病发病率和重点药物耐药率均高于广东省其他地区,值得进一步关注和采取防控策略。

中牟县基层医疗机构医生结核感染控制知识知晓情况及影响因素分析

目的:了解河南省郑州市中牟县基层医疗机构医生群体结核感染控制知识知晓情况,并分析其影响因素,为提升基层医疗卫生机构结核感染控制水平提供参考数据。方法:针对中牟县符合纳入标准的全部社区(村)医生进行问卷调查和γ-干扰素释放试验。同时,利用自主命题问卷(10道题)开展考核,获得基层医疗机构医生对患者管理、消毒通风、个人防护及健康教育等结核感染控制知识知晓的情况。量化考核指标(满分10分制),以8分作为掌握良好标准,分析与结核感染控制知识知晓情况有关的因素。结果:494名基层医疗机构医生参与本次调查,结核感染控制知识答题得分中位数(四分位数)为6(5,7)分,仅有2.23%(11/494)的基层医疗机构医生全部回答正确,21.66%(107/494)的基层医疗机构医生答题得分≥8分。基层医疗机构医生结核感染控制知识知晓情况受性别(OR=1.68,95%CI=1.03~2.76)和服务的总人口数(OR=1.68,95%CI=1.05~2.69)影响。结论:中牟县基层医疗机构医生结核感染控制知识知晓水平有待提高,建议加强结核感染控制知识宣传、培训和考核,提高基层医疗机构医生结核防控认识,降低职业暴露风险,保护基层医疗机构医生生命健康的同时降低结核病在社区中的传播风险。

2005—2022年上海市青浦区肺结核时空特征分析

目的:通过分析上海市青浦区2005—2022年的肺结核疫情,旨在发现区域内肺结核发病的空间聚集性及时空特征,为相关部门制定防控策略提供参考依据。方法:从中国疾病预防控制信息系统中筛选2005年1月1日—2022年12月31日上海市青浦区肺结核登记报告资料,进行空间全局自相关分析、空间局部自相关分析和时空扫描分析。结果:2005—2022年上海市青浦区男性肺结核患者数量多于女性患者,20~39岁年龄段肺结核患者数量最多。从时间上看,2013—2015年青浦区各街(镇)的发病率普遍上升,大部分街(镇)在此期间达到历年发病峰值,2015年之后各街(镇)的发病率呈逐步下降趋势。从空间上看,青浦区东部和西部地区整体发病率高于中心地区。2011年、2013年、2016年、2017年、2020年青浦区肺结核发病在空间上存在显著正相关性,呈现明显的空间集聚趋势,2010年青浦区肺结核发病的空间分布呈现负相关性。2005—2022年青浦区各街(镇)肺结核患者年均登记率的空间分布不均衡。2015—2022年青浦区肺结核患者呈现出明显的时空聚集特征。结论:2005—2022年青浦区肺结核病例男性显著多于女性,肺结核患者主要集中在20~39岁年龄段人群,且呈现时空聚集性,高发病率区域主要集中在青浦区西南部地区。相关部门应针对高发病区域和高风险人群加强筛查,制定分类分时的防控措施,从而有效防控肺结核疫情。

2019和2022年北京市社区卫生服务机构传染病防控能力调查

目的 了解2022年相较于2019年北京市社区卫生服务机构传染病防控能力变化,为完善北京市基层卫生能力提供政策建议。方法 采用问卷调查方式收集2019和2022年北京市社区卫生服务机构基本情况。结果 相较2019年,2022年北京市社区卫生服务机构平均服务人口由43 491人增长至45 096人,距离最近的二级或三级医院的服务平均距离由4.42 km缩短至2.94 km,发热哨点设置率由5.39%提升至38.77%,传染病防控专职人员占比由5.19%增加至10.05%,传染病防控兼职人员占比由2.98%增加至8.30%,社区卫生服务机构P2实验室数量由32家增长至97家。结论 相较于2019年,2022年北京市社区卫生服务机构的传染病防控能力有所提升,但人力资源、实验室能力等方面仍比较薄弱,建议制定有效提升社区卫生服务机构相关能力的防控政策。

基于“人机料法环测”管理模式的疑似白喉在医疗机构中的防控策略

白喉是由白喉棒状杆菌引起的死亡率高的急性呼吸道传染病,是我国《传染病防治法》规定的乙类传染病。感染者咽喉部可出现白色伪膜,同时出现发热、声音嘶哑、犬吠样咳嗽、呼吸困难等症状,严重感染患者可能会产生全身性中毒症状,甚至诱发周围神经麻痹和心肌炎,曾严重危害人民健康。虽然现阶段白喉在我国属于罕见传染病,但国内仍有散发病例出现,与此同时,非产毒菌分离率呈上升趋势。本研究通过对西安市某三甲医院检出的疑似白喉患者的防控策略进行梳理,旨在有力、有序推进医疗机构内发现疑似白喉等罕见传染病的防控策略,为医疗卫生行业疑似白喉的医院感染防控提供先进成熟经验。