Prevention and Control Strategies of Nosocomial Infection and Effectiveness Evaluation in a Tertiary Teaching Hospital during the Epidemic of COVID-19

Objective: To evaluate the role of prevention and control strategies for nosocomial infection in a tertiary teaching hospital during the sudden outbreak of Corona Virus Disease 2019 (COVID-19). Methods: The hospital initiated an emergency plan involving multi-departmental defense and control. It adopted a series of nosocomial infection prevention and control measures, including strengthening pre-examination and triage, optimizing the consultation process, improving the hospital’s architectural composition, implementing graded risk management, enhancing personal protection, and implementing staff training and supervision. Descriptive research was used to evaluate the short-term effects of these in-hospital prevention and control strategies. The analysis compared changes in related evaluation indicators between January 24, 2020 and February 12, 2020 (Chinese Lunar New Year’s Eve 2020 to lunar January 19) and the corresponding lunar period of the previous year. Results: Compared to the same period last year, the outpatient fever rate increased by 1.85-fold (P P Conclusion: The nosocomial infection prevention and control strategies implemented during this specific period improved the detection and control abilities for the COVID-19 source of infection and enhanced the compliance with measures. This likely contributed significantly to avoiding the occurrence of nosocomial infection.

Combined prevention and treatment measures are essential to control nosocomial infections during the COVID-19 pandemic

Severe acute respiratory syndrome coronavirus-2 is a highly contagious positive-sense,single-stranded RNA virus that has rapidly spread worldwide.As of December 17,2023,772838745 confirmed cases including 6988679 deaths have been reported globally.This virus primarily spreads through droplets,airborne transmission,and direct contact.Hospitals harbor a substantial number of confirmed coronavirus disease 2019(COVID-19)patients and asymptomatic carriers,accompanied by high population density and a larger susceptible population.These factors serve as potential triggers for nosocomial infections,posing a threat during the COVID-19 pandemic.Nosocomial infections occur to varying degrees across different countries worldwide,emphasizing the urgent need for a practical approach to prevent and control the intra-hospital spread of COVID-19.This study primarily concentrated on a novel strategy combining preventive measures with treatment for combating COVID-19 nosocomial infections.It suggests preventive methods,such as vaccination,disinfection,and training of heathcare personnel to curb viral infections.Additionally,it explored therapeutic strategies targeting cellular inflammatory factors and certain new medications for COVID-19 patients.These methods hold promise in rapidly and effectively preventing and controlling nosocomial infections during the COVID-19 pandemic and provide a reliable reference for adopting preventive measures in the future pandemic.

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.

Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics

Objective:To explore the effect of the Plan-Do-Check-Action(PDCA)cycle on hand hygiene and nosocomial infection quality of or thopedic medical staff.Methods:The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization.Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time,and compare the compliance of hand hygiene before and after implementation,and evaluate the quality of nosocomial infection.Results:The hand hygiene compliance of doctors and nurses in stage P was 82%.The compliance of medical staff in stage D was 93%.The compliance of stage C was 94%and that of stage A was 95%.The quality score of hospital self-examination nosocomial infection was also significantly increased.Conclusions:The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality,which is wor thy of circulatory application in or thopedic nosocomial infection quality control,especially improving the quality of hand hygiene.

Impact of 222-nm ultraviolet disinfection combined with psychological care on the emotional and hospital infection of critical patients

BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.

Nosocomial infections:Epidemiology,prevention,control and surveillance

Nosocomial infections or healthcare associated infections occur in patients under medical care.These infections occur worldwide both in developed and developing countries.Nosocomial infections accounts for 7% in developed and 10% in developing countries.As these infections occur during hospital stay,they cause prolonged stay,disability,and economic burden.Frequently prevalent infections include central line-associated bloodstream infections,catheter-associated urinary tract infections,surgical site infections and ventilator-associated pneumonia.Nosocomial pathogens include bacteria,viruses and fungal parasites.According to WHO estimates,approximately 15% of all hospitalized patients suffer from these infections.During hospitalization,patient is exposed to pathogens through different sources environment,healthcare staff,and other infected patients.Transmission of these infections should be restricted for prevention.Hospital waste serves as potential source of pathogens and about 20%–25% of hospital waste is termed as hazardous.Nosocomial infections can be controlled by practicing infection control programs,keep check on antimicrobial use and its resistance,adopting antibiotic control policy.Efficient surveillance system can play its part at national and international level.Efforts are required by all stakeholders to prevent and control nosocomial infections.

Morbidity and Mortality of Nosocomial Infection after Cardiovascular Surgery： A Report of 1606 Cases

Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated the morbidity, mortality, and independent risk factors associated with NI following open heart surgery. We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI. The NI selection criteria were based on the Centers for Disease Control and Prevention （CDC） guidelines. The term NI encompasses surgical site infection （SSI）, central venous catheter-related infection （CVCRI）, urinary tract infection （UTI）, respiratory tract infection and pneumonia （RTIP）, as well as other types of infections. Of 1606 cardiovascular surgery patients, 125 developed NI （7.8%, 125/1606）. The rates of NI following surgery for congenital malformation, valve replacement, and coronary artery bypass graft were 2.6% （15/587）, 5.5% （26/473） and 13.6% （32/236）, respectively. The NI rate following surgical repair of aortic aneurysm or dissection was 16.8% （52/310）. Increased risk of NI was detected for patients with a prior preoperative stay 〉3 days （OR=2.11, 95% CI=1.39-3.20）, diabetes （OR=2.00, 95%=CI 1.26-3.20）, length of surgery 〉6 h （OR=2.26, 95% CI=1.47-3.47）, or postoperative cerebrovascular accident （OR=4.08, 95% CI=1.79-9.29）. Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.

Nosocomial Infection Surveillance in a Tuberculosis Specialized Hospital in China

Nosocomial infections（NIs） are a critical issue affecting the quality of healthcare. In this study, we performed a retrospective study to explore the incidence rates, mortality rates, and microbial spectrum of NIs in Beijing Chest Hospital, a tuberculosis（TB） specialized hospital in China. Our data demonstrate that the overall incidence rate of inpatients with NIs slightly decreased from 2012 to 2016, which may be associated with the implementation of hand hygiene measures, while the mortality rates associated with NI did not significantly change. In addition, the species distribution of NIs was quite different from that presented in previous reports, and Klebsiella pneumoniae was the most frequently isolated microorganism.

Is every microorganism detected in the intensive care unit a nosocomial infection?Isn’t prevention more important than detection?

The present letter to the editor is related to the study entitled“Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors.”Not every microorganism grown in samples taken from critically ill patients can be considered as an infectious agent.Accurate and adequate information about nosocomial infections is essential in introducing effective prevention programs in hospitals.Therefore,the development and implementation of care bundles for frequently used medical devices and invasive treatment devices(e.g.,intravenous catheters and invasive ventilation),adequate staffing not only for physicians,nurses,and other medical staff but also for housekeeping staff,and infection surveillance and motivational feedback are key points of infection prevention in the intensive care unit.

Analysis on Risk Factors of Nosocomial Infection in Orthopedic Patients and Research on Nursing Strategies

Orthopedic patients mostly comprise traumatic patients and elderly or sick individuals. More patients with emergency surgery suffer from open wounds and serious pollution, and operation time is relatively long. Thus, orthopedic patients with surgical incision infection account for a large proportion of incidence of hospital infection. Orthopedic patients are also bedridden for long periods, and they receive poor bone tissue blood supply. In surgical incision infections, mild cases suffer from delayed wound healing, whereas severe cases can form osteomyelitis. This study reviews progress of research on risk factors of nosocomial infection among orthopedic patients in recent years.

Urgent call for attention to diabetes-associated hospital infections

In this editorial,we discuss the recent article by Zhao et al published in the World Journal of Diabetes,which highlights the importance of recognizing the risk indicators associated with diabetes mellitus(DM).Given the severe implications of healthcare-associated infections(HAIs)in hospitalized individuals-such as heightened mortality rates,prolonged hospitalizations,and increased costs-we focus on elucidating the connection between DM and nosocomial infections.Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection,with some already harboring co-infections upon admission.Notably,DM is an important risk factor for nosocomial urinary tract infections and surgical site infections,which may indirectly affect the occurrence of nosocomial bloodstream infections,especially in patients with DM with poor glycemic control.Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive,attention to this potential association is warranted.Hospitalized patients with DM should prioritize meticulous blood glucose management,adherence to standard operating procedures,hand hygiene practices,environmental disinfection,and rational use of drugs during hospitalization.Further studies are imperative to explore the main risk factors of HAIs in patients with DM,enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.

Different outcomes of nosocomial infection with hepatitis C virus from the same origin

The outcome of infection with hepatitis C virus （HCV） varies substantially from self-limiting infection to chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma among the individuals. The mechanisms that determine the clearance or the persistence of HCV have not yet been clarified. Here, we experienced two cases of hospital-related infection with HCV from the same origin but with quite different outcomes. One case resolved after an episode of acute hepatitis, while the other case developed a chronic hepatitis although they were infected with HCV of the same origin. Although infected with the virus of the same origin, the clinical and virological courses were completely different. This suggests that host factors play a major role in conditioning the outcome of acute HCV infection.

Development of a questionnaire assessing nursing staff’s knowledge,attitude,and practice on the prevention of the nosocomial infection in elderly patients:testing reliability and validity

Objective:To develop a questionnaire assessing nursing staff’s knowledge,attitude,and practice on the prevention of the nosocomial infection in elderly patients and test its reliability and validity.Methods:After the drafted questionnaire was developed,two rounds of Delphi survey were conducted by consulting experts to improve the questionnaire.Subsequently,700 copies of the questionnaire were distributed to nursing staff to assess its reliability and validity.Results:Exploratory factor analysis(EFA)identifies 3 aspects,namely knowledge,attitude,and practice,with a total of 38 items.The Cronbach’s a coefficients of the questionnaire and each of the aspects are 0.85,0.80,0.886,and 0.77(>0.7),respectively.Confirmatory factor analysis(CFA)of each of the aspects are c2/df=3.99,2.26,and 3.32;Goodness-of-fit index(GFI)=0.91,0.97,and 0.92;Root mean square error of approximation(RMSEA)=0.06,0.04,and 0.05;Comparative fit index(CFI)=0.91,0.96,and 0.90.Conclusions:Through this study,it can be ascertained whether the developed questionnaire enjoys sound reliability and validity in assessing nursing staff’s knowledge,attitude,and practice on preventing the nosocomial infection in elderly patients and thus has certain application value.

Pantoea SPP: A New Nosocomial Infection in the Neonatal Intensive Care Unit

Pantoea SPP is a gram-negative bacillus, which usually colonizes plants, soil and water. This pathogen very rarely causes neonatal sepsis. The most common infections caused by Pantoea SPP are septic arthritis or synovitis, meningitis frequently complicated by brain abscess, upper respiratory infections, and peritonitis. We present the case of a premature infant who presented neonatal respiratory distress and whose evolution was complicated by the occurrence of a nosocomial infection for which a blood culture was performed isolating the germ Pantoea SPP. The patient’s management was initially centered on non-invasive ventilation with antibiotherapy based on carbapenem and aminoglycoside. Due to the clinical and biological worsening, the neonate was intubated and sedated and put on colymicin. The evolution was unfavorable marked by a death at 16th days of life. Considering the high pathogenicity of this germ and its multi-resistance to antibiotics, it is crucial to know the clinical spectrum of Panteoa SPP infections in neonatal intensive care units, in order to palliate the fulminant evolution of multifocal attacks due to this germ.

Nosocomial Klebsiella variicola Infection in Neonatal Intensive Care: A New Emerging Pathogen

Klebsiella variicola is a human pathogen that has been misidentified as K. pneumoniae. This misidentification has led to a lack of understanding of important clinical and biological aspects of this bacterial species. It is responsible for serious and potentially fatal infections, with a prevalence of multi-resistance to routine antibiotics. We present through three clinical observations, the case of three newborns having been hospitalized in the neonatal intensive care unit and whose evolution was complicated by the occurrence of a nosocomial infection in front of which a blood culture was done on blood agar, with a manual antibiogram on antibiotic disks, isolated the germ Klebsiella variicola. The management of the newborns was initially centered on non-invasive ventilation with a bi-antibiotic therapy based on carbapenem and amikacin for two newborns and switched to colymicin for the third case. Newborn follow-up was based on assessment of general condition, clinical signs of infection, as well as a biological control made of a blood count, a c-reactive protein, a complete ionogram, and a blood culture, every four days or if signs of clinical call. The evolution was favorable for two cases with good clinical and biological improvement, and complicated by death due to alveolar hemorrhage in the third case. Given the high pathogenicity of this germ, and the frequency of misidentification, it is crucial to know the clinical spectrum of Klebsiella variicola infections in neonatal intensive care units, in order to adapt the antibiotic therapy and to mitigate the fulminant evolution of this germ.

Risk of Getting Nosocomial Water-Borne Infections from the Main Water Systems in Hospitals

Drinking water may be a risk factor for human infections if the water supply is contaminated with biofilm producing bacteria such as Legionella pneumophilae or Pseudomonas aeruginosa. Several situations have to be considered when water supply to new buildings is planned. The aim of this paper is to review situations that have to be considered in new buildings and give an example on a new water supply contaminated with biofilm producing water bacteria and the precautions introduced to eliminate the contamination. When new buildings are planned it should be considered where to get the water and what is the microbiological quality of the water. If the water is contaminated there will be troubles from the beginning. The material for the pipes should be considered as biofilm which is produced in greater amounts and faster in PEG pipes than in stainless steel pipes. The choice of material depends on the expected lifetime of the building, the dimensions of the pipes, and the choice of forceps, how often the taps are used and thereby the flow in the system. The higher flow the less and slower biofilm formation. It is important to reduce the number of taps to a minimum to ovoid ＂dead ends＂ if they are not or only seldom used. Alternatively all taps could be opened automatically regularly. It is important to establish precautions to ovoid contamination of the water system in the period from when it is established until the building is taken in use. The period can be several months during which the system can act as a ＂dead end＂ if no precautions, such as regularly opening of all taps, are taken. The microbiological quality of the water in the system should be controlled before the building is taken in use. In a new building, where the water supply and the water in the building was not controlled before the building was taken in use, extremely high total and Legionella germ counts were found. The water was disinfected with low concentrations of chloride with very little effect. After disinfection with high concentrations of chloride for few hours and placing a sterile filter at the water entrance both the total and Legionella germ count decreased to an acceptable level.

Risk of Getting Nosocomial Water-borne Infections from the Main Water Systems in Hospitals

Summary： Drinking water may be a risk factor for human infections if the water supply is contaminated with biofilm producing bacteria such as Legionella pneumophilae or Pseudomonas aeruginosa. Several situations have to be considered when water supply to new buildings is planned. The aim of this paper is to review situations that have to be considered in new buildings and give an example on a new water supply contaminated with biofilm producing water bacteria and the precautions introduced to eliminate the contamination. When new buildings are planned, it should be considered where to get the water and what is the microbiological quality of the water. If the water is contaminated there will be troubles from the beginning. The material for the pipes should be considered as biofilm is produced in greater amounts and faster in PEG pipes than in stainless steel pipes. The choice of material depend on the expected lifetime of the building, the dimensions of the pipes, and the choice of forceps, how often the taps are used and thereby the flow in the system. The higher flow the less and slower biofilm formation. It is important to reduce the number of taps to a minimum to ovoid ＂dead ends＂ if they are not or only seldom used. Alternatively all taps could be opened automatically regularly. It is important to establish precautions to ovoid contamination of the water system in the period from it are established until the building is taken in use. The period can be several month where the system can act as a ＂dead end＂ if no precautions, such as regularly opening of all taps, are taken. The microbiological quality of the water in the system should be controlled before the building is taken in use. In a new building, where the water supply and the water in the building was not controlled before the building was taken in use, extremely high total and Legionella germ counts were found. The water was disinfected with low concentrations of chloride with very little effect. After disinfection with high concentrations of chloride for few hours and placing a sterile filter at the water entrance both the total and Legionella germ count decreased to an acceptable level.

Coping with the COVID‑19 pandemic:Strategies for controlling nosocomial infections in the observation area in a general hospital in China

This study shared experiences in implementing infection prevention and control strategies in an observation area to minimize nosocomial infections of COVID‑19 in a 3A‑level general hospital in China,including area division,human resources and teamwork,instructions for infection control,and the establishment of workflow management groups in the operation center.These experiences will be helpful to countries,especially developing countries,who are fighting against COVID‑19 now and other infectious diseases in the future to control nosocomial infections.

Comparison of Emergency Management Strategies for Nosocomial Infections Between Two Earthquakes

Aim:Based on the experience of the 5.12 Wenchuan Earthquake and the 8.8 Jiuzhaigou Earthquake,the emergency management strategies for nosocomial infections were compared between the two earthquakes.The experience shared in the present study provides a guideline for the emergency medical rescue of future earthquake.Methods:The patients involved in this study were those injured in the earthquake and admitted to the hospital for treatment.As an earthquake relief center,the hospital participated in the emergency rescue work of the two recent major earthquakes in western China.Review analysis was carried out in the hospital's infection control experience adopted in the two major earthquakes.It was emphasized that,targeting the characteristics and difficulties in the prevention and control of nosocomial infection,different innovative infection control emergency strategies were adopted by the frontline disaster relief hospitals,under the special circumstances and medical conditions in an earthquake disaster.Results:According to the different focus of infection control in the two earthquakes,different hospital infection control strategies were adopted,and the incidence of nosocomial infections was effectively controlled.

Effect of a program to control perioperative blood glucose on the incidence of nosocomial infections in patients with diabetes: A pilot study

Aim: To evaluate the safety and effectiveness of a pilot program to control perioperative blood glucose in patients with diabetes. Methods: A pre-post intervention study was conducted in a 280-bed hospital in Spain. In the year 2008 we implemented perioperative insulin protocols aimed at blood glucose values from 80 to 180 mg/dL. Surgical patients with diabetes admitted on year 2009 (intervention group) were compared with a control group of patients with diabetes admitted for surgery on year 2007, matched 1:1 by traditional wound class. Results: We analyzed 96 patients. Implemented protocols were followed in 48% of patients intra-operatively and 75% of patients postoperatively. Patients in the intervention group had reductions in blood glucose at surgery 150 +/- 61 mg/dL vs. 172 +/- 53 mg/dL;p = 0.05), greater proportion of target glucose values throughout hospitalization (67% vs. 55%;p = 0.07), and reductions in the incidence of nosocomial infections after controlling for confounders (Odds Ratio: 0.20;95% Confidence intervals: 0.06 - 0.72;p = 0.014) when they were compared with the control group: The incidence of hypoglycemia was similar between two groups (0.12% vs. 0.10%, p = 0.867), respectively. Conclusion: Although our protocol needs improvements to increase implementation it was useful to control blood glucose safely and for reducing nosocomial infections.