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.

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.

Strategy and technology to prevent hospital-acquired infections:Lessons from SARS,Ebola,and MERS in Asia and West Africa

Hospital-acquired infections(HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome(MERS), and severe acute respiratory syndrome(SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.

Nosocomial infections and their control strategies

Nosocomial infections are also known as hospital-acquired/associated infections. National Healthcare Safety Network along with Centers for Disease Control for surveillance has classified nosocomial infection sites into 13 types with 50 infection sites, which are specific on the basis of biological and clinical criteria. The agents that are usually involved in hospitalacquired infections include Streptococcus spp., Acinetobacter spp., enterococci, Pseudomonas aeruginosa, coagulase-negative staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members, namely, Proteus mirablis, Klebsiella pneumonia, Escherichia coli, Serratia marcescens. Nosocomial pathogens can be transmitted through person to person, environment or contaminated water and food, infected individuals, contaminated healthcare personnel's skin or contact via shared items and surfaces. Mainly, multi-drug-resistant nosocomial organisms include methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Pseudomonas aeruginosa and Klebsiella pneumonia, whereas Clostridium difficile shows natural resistance. Excessive and improper use of broadspectrum antibiotics, especially in healthcare settings, is elevating nosocomial infections, which not only becomes a big health care problem but also causes great economic and production loss in the community. Nosocomial infections can be controlled by measuring and comparing the infection rates within healthcare settings and sticking to the best healthcare practices. Centers for Disease Control and Prevention provides the methodology for surveillance of nosocomial infections along with investigation of major outbreaks. By means of this surveillance, hospitals can devise a strategy comprising of infection control practices.

Infection Prevention Strategy in General Hospital under Regular Epidemic Prevention and Control

New coronavirus pneumonia spread rapidly all over the world in the first half of 2020, which is a new respiratory disease with strong infectiousness. At present, the epidemic situation in China has been effectively controlled, but the global epidemic situation remains grim, and the National Health Commission has instructed that the prevention and control of new coronavirus pneumonia should become normalized. As outposts for surveillance of public health events, hospitals are an important front in the fight against the epidemic. Therefore, it is very crucial to construct infection prevention and control system actively to contain the outbreak. This paper analyzes and summarizes the normal prevention and control management strategy of Infection Control Branch Management (hereinafter referred to as Hospital Infection-Control Dept) in a certain designated comprehensive third-grade hospital in Guangdong Province and transforms the prevention and control means in emergency state into measures for sustainable development, which also provides basis and reference for Hospital Infection-Control Dept of medical institutions to formulate prevention and control guidelines.

Immune Control Strategies for Vaccinia Virus-related Laboratory-acquired Infections

While presenting biological characteristics of vaccinia virus and laboratory-acquired infections during related research processes, this paper focuses on benefits and risks of vaccinia virus immunization in relation to laboratory-acquired infections, describes characteristics and the adaptation of vaccinia virus vaccine, analyses the role vaccinia virus immunization plays in the prevention and control of laboratory-acquired infections, and finally proposes solutions and countermeasures to further promote and implement immune control strategies. The problem related to immune strategy and laboratory- acquired infections which is being raised, analyzed and explored plays an active and instructive role in vaccinia virus related researches and laboratory- acquired infections, and also helps to recommend and develop relevant immune strategy for future vaccine control of such infections.

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.

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.

Effects of Helicobacterpyloriinfection on gastric emptying rate in patients with non-ulcer dyspepsia

AIM:The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia(NUD)remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori(Hpylori) infection and whether it was affected by eradication of the infection. METHODS:Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls(n=17).Hpylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients(n=23)received 10-day triple eradication therapy.Hpyloristatus was re-assessed by biopsy urease test four weeks later,and if eradication was confirmed,gastric emptying rate was re-evaluated. RESULTS:Thirty-three NUD patients and 17 controls were evaluated.NUD patients had significantly delayed gastric emptying compared with controls.The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM)was 0.173 and 0.224 mg/L.kg respectively (P=0.02),the mean area under plasma paracetamol concentration-time curve divided by body mass(AUC/BM) was 18.42 and 24.39 mg.min/L.kg respectively(P=0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients.The mean Cmax/BM was 0.172 and 0.177 mg/L·kg respectively (P=0.58),the mean AUC/BM was 18.43 and 18.38 mg·min/ L·kg respectively(P=0.91).Among 14 NUD patients who were initially H pylori-positive,confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L.kg before and after Hp eradication,respectively(P=0.64),the mean AUC/BM was 17.41 and 18.02 mg.min/L.kg before and after eradication,respectively(P=0.93). CONCLUSION:Although gastric emptying is delayed in NUD patients compared with controls,gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.

Empirical antibiotic treatment with piperacillin-tazobactam in Patients with microbiologically-documented biliary tract infections

AIM: To report our experience with empiric antimicrobial monotherapy (piperacillin/tazobactam, of which no data are available in such specific circumstances) in microbiologically-documented infections in patients with benign and malignant conditions of the biliary tract.METHODS: Twenty-three patients, 10 with benign and 13 with malignant conditions affecting the biliary tree and microbiologically-documented infections were recruited and the efficacy of empirical antibiotic therapy was assessed.RESULTS: The two groups featured similar demographic and clinical data. Overall, the infective episodes were most due to Gram negative agents, more than 60% of such episodes (mostly in malignant conditions) were preceded by invasive instrumental maneuvers. Empirical antibiotic therapy with a single agent (piperacillin/tazobactam) was effective in more than 80% of cases. No deaths were reported following infections. CONCLUSION: An empiric therapeutic approach with piperacillin/tazobactam is highly effective in biliary tract infections due to benign or malignant conditions.

Optimal Treatment Strategy for Infectious Diseases with Two Treatment Stages

In this paper, a disease transmission model with two treatment stages is proposed and analyzed. The results indicate that the basic reproduction number is a critical threshold for the prevalence of the disease. If the basic reproduction number is less than one, the disease free equilibrium is globally asymptotically stable. Otherwise, the endemic equilibrium is globally asymptotically stable. Therefore, besides the basic reproduction number, a new marker for characterizing the seriousness of the disease, named as dynamical final infective size, is proposed, which differs from traditional final size because the proposed model includes the natural birth and death. Finally, optimization strategies for limited medical resources are obtained from the perspectives of basic reproduction number and dynamical final infective size, and the real-world disease management scenarios are given based on these finding.

Recent advances in endogenous and exogenous stimuli-responsive nanoplatforms for bacterial infection treatment

As drug-resistant bacterial infections escalate and antimicrobial resources become insufficient,new alternative therapies are critical.The emergence of nano drug delivery system,in addition to giving drugs sustained,targeted or longer half-life characteristics,also plays an important role in improving the therapeutic effect and reducing the toxic side effects of conventional drugs.Despite its potential benefits,the traditional nanomedical drug delivery system has some practical limitations,including incomplete and slow drug release,as well as insufficient accumulation at infection sites.Stimuli responsive nanoplatforms are hence developed to overcome the disadvantages of conventional nanoparticles,which can provide several advantages like:enhancing the pharmacokinetics and biodistribution of antimicrobial drugs,increasing their effective bioavailability,reducing their dosage frequency,and improving their antimicrobial efficacy against biofilm-related infections,while slowing down the development of antimicrobial resistance,which is expected to trigger a medical revolution in the field of human health,thus bringing huge clinical benefits.In this review,we provide an extensive review of the recent progress of endogenous and exogenous stimuli-responsive nanoplatforms in the antibacterial area.Using specific infectious microenvironments(pH,enzymes,reactive oxygen species and toxins),this review systematically presents the design principles of nano delivery systems and the mechanisms by which endogenous stimuli induce changes in the morphology or properties of delivery systems to achieve programmed drug release.Furthermore,exogenous stimuli such as light,heat,and magnetic fields can also control the release of drugs.Last but not least,we discussed the challenges and opportunities for future clinical translation of stimuli-responsive nanoplatforms in bacterial infections.

Trizivir (Abacavir/Lamivudine/Zidovudine) plus Lopinavir/Ritonavir Induction Therapy Followed by Trizivir-Alone Maintenance for HIV-1-Infected Patients: A 96-Week Pilot Treatment Simplification Study

Objective: The purpose of this study was to investigate whether switching HIV-infected patients stabilized on Trizivir (abacavir 300 mg/lamivudine 150 mg/zidovudine 300 mg) plus lopinavir/ritonavir 400 mg/100mg twice daily to Trizivir alone affects clinical efficacy and tolerability. Methods: This phase 4, open-label, pilot study was conducted over 96 weeks in 23 antiretroviral-na?ve, HIV-infected patients. Initially, these patients received induction therapy with Trizivir plus lopinavir/ritonavir 400 mg/100mg twice daily. Patients who achieved a viral load 3. Nineteen patients completed induction;of the four who did not, three were lost to follow-up and one withdrew due to gastrointestinal adverse events. In 14 induction completers who had viral load measurements taken at week 48, intent-to-treat: observed analysis showed a week 48 viral load 3 higher than the baseline count. Twelve patients completed the subsequent 48-week Trizivir-alone maintenance phase, of whom 11 (92%) achieved viral loads of both 3 above baseline. Trizivir-only maintenance was associated with fewer adverse events than the Trizivir-lopinavir/ritonavir induction phase and with improvement in total cholesterol, LDL-cholesterol, and triglycerides. Conclusions: Trizivir-alone maintenance after Trizivir-lopinavir/ritonavir induction maintained virologic and CD4+ cell response, and was associated with an improved adverse event and lipid profile.

Effective Control Strategies on the Transmission Dynamics of a Vector-Borne Disease

In this paper, we have rigorously analyzed a model to find the effective control strategies on the transmission dynamics of a vector-borne disease. It is proved that the global dynamics of the disease are completely determined by the basic reproduction number. The numerical simulations (using MatLab and Maple) of the model reveal that the precautionary measures at the aquatic and adult stage decrease the number of new cases of dengue virus. Numerical simulation indicates that if we take the precautionary measures seriously then it would be more effective than even giving the treatment to the infected individuals.

Study on the psychological reaction and coping strategies of nursing students under the spread of COVID-19

Background:To understand the psychological reaction and coping strategies of infectious diseases among nursing students.Methods:A convenience sampling method was used to select 455 nursing students in the school,and a questionnaire survey was conducted on the general data table and the psychological reaction and coping strategy scale of infectious diseases of college students and coronavirus disease 2019(COVID-19)was used as an example of the infectious diseases.Results:the psychological reaction of nursing students was related to gender(P=0.006),age(P=0.001),education level(P=0.019),professional category of senior high school(P=0.014),whether they were student cadres(P<0.001)and whether there were immediate relatives engaged in medical and health related work(P=0.022).Different education level(P=0.017),different age(P=0.041),different residence(P=0.003),high school professional category(P=0.008)and whether there are immediate relatives engaged in medical and health related work(P=0.021)are related to their coping strategies.Conclusion:Nursing students with different demographic data have different psychological reactions and coping strategies.In the future research on the infectious diseases related to nursing students,it is suggested to focus on the female,the younger,the less educated,the liberal arts students and the nursing students who have no immediate family members engaged in medical and health related work,so as to promote the physical and mental health development of the nursing students in school.

儿童骨科患者植入物感染的目标性监测及预防策略研究

目的 探究儿童骨科患者植入物感染的目标性监测及预防策略研究。方法 回顾性分析2021年6月至2023年6月湖南省儿童医院收治的1 480例儿童骨科植入物患者的临床资料,根据术后植入物是否发生感染分为感染组和未感染组,分析儿童骨科患者植入物感染的影响因素。检索亚太感染控制协会网站、澳大利亚JBI循证卫生保健中心数据库、PubMed、中国知网等数据库中最新版本的循证指南、系统评价、专家共识。以循证卫生保健模式和德尔菲法为理论指导,构建预防儿童骨科植入物感染的循证实践方案。结果1 480例行骨科植入手术的患者中植入物感染12例,发生率为0.81%。两组年龄、手术时间、住院时间、伤口感染情况、抗菌药物使用情况、基础疾病比较,差异有统计学意义(P<0.05)。年龄、手术时间、住院时间、伤口感染情况、抗菌药物使用情况、基础疾病是儿童骨科患者植入物感染的危险因素(OR>1,P<0.05)。两轮专家函询问卷有效回收率和意见提出率皆为100%,专家权威系数均>0.9。经过两轮专家函询,最终形成预防儿童骨科患者植入物感染的循证实践方案共7个维度、31个条目。结论 开展目标性监测能及时了解儿童骨科患者植入物感染情况和高危因素,以此为基础构建的循证实践方案具有科学性和实用性,可为临床实践提供参考。

急性淋巴细胞白血病患儿医院感染防控对策研究

目的探讨急性淋巴细胞白血病患儿医院感染的防控对策。方法选取2019年1月至2022年6月该院血液肿瘤科收治的282例急性淋巴细胞白血病住院患儿,将其随机分为对照组(n=138)、观察组(n=144),2组均实施常规治疗及护理措施,观察组增加预防医院感染防控对策,对比2组患儿医院感染率、感染部位及总体健康水平。结果对照组患儿共发生医院感染22例25例次,观察组共发生医院感染10例12例次,对照组、观察组患儿医院感染发生率分别为15.94%、6.94%,对照组、观察组患儿医院感染例次发生率分别为18.12%、8.33%,观察组患儿医院感染发生率、医院感染例次发生率均低于对照组,差异均有统计学意义(P<0.05);感染主要部位为上呼吸道,革兰阴性菌为主要感染病原菌;观察组生活质量(QOL)评分[(69.87±3.41)分]高于对照组[(63.88±3.09)分],差异有统计学意义(P<0.05)。结论对急性淋巴细胞白血病采取感染防控对策可有效降低患儿医院感染发生率,提高其总体健康水平,有效缓解负性情绪。

医用导管抗菌涂层的研究进展

导管相关性感染(CRI)作为目前常见的医院获得性感染之一,导致死亡率和发病率增加,极大影响了医疗质量与患者健康,避免导管在植介入人体时产生感染已成为临床共性问题。细菌定植形成的生物膜是造成导管相关感染的主要原因,通过在医用导管表面设计功能性涂层来限制细菌定植及生物膜形成能有效避免感染。本文从防污改性、杀菌改性及防污-杀菌改性3个方面综述了近年来医用导管表面改性策略。防污改性一般通过将亲水的非离子型聚合物(如聚乙二醇、聚乙烯吡咯烷酮)以及两性离子聚合物制备在材料表面防止细菌及蛋白质黏附。杀菌改性根据机制可分为接触灭杀、释放灭杀和多机制联合灭杀,主要通过将杀菌剂接枝或负载在材料表面来赋予表面杀菌能力。防污-杀菌改性主要通过制备复合材料及聚合物刷、构建自适应表面及亲水聚合物负载杀菌剂等方式使表面同时具备防污及杀菌的能力。最后,在上述综述基础上对医用抗菌导管存在的问题进行了分析和展望,以期为制备应用于临床的高性能医用抗菌导管提供参考。

SHEA/IDSA/APIC实践建议:预防医院感染策略纲要(2022年更新版)

美国医疗保健流行病学学会/美国感染病协会/感染控制和流行病学专业人员协会(SHEA/IDSA/APIC)2022年更新了“急诊医院医疗保健相关感染的预防策略纲要”,内容包括“导尿管相关尿路感染(CAUTI)的预防策略”“中央导管相关血流感染(CLABSI)的预防策略”“艰难梭菌感染(CDI)的预防策略”“预防耐甲氧西林金黄色葡萄球菌(MRSA)传播和感染的策略”“手术部位感染(SSI)的预防策略”“呼吸机相关肺炎(VAP)和呼吸机相关事件(VAE)的预防策略”“预防非呼吸机医院获得性肺炎(NV-HAP)的策略”“通过手卫生预防医疗保健相关感染的策略”“实施预防医疗保健相关感染的策略”九部分。

2012-2021年黑龙江省佳木斯市不同检测类型HIV/AIDS晚发现特征分析

目的分析黑龙江省佳木斯市不同检测类型发现HIV/AIDS的晚发现特征。方法资料来源于中国疾病预防控制信息系统艾滋病综合防治数据信息管理系统,收集现住址为佳木斯市、确证时间为2012-2021年且确证年龄≥15岁的HIV/AIDS。收集基线和随访信息,采用分层分析和logistic回归分析了解不同检测类型HIV/AIDS的晚发现影响因素。采用Excel 2019、SPSS 26.0和Joinpoint 4.9.1.0软件进行数据整理和统计学分析。结果在956例HIV/AIDS中,自愿咨询检测、医疗机构检测和常规筛查检测发现HIV/AIDS分别占53.24%(509/956)、38.81%(371/956)和7.95%(76/956)。晚发现比例为35.04%(335/956),医疗机构检测晚发现比例(53.37%,198/371)高于自愿咨询检测(23.38%,119/509)和常规筛查检测(23.68%,18/76),差异具有统计学意义(P<0.001)。自愿咨询检测和常规筛查检测晚发现风险比医疗机构检测分别减少67%(a OR=0.33,95%CI:0.24~0.46)和71%(a OR=0.29,95%CI:0.16~0.52)。医疗机构检测发现HIV/AIDS中初中及以下(a OR=3.12,95%CI:1.46~6.68)和高中/中专者(a OR=3.78,95%CI:1.68~8.53)的晚发现风险高于大专及以上者,自愿咨询检测发现HIV/AIDS的确证年龄每增加10岁,晚发现风险提高50%(a OR=1.50,95%CI:1.18~1.92)。结论2012-2021年佳木斯市HIV/AIDS的晚发现水平与同时期全国和其他地区接近,未见明显下降。不同检测策略发现HIV/AIDS的晚发现比例和影响因素存在差异,应针对不同检测策略的目标人群开展差异化干预措施,识别晚发现HIV/AIDS的关键特征,推动主动检测,促进早检测早诊断。