Practice of Infection Prevention and Control Strategies in Risk Departments during the COVID-19 Epidemic

Objective: To explore the practice and application of infection prevention and control strategies in risk departments during the COVID-19 epidemic, and to formulate the infection prevention and control measures to provide advice and guidance in risk departments. Methods: According to the latest plan of diagnosis and treatment, prevention and control issued by the National Health Commission, expert advice and consensus, combined with the actual situation in our hospital, a series of infection prevention and control measures of COVID-19 in risk department was formulated. Results: During the epidemic period, the prevention and control measures of nine risk departments including emergency operation, anesthesiology, endoscopy center, blood purification center, otolaryngology, stomatology, medical imaging department, medical cosmetology department and pulmonary function room were established from six aspects, including pre-examination and screening, medical technology control, personnel management, personal protection, environmental disinfection, medical waste disposal, etc. Conclusion: During the epidemic period, the infection prevention and control strategy of risk departments is one of the key links to control the spread of the epidemic, and risk departments must pay attention to and strictly implement various infection prevention and control measures.

Radiographic Equipment and Accessories as a Potential Source of Nosocomial Infection

Background: Nosocomial infections have become a major challenge in healthcare facilities as they affect the quality of medical care. Radiological imaging plays a crucial role in medical diagnosis. However, the equipment and accessories used increase the risk of transmission of nosocomial bacteria. Objective: This study aims to reveal the extent and nature of microbiological contamination in four hospital diagnostic imaging departments to determine their potential role in the spread of nosocomial bacteria and to evaluate the effectiveness of routine daily disinfection practices in controlling microorganisms in diagnostic imaging departments. Methods & Results: In each department, swabs were taken from the surfaces of selected parts of the equipment and accessories three times a day (early morning, noon, and evening) for five consecutive days. Bacteria were isolated from 65 swabs (36.1% of all samples). The bacteria were isolated 3 times (4.6%) in the morning, 16 times (24.6%) at midday, and 46 times (70.7%) in the evening. The bacteria isolated were Escherichia coli (isolated 34 times;52.3%), Staphylococcus aureus (20 times;30.8%), Staphylococcus epidermidis (6 times;9.3%), and Klebsiella species (5 times;7.7%). Discussion & Conclusion: Findings demonstrated that radiology equipment and accessories are not free of bacteria and further improvements in the sterilization and disinfection of radiology equipment and accessories are needed to protect staff and patients from nosocomial infections.

An Analysis of Clinical Characters of Inpatients with Infection in the Department of Endocrinology

Objective:To analyze the clinical characters of 812 inpatients with infection in the Department of Endocrinology.Methods:Retrospective exhibition of these patients'clinical characters included undergoing diseases,infectious organs,history illness,blood glucose and glycosylated hemoglobin(HbA1C),biochemical indicators,pathogens training description and results,medical imagines,antibiotic utilization,length of stay and hospital costs,final diagnosis and situations.Results:Non-diabetic patients accounted for 176(21.67%),who were the cases of untreated well hyperthyroidism,mainly suffered with respiratory tract infection.Diabetic patients accounted for 636(78.33%).In the type2 diabetes patients 376(59.12)suffered with urinary tract infection.192(30.19%)suffered with respiratory system infection,124(19.50%)were accompanied with diabetic foot infection,which had 74(59.67%)patients with HbA1C>9.0%.Statistical comparisons showed that the days of antibiotic use and average length of stay in hospital per capita in patients with HbA1C≥8%were more than ones with HbA1C<8%in those with diabetic infections(P<0.01).The days of antibiotic use per capita in patients with HbA1C>9%were more than ones with HbA1C<7%in those with diabetic foot infections(P<0.01).Conclusion:Endocrine diseases lack rigid and effective long-term control,which may result in the complications involved with urinary tract,respiratory tract and infections in other organs.The time of hospitalization per capita and the duration of antibiotic use rise are longer in diabetic patients with poor blood sugar control and diabetic foot infection.

Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.

Infected aortic and iliac aneurysms:Clinical manifestations in the emergency departments of two hospitals in southern Taiwan,China

BACKGROUND: Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinical features that can help physicians to identify these patients.METHODS: We reviewed the discharge notes from two hospitals and identifi ed all patients who had a diagnosis of infected aneurysms of the thoracoabdominal aorta and iliac arteries between July 2009 and December 2013. Eighteen patients, aged from 41 to 93, were reviewed. Only 6 patients were diagnosed accurately in their fi rst visit to our ED.RESULTS: Most patients had at least one underlying illness, and it took 1 to 30(9.9±6.5) days for physicians to diagnose their infected aneurysm. Localized pain and fever were the two most commonly presented symptoms. The majority(92%) of isolated microorganisms were gram-negative bacilli, including Salmonella spp, Klebsiella pneumoniae, and Escherichia coli. Two of the 3 patients who underwent non-operative therapy died, and all of the patients who underwent a combination of medical and operative therapies survived.CONCLUSION: We suggest that physicians liberally use computed tomography scans on patients with unknown causes of pain and inflammatory processes. A combination of surgical and medical treatments is indicated for all patients with infected aortic and iliac aneurysms.

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.

Ophthalmology in the time of COVID-19: experience from Hong Kong Eye Hospital

AIM:To review international guidelines and to share our infection control experience during the coronavirus disease 2019(COVID-19)pandemic at a tertiary eye centre in Hong Kong.METHODS:Infection control guidelines and recommendations from international ophthalmological bodies are reviewed and discussed.The measures at our hospital were drawn up as per international and local health authorities’guidelines and implemented with the collaboration of doctors,nurses and administrative staff.RESULTS:The aims of our infection control measures are to 1)minimize cross-infection within the hospital;2)protect and support hospital staff;3)ensure environmental control.To minimize the risk of cross-infection,outpatient attendance and elective surgery have been reduced by 40%,and general anesthesia procedures were reduced by 90%.Patients entering the hospital are screened for fever,travel history,contact and cluster history,and COVID-19 related symptoms.To protect and support hospital staff,we ensure provision of adequate personal protective equipment(PPE)and provide clear guidelines on the level of PPE needed,depending on the clinical situation.Other protective measures include provision of work uniforms,easy access to alcohol-based hand rub,opening new lunch areas,implementation of self-monitoring and self-reporting systems,and communication via online education and updates.Finally,environmental control is achieved by ensuring regular disinfection of the hospital premise,enhancing ventilation,and usage of disposable ophthalmic instruments.CONCLUSION:Our multi-pronged approach to infection control is,so far,successful in minimizing infection risks,while allowing the maintenance of essential ophthalmic services.

Diagnostic value of biomarkers for sepsis in adult patients in the emergency department: Don't forget the neutrophil-lymphocyte count ratio

Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.

The Application of the “3 + 1” Mode in the COVID-19 Epidemic Prevention and Control at the Infection Ward of a Designated Comprehensive Hospital for COVID-19 Treatment

Objective: We assess the application effect of the “3 + 1” mode in the COVID-19 epidemic prevention and control at the infection ward of a designated comprehensive hospital for COVID-19 treatment. Method: Based on the features of the inpatients of the infection ward and their relatives, a “3 + 1” mode for the COVID-19 prevention and control is developed to conform to the demands for epidemic prevention and control and the overall prevention and control scheme of the whole hospital. Here, “3” stands for the epidemic prevention and control system, personnel management, and prevention and control measures;“1” stands for COVID-19 testing. Result: From March 1, 2020 to March 31, 2021, a total of 3056 patients were hospitalized in the three infection wards. Among them, 265 patients had a fever, and 113 patients had respiratory symptoms. None of them were infected with COVID-19. The participation rate of the test about the knowledge related to COVID-19 and the knowledge mastery rate were both 100% among the medical staff. None of the inpatients and their companions or the medical staff was diagnosed with COVID-19. Conclusion: Thus the “3 + 1” mode proves successful for avoiding nosocomial infection and the spread of the epidemic.

Risk factors and strategy for surgical incision infection in department of abdominal surgery

Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The diagnosis standard was based on Diagnosis Standard of Hospital Infection published by Ministry of Health.

口腔门诊感染控制风险评估的建立与实施

目的建立口腔门诊感染控制风险评估体系,掌握口腔门诊感染高风险因素,为口腔诊疗感染控制措施的持续改进提供方向。方法基于德尔菲专家咨询法,抓取国家行业标准、规范中与口腔门诊感染控制相关条款,建立风险评估体系,评估某三级口腔专科医院门诊医院感染风险,运用失效模式与效应分析法定量获得高风险点。结果建立了口腔门诊感染控制风险评估体系,包括一级指标3个,二级指标15个,三级指标74个。共查找风险点18个,包括医务人员对手卫生时机掌握不正确,保洁用具清洗消毒方法不正确,手卫生依从率低于全院基线水平,盛装使用后织物的容器和区域未及时消毒,保洁用具分区使用不明确,感染控制制度内容不齐全或不正确,紫外线灯辐照强度未定期监测,医疗废物盛装过满,无清洁消毒质量考核和防护用品未正确穿戴或脱卸等。结论初步形成口腔门诊感染控制风险指标体系建立方法,并找出口腔门诊感染控制措施执行中可能存在的高风险点,可为口腔门诊感染控制工作的持续改进提供参考。

护理主导多部门协作管理提升血培养标本质量的效果研究

目的 :评价护理主导的多部门协作管理模式对血培养标本质量提升的效果,为护理临床实践和质量改进提供参考。方法 :成立护理主导多部门协作管理团队,开展质量改进,比较措施实施前后血培养标本送检率、合格率、污染率,以及护士血培养知识、态度、行为的变化。结果 :2023年5月—6月血培养标本送检率、送检方式为双瓶双侧的比例分别为19.1%、61.3%,高于2022年同期的4.7%、35.6%,差异有统计学意义(P<0.05);2023年5月—6月和2022年同期污染率分别为2.9%和3.8%,呈下降趋势;2023年护士血培养相关知识、态度、行为得分分别为(12.69±2.81)、(5.89±0.44)、(36.73±3.40)分,高于2018年的(7.89±2.79)、(5.82±0.52)、(30.81±4.35)分,差异有统计学意义(P<0.05)。结论 :护理主导多部门协作管理模式下的质量改进策略,提高了血培养标本送检率和合格率,降低了血培养标本污染率,提高了护士血培养的知识、态度、行为水平,体现了护士在院感防控工作中的价值。

案例式教学法在感染科专硕研究生临床带教中的应用

目的观察并探讨感染科专硕研究生临床带教过程中案例式教学法的应用效果。方法选取2022年1—12月在昆明医科大学第一附属医院感染科住院医师规范化培训(简称“住培”)的26名专硕研究生作为研究对象。其中2022年1月—2022年5月在昆明医科大学第一附属医院感染科住培的13名专硕研究生作为对照组并进行传统教学,于2022年6月—12月在昆明医科大学第一附属医院感染科住培的13名专硕研究生作为研究组并进行案例式教学。比较2组理论与实践考核成绩、岗位胜任能力评分、批判性思维能力评分、教学满意度。结果研究组专硕研究生出科时理论成绩(67.62±1.08)分、实践考核成绩(28.01±0.36)分,均高于对照组,差异有统计学意义(P<0.001)。研究组公共卫生服务能力(27.64±1.76)分、基础诊疗能力(46.75±2.24)分、继续学习能力(8.76±0.55)分、人文关怀能力(9.01±0.42)分、总分(91.49±5.05)分,均高于对照组,差异有统计学意义(P<0.001)。研究组分析(4.04±1.23)分、评估(4.94±0.63)分、推理(8.01±1.54)分、总结(8.08±0.35)分、演绎(8.55±0.35)分、总分(33.59±0.15)分,均高于对照组,差异有统计学意义(P<0.05)。研究组专硕研究生对感染科临床教学满意度为92.31%,明显高于对照组,差异有统计学意义(P<0.05)。结论感染科临床带教过程中引入案例式教学法,能够显著提高专硕研究生岗位胜任能力及批判性思维能力,提升教学质量,且备受专硕研究生青睐。

某医院骨科疑似手术部位感染暴发事件的调查

目的针对某三甲综合医院骨科短期内发生疑似手术部位感染暴发事件的原因并及时采取防控措施。方法采用现场流行病学调查、环境卫生学监测等方法分析手术部位感染事件发生的原因,并运用PDCA循环法在实施相应防控措施中持续改进。结果单因素分析结果显示,不同上台一助、换药人员、病人性别、合并症对发生术后切口感染有统计学意义(P<0.05)。结论及时找到了事件发生原因,通过强化无菌操作、手卫生及环境卫生整改可及时有效降低骨科手术切口感染新增病例的发生。

某院2019年至2021年下呼吸道病原菌分布与耐药性分析

目的 分析某院住院患者下呼吸道感染病原菌的分布及耐药性,促进临床合理应用抗菌药物。方法 选取北京市平谷区医院2019年1月至2021年12月收治的住院下呼吸道感染患者12 040例,统计并分析送检的合格下呼吸道分离标本细菌培养、药物敏感试验(简称药敏试验)结果,根据指南评价抗菌药物处方合理性。结果 送检的合格下呼吸道标本5 074份,病原学送检率为42.14%(5 074/12 040)。共分离病原菌3 137株,其中革兰阴性杆菌2 966株(94.55%),革兰阳性球菌171株(5.45%)。常见革兰阴性杆菌包括肺炎克雷伯菌889株(28.34%),铜绿假单胞菌819株(26.11%),鲍曼不动杆菌284株(9.05%),嗜麦芽窄食单胞菌212株(6.76%),阴沟肠杆菌168株(5.36%)及大肠埃希菌163株(5.20%)。肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对亚胺培南的耐药率分别为5.85%,16.12%,13.03%。革兰阳性球菌中以金黄色葡萄球菌为主(111株,3.54%),对万古霉素及利奈唑胺的耐药率均为0,对青霉素的耐药率为90.99%。共收集4 719张抗菌药物不合理处方,环丙沙星、左氧氟沙星、复方新诺明不合理用药率分别为41.43%,35.16%,33.95%;常见不合理用药行为包括药物品种选择不当(40.16%)、联合用药不合理(15.60%)及无指征使用(13.67%)。结论 革兰阴性杆菌是该院下呼吸道感染的主要致病菌,常见病原菌对抗菌药物有不同程度的耐药。故应加强病原菌耐药性监测及分析,促进抗菌药物的合理应用。

河南省县级综合医院眼科资源调查研究

目的:通过了解河南省县级综合医院眼科资源现状,为“十四五”期间中国防盲治盲全面提升以及制定符合河南省情的眼科发展规划提供参考依据。方法:利用横断面调查,于2021年12月31日至2022年4月1日采用调查问卷方式对河南省所有县级综合医院进行调查,调查问卷内容主要包括眼科基本情况、人员配置、设备、业务开展情况等。计算不同区域间医护人员职称、学历、开展业务、每千人设备拥有率是否存在差异。计数资料采用构成比进行统计描述,采用χ^(2)检验进行差异性分析,设定检验水平为0.05,P<0.05表明差异存在统计学意义。结果:不同区域间,医生职称(P=0.136)和医生学历(P=0.061)不存在统计学差异;护理高级职称占比(P=0.038),护理学历分布(P=0.009)及眼科设备(P<0.001)存在统计学差异。青光眼手术、白内障手术等常见眼科手术开展率较高,角膜手术、视神经减压手术、眼视光手术等高难度手术开展率较低。所开展的14种眼科手术中,除青光眼手术外,其他业务在不同区域间不存在统计学差异。结论:河南省县级综合医院眼科医生资源配置均衡,护理及眼科设备在不同地区间存在统计学差异。常规眼科手术开展率较高,眼科所开展业务在不同区域间差异性小,眼科服务公平性高,但高难度眼科手术开展率低。建议加强“双高”专业技术人才引培及眼科设备购置,缩小地区间差异,填补县域眼科技术空白,提升常见病、多发病诊疗技术能力。

消毒供应中心建筑布局相关感染风险防范措施研究进展

消毒供应中心(CSSD)是医院预防和控制感染的重点部门。基于相关文献检索,回顾了CSSD建筑布局的发展历程,总结分析了CSSD的建筑布局、流线和各区域功能及卫生学要求,并对CSSD建筑布局的发展进行了讨论。

急诊科感染治疗中降钙素原动态监测与预后的相关性分析

目的:探讨急诊科感染治疗中PCT动态监测与预后的相关性。方法:本研究选取2021年4月-2023年7月期间本院急诊科收治细菌感染性患者63例纳入研究组。另选取同期本院收治的非感染性疾病患者58例作为对照组。评价研究组抗感染治疗效果,并根据治疗效果将研究组进一步分为治疗有效组和治疗无效组。根据患者的预后情况将研究组进一步分为预后良好组和预后不良组。分析对比对照组和研究组入院当日血清PCT水平。分析比较治疗有效组、治疗无效组治疗后24 h、48 h及72 h血清PCT水平。分析影响细菌感染性患者预后的单因素和多因素。结果:研究组入院当日PCT水平显著高于对照组(P<0.05)。研究组中,治疗有效组51例、治疗无效组12例;随着时间增长,两组PCT水平均显著上升,但治疗无效组治疗后24 h、48 h及72 h PCT上升幅度均显著高于治疗有效组(P<0.05)。研究组患者治疗后预后良好组有54例、预后不良组有9例。预后不良组的APACHEⅡ评分、血糖、TNF-α、IL-6及PCT水平均显著高于预后良好组(P<0.05)。APACHEⅡ评分、血糖、TNF-α、IL-6及PCT水平升高是影响细菌感染性患者预后的多因素(P<0.05)。结论:PCT动态监测有助于临床更准确地评估患者的病情和预后风险。

皮肤科住院患者多重耐药菌感染风险诺莫图预测模型的建立与验证

目的通过分析皮肤科住院患者多重耐药菌(MDRO)感染风险的影响因素建立诺莫图预测模型,并进行验证。方法选取2018年1月—2022年6月皮肤科住院患者8950例作为研究对象,统计其MDRO感染发生情况,采用Lasso-Logistic回归分析法筛选MDRO感染影响因素,构建诺莫图预测模型,并验证预测模型预测MDRO感染的价值。结果8950例皮肤科住院患者发生MDRO感染782例,发生率为8.74%。多因素Logistic回归分析显示年龄、免疫性皮肤疾病、侵入性操作、糖尿病、住院天数、长期应用糖皮质激素/免疫抑制剂、抗生素联用、C反应蛋白(CRP)为皮肤科住院患者MDRO感染的独立危险因素(P<0.01);采用R软件rms程序建立皮肤科住院患者MDRO感染的诺莫图预测模型,该模型预测风险能力指数为0.920,校准度为0.885;受试者工作特征曲线分析显示,该模型预测MDRO感染的曲线下面积为0.945(95%CI:0.903,0.991),敏感度为0.905,特异度为0.918。结论皮肤科住院患者MDRO感染风险较高,影响因素包括年龄、免疫性皮肤疾病、侵入性操作、糖尿病、住院天数、长期应用糖皮质激素/免疫抑制剂、抗生素联用、CRP,根据上述因素构建的诺莫图预测模型具有较高的预测效能。

重庆某院皮肤科皮肤和软组织感染病原菌流行特征分析

目的了解皮肤科门诊及住院皮肤和软组织感染患者病原菌分布情况,并探讨其耐药性。方法采用回顾性分析的方法,对皮肤科2019年1月至2022年12月皮肤和软组织感染患者病原菌分布及药敏结果进行统计分析。菌株鉴定和药敏试验采用美国碧迪公司Phoenix-100 system全自动微生物鉴定/药敏系统及其配套的鉴定及药敏卡,按照美国临床实验室标准化协会(Clinical and laboratory standards institute,CLSI)M100-S31标准进行判定。采用Whonet 5.6软件进行数据的分析。结果共分离出1534株细菌;其中革兰阳性菌和革兰阴性菌分别占71.90及28.10%;耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)检出率为17.27%;碳青霉烯类耐药铜绿假单胞菌检出率为5.52%;大肠埃希菌及肺炎克雷伯菌的超广谱β-内酰胺酶(Extended spectrum beta-lactamases,ESBLs)检出率分别为64.4%、45.5%。结论皮肤和软组织感染的主要致病菌为金黄色葡萄球菌,临床医师在治疗此类感染时应充分结合药敏试验结果,合理用药。