Objective To evaluate the effect of bundle intervention measures on preventing ventilator-associated pneumonia (VAP).Methods Patients who were admitted to an intensive care unit(ICU)of a hospital from January 2012 to December 2013 were monitored,patients from January to December 2012 were as control group,while from January to December 2013 were as intervention group (bundle intervention measures were implemented).Usage rate of ventilators and incidence of VAP between two groups were compared.Results A total of 4 560 patients were mo-nitored,2 608 in intervention group and 1 952 in control group.Usage rate of ventilators in intervention group was lower than control group (53.95% vs 61 .17%;χ2 =65.756,P <0.01).Incidence of VAP per 1 000 ventilator days in intervention group was lower than control group (13.00‰ vs 19.56‰;χ2 =4.649,P =0.031 ).Percentage of late-onset VAP per 1 000 ventilator days in tervention group was higher than control group(41 .82‰ vs 24.59‰). Conclusion Bundle intervention measures are helpful for reducing the incidence of VAP in ICU patients.

Objective To analyze the distribution and change of antimicrobial resistance of common pathogenic bacteria from geriatric ward,and provide reference for rational use of antimicrobial agents.Methods Specimens from hospitalized patients in a geriatric ward from 2009 to 2013 were analyzed,the isolated pathogenic bacteria and antimicrobial resistance of bacteria were analyzed statistically.Results From 2009 to 2013,a total of 7 426 patho-genic bacteria were isolated,the percentage of gram-negative bacilli,gram-positive cocci,and fungi were 90.96%(n=6 755),7.23%(n =537),and 1 .81 % (n = 134),respectively.The top 5 detected bacteria were Pseudomonas aeruginosa (39.16%),Escherichia coli (16.47%),Stenotrophomonas maltophilia (10.65%),Klebsiella pneu-moniae (7.22%),and Acinetobacter baumannii (6.21 %),these strains were mainly isolated from sputum (94.15%,n =5 573 ).Resistance rates of Acinetobacter baumannii to all detected antimicrobial agents,Pseudo-monas aeruginosa to 8 kinds of common antimicrobial agents (piperacillin / tazobactam,ceftazidime,aztreonam, imipenem,et al),Escherichia coli to 5 kinds of common antimicrobial agents (piperacillin/ tazobactam,cefopera-zone/sulbactam,aztreonam,levofloxacin,and ciprofloxacin),and Stenotrophomonas maltophilia to ceftazidime and levofloxacin all showed an increased tendency (all P <0.01 );there was no obvious change in resistance rates of Klebsiella pneumoniae to all detected antimicrobial agents (all P >0.05).Conclusion The major pathogenic bacteria isolated from geriatric ward is Pseudomonas aeruginosa ,which is highly resistant to multiple antimicrobial agents, antimicrobial agents should be chosen based on antimicrobial susceptibility testing results.

Objective To understand the empiric antimicrobial use in patients with pyelonephritis in a hospital,and pro-vide reference for clinical rational antimicrobial use.Methods Data of 620 patients with pyelonephritis admitted to the nephrology department of a hospital between January 2011 and September 2014 were collected,application of antimicrobial agents,coincidence between empiric antimicrobial use and antimicrobial susceptibility testing results in patients with different diseases and different ages were analyzed.Results Before antimicrobial susceptibility testing results were reported,620 pa-tients use 625 times of antimicrobial agents,5 of whom used two kinds of antimicrobial agents at the same time,8 varieties in 15 types of antimicrobial agents were involved,the most frequently used antimicrobial agents were third generation ceph-alosporins,cephamycins,and fluoroquinolones.The overall,partial,and non-coincidence rate between antimicrobial use and antimicrobial susceptibility testing results were 64.32%(n=402),8.32%(n=52),and 27.36%(n=171)respective-ly.The overall coincidence rate in patients with acute pyelonephritis was higher than those with chronic pyelonephritis (77.61% [n=357]vs 58.79%[n=97],P <0.05).The overall coincidence rate in patients <50 years old and ≥50 years old were 68.12%(156/229)and 75.25%(298/396)respectively,there was no significant different between two groups (χ2 =2.93,P =0.09).Conclusion The non-coincidence rate between empiric antimicrobial use and antimicrobial suscepti-bility testing results is high,measures needs to be taken to improve the empiric antimicrobials use.

Objective To evaluate the incidence and influencing factors for post-operative healthcare-associated in-fection(HAI)in Uyghur patients undergoing cardiothoracic surgery in a hospital.Methods Clinical data of Uyghur patients hospitalized in the department of cardiothoracic surgery in a hospital of Kashgar region between June 2010 and June 2014 were collected,incidence of post-operative HAI was surveyed.Influencing factors for post-operative HAI were analyzed by univariate and multivariate logistic regression models.Results A total of 779 patients’clini-cal data were collected,53 patients (6.80%)developed post-operative HAI.The major infection sites were lower respiratory tract (2.44%),digestive tract(1 .28%),urinary tract(1 .16%),upper respiratory tract(1 .03%),and surgical sites(0.51 %).Multivariate logistic regression analysis showed that history of diabetes,body mass index (BMI)≥30 kg/m2 ,duration of operation ≥ 160 minutes,and invasive procedure were risk factors for post-opera-tive HAI in Uyghur patients undergoing cardiothoracic surgery.Conclusion Incidence of post-operative HAI in Uy-ghur patients undergoing cardiothoracic surgery in this hospital is high,risk factors for HAI are history of diabetes, high BMI,long duration of operation,and invasive procedure.

Objective To understand the results and characteristics of targeted monitoring of healthcare-associated infection (HAI)in an intensive care unit (ICU)of a tumor hospital,so as to provide scientific basis for formulating measures of prevention and control of HAI.Methods Patients who admitted to an ICU from January to December 2013 were performed targeted monitoring,incidence of HAI was adjusted with an average severity of illness score (ASIS),three types of invasive procedure-related infection,distribution of pathogens,and multidrug-resistant or-ganisms were monitored.Results A total of 455 patients were monitored,the total patient-days were 2 483 days, 52 cases of HAI occurred,incidence of HAI was 11 .43%,incidence of HAI per 1 000 patient-days was 20.94‰,af-ter the adjustment with ASIS,incidence of HAI per 1 000 patient-days was 6.29‰.The main infection site was re-spiratory system(63.46%),followed by urinary system(19.23%);Incidence of ventilator-associated pneumonia per 1 000 ventilation-days,catheter-related bloodstream infection per 1 000 catheter-days,and catheter-associated urinary tract infection per 1 000 urinary catheter days were 12.08‰,0.95‰,and 4.07‰ respectively.A total of 181 path-ogenic isolates were detected,74.59% (n=135)of which were gram-negative bacteria,18.23%(n=33)were gram-positive bacteria,and 7.18%(n=13)were fungi;18.23%(n=33)were multidrug-resistant strains.Conclusion ICU is the high risk department of the occurrence of HAI,the main infection is respiratory tract infection,the major pathogen is gram-negative bacteria.Targeted monitoring can timely reflect the deficiency in infection control practice,is helpful for formula-ting effective prevention and intervention measures,and reducing the occurrence of HAI.

Objective To investigate the current situation of healthcare-associated infection(HAI)in hospitals of Miao and Dong Autonomous Prefecture of Guizhou Province,and provide basis for formulating prevention and con-trol measures of HAI.Methods According to the unified plan of the National HAI Surveillance Network,26 hospi-tals in Miao and Dong Autonomous Prefecture of Guizhou Province were performed cross-sectional survey on HAI prevalence rate,antimicrobial use,and specimen bacterial culture rate.Results A total of 3 tertiary and 23 seconda-ry hospitals were investigated,7 799 inpatients were included,the prevalence rate of HAI was 2.54%(n =198), and case prevalence rate was 2.65% (n=205).HAI mainly distributed in intensive care unit (29.63%);the main infection site was lower respiratory tract (44.44%);HAI mainly caused by gram-negative bacteria,the major pathogens were Escherichia coli ,Pseudomonas aeruginosa ,and Klebsiella pneumoniae .The usage rate of antimi-crobial agents was 45.66%,secondary hospitals was higher than tertiary hospitals (53.65% vs 31 .14%,χ2 =148.53,P <0.001 ).74.02% of antimicrobial agents were for therapeutic purpose,19.77% for prophylaxis,and 6.21 % for both prophylactic and therapeutic application;81 .02% of patients received one agent,17.21 % received two,and 1 .77% received three and more agents;among patients who received antimicrobials for therapeutic as well as for both therapeutic and prophylactic purpose,only 29.37% were sent specimens for pathogenic detection.Conclusion The prevalence rate in this region is lower than national average level,antimicrobial usage rate is lower than national standard,management of key departments and key sites should be strengthened,antimicrobial agents,especially used in secondary hospitals should be used rationally.

Objective To analyze the genomic evolution characteristics of pathogenicity islands (PAIs)in Deng strain of enteropathogenic Escherichia coli (E.coli,EPEC Deng).Methods EPEC Deng was isolated from infant stool specimen,serotypes were identified and antimicrobial susceptibility testing was performed;whole-genome se-quencing was performed by Illumina 2000 system,the locations of prophages(PPs)in the chromosome were detected using PHAST software,collinearity analysis was performed by MUMmer software,phylogenetic trees of homolo-gous gene were constructed in order to understand the evolutional rule of homology gene.PAIs prediction was per-formed using PAI finder software,the homologous evolutionary rule of PAIs core region(LEE)and core genes were clarified,genetic polymorphism was analyzed.Results The serotype of EPEC Deng strain was O119:H6,the strain was resistant to ciprofloxacin,levofloxacin,and ampicillin,but sensitive to other antimicrobial agents.The complete circular chromosome contained 5 025 482 bp with a GC content of 50.52 %,and the plasmid contained 207 564 bp with a GC content of 49.50%.A total of 17 PPs in the chromosomal genome were discovered,phyloge-netic trees analysis suggested that EPEC Deng strain was highly homologous with O26:H11 and O111 :H strains;PAIs and core genes were highly homologous with RDEC-1 and O26:H413/89-1 strains;genetic diversity analysis showed that the intimin (eae)and its receptor tir had high polymorphism,with the pi (π)value>0.10,the genes in type III secretion system was relatively stable.Conclusion The study clarified the genomic evolution characteris-tics of EPEC Deng genome and it’s PAIs,and is helpful for understanding genetic characteristics of native EPEC.

Objective To explore the application of adenosine triphosphate (ATP )bioluminescence assay in evaluating cleaning quality of medical devices.Methods Manual and machine cleaned medical devices were randomly selected from central sterile supply department of a hospital in 2011 -2013,cleaning quality was detected with ATP biolumi-nescence assay,relative light unit (RLU)value was determined to assess the cleaning quality.Results A total of 460 pieces of cleaned devices were detected in 2011 -2013,404 (87.83%)were qualified.The qualified rates of manual cleaning and machine cleaning were 70.73% and 94.07% respectively,the qualified rates of general surgical devices and lumen devices were 90.71 % and 81 .76% respectively,there were significant differences in qualified rates of different cleaning methods and different categories of medical devices (both P <0.01 ).The qualified rates of manual cleaning in 2011 - 2013 were 32.35%,79.63%,and 94.29% respectively,machine cleaning were 79.45%,98.15%,and 98.08% respectively;differences in qualified rates of manual cleaning and machine cleaning in different years were significant (all P <0.01 ).Conclusion ATP bioluminescence assay can be used for evalua-ting cleaning quality of medical devices.

Objective To evaluate efficacy of routine cleaning and disinfection methods for incubators,and put forward a feasible improvement solution.Methods 30 incubators used in a neonatal intensive care unit of a hospital between Decem-ber 2013 and June 2014 were chosen and randomly divided into baseline,control,and trial groups(10 incubators in each group).Baseline group and control group were disinfected by routing disinfection method (wiping internal and external sur-faces of incubators with water and chlorine-containing disinfectant),trial group adopted intensified disinfection method (wi-ping internal surfaces of incubators with alcohol)on the basis of routine disinfection,disinfectant efficacy of three groups were compared.Results In baseline group,unqualified incubators were initially detected on the fourth day of monitoring, all incubators were contaminated in varying degrees on the seventh day of monitoring,the detection rate of unqualified spec-imens was 31.43% (88/280).The median time for the initial detection of unqualified incubators in control group and trial group were on the fifth day and seventh day respectively,there was significant difference between two groups(χ2 =12.38, P <0.05);The unqualified rate of trial group was significantly lower than control group (15.36%[43/280]vs 32.86%[92/280],χ2 =23.43,P <0.05 ).Conclusion Intensified disinfection with alcohol on the basis of routine disinfection method can effectively improve the disinfectant efficacy of the surface of incubators,it is convenient,inexpensive and safe, and worth to be popularized in primary hospitals.

Objective To investigate cleanliness of hospital environmental object surfaces and hands of health care workers(HCWs).Methods The adenosine triphosphate (ATP)bioluminescence assay was used to detect object surfaces and hands of HCWs in a hospital,on-the-spot intervention was conducted.Results The qualified rates of hospital environmental object surfaces and ventilator-relevant object surfaces were 58.14% (200/344)and 69.88%(116/166)respectively,the qualified rate of ventilator tracheal intubation site was low (29.17%);the qualified rate of telephone surfaces was the lowest (27.27%).The qualified rates of ventilator-relevant object surfaces used con-tinuously for ≥48h and <48 h were 56.70%(55/97)and 88.41 %(61/69)respectively,there was significant differ-ence between the two(χ2 =19.26,P <0.01).The qualified rates of HCWs’hands before and after intervention were 34.18% and 85.58% respectively,relative light unit (RLU)values were (1 033.46±106.20)and (80.46±10.68) respectively,the qualified rates and RLU before and after intervention were both significantly different (both P <0.01).Conclusion Contamination of object surfaces and hands’of HCWs in hospital dynamic environment is seri-ous,ATP bioluminescence detection and on-the-spot intervention is helpful for improving cleanliness of hospital en-vironment object surfaces and HCWs’compliance to hand hygiene.