Objective To investigate healthcare-associated infection (HAI)in neonatal intensive care unit(NICU),and provide reference for controlling HAI in newborns.Methods Targeted surveillance on HAI in all newborns in NICU of a hospital from January 2011 to December 2013 was performed by prospective investigation method.Results A total of 5 365 newborns were monitored,128 newborns developed 133 times of HAI,HAI rate and HAI case rate was 2.39% and 2.48% respectively.The major infection sites were conjunctiva (33.08%),upper respiratory tract (23.31%)and skin soft tissue (17.29%).The daily infection rate was 3.32‰(128/38 528),vascular catheter usage rate and respirator usage rate was 1.75%(676/38 528)and 1.09%(420/38 528)respectively.The difference in vascular catheter usage rate and res-pirator usage rate in newborns with different body weight had statistical difference (χ2 =3 075.22;442.46,both P <0.01).HAI in newborns with body weight of ≤1 000 g,1 001-1 500 g,1 501-2 500 g,and >2 500 g was 16.67%, 12.26%,4.15% and 1.06% respectively.None newborns developed catheter-related bloodstream infection(CRBSI),the incidence of ventilator-associated pneumonia (VAP )was only 4.76‰(2/420).A total of 51 specimens were sent for de-tection,27 pathogens were isolated,the major were gram-positive bacteria(55.56%).Conclusion The incidence of HAI in newborns is high,the main infection sites are eye,upper respiratory tract,and skin and soft tissue.

Objective To investigate the cleaning quality of frequently touched object surfaces in a hospital,so as to formulate effective evidence-based intervention measures.Methods Frequently touched object surfaces in common wards,operating rooms,and intensive care unit(ICU)of the hospital between October 2014 and February 2015 were labeled by fluorescent adhesive agents 1 -2 times a week,objects were labeled before patients’discharge and at the end of operation,cleaning quality of frequently touched object surfaces were checked after routine cleaning. Results A total of 2 131 object surfaces were monitored,fluorescent adhesive agents on 1 732 objects were cleared, clearance rate was 81 .3%,hygienic clean was qualified.642,650,and 839 objects surfaces in common wards, operating rooms,and ICU were monitored respectively,the clearance rates were 82.1 %,75.8%,and 84.9%respectively,the clearance rates among three wards were significantly different (χ2 =19.964,P <0.001 ).In com-mon wards,fluorescent clearance rates of call buttons,power switches,and equipments were 51 .3%,55.2%,and 58.5% respectively;in operating room,fluorescent clearance rates of room wall,control panel of anesthesia ma-chine,bed-adjusting device,keyboards,and infusion pumps were 38.6%,48.8%,60.0%,61 .3%,and 68.4%,re-spectively;in ICU,fluorescent clearance rates of equipments was 65.9%,all were unqualified.Conclusion The en-vironmental hygiene quality is generally qualified in this hospital,but the cleaning quality of frequently touched ob-ject surfaces needs to be further improved.

Objective To evaluate the occurrence and risk factors for healthcare-associated infection(HAI)in pre-mature infants.Methods The occurrence of HAI among premature infants who were born in a hospital from Janu-ary 2011 to June 2015 and admitted in the neonatal intensive care unit within 24 of birth were investigated prospec-tively,the related risk factors and intervention measures were analyzed.Results 644 premature infants were inves-tigated,32(4.97%)had HAI,the main infection site was lower respiratory tract (n=18,56.25%).34 pathogenic isolates causing HAI were detected, 24 (70.59%) were gram-negative bacteria, the major was Klebsiella pneumoniae (n=14);10 isolates were gram-positive bacteria(29.41%).Logistic regression analysis revealed that small for gestational age, low birth weight, severe amniotic fluid pollution, mechanical ventilation, feeding intolerance,indwelling gastric tube,irrational antimicrobial use,and long length of hospital stay were risk factors for HAI in premature infants (all P < 0.05).Conclusion Risk factors for HAI in premature infants are multiple, targeted interventions,such as shorten the length of hospital stay,reduce unnecessary invasive operation,use antimicrobial rationally,improve the feeding tolerance,are helpful for reducing the risk factors for HAI in premature infants.

BACKGROUND: Microglia is the immune effect cell in central nervous system, if it is activated, it will release neuron poisoning factors and inflammatory factors, and bring fatal injury.OBJECTIVE: To investigated the effect of focal cerebral reperfusion on activation of microglia and the effect of the regulation of electroacupuncturing Shuigou and Baihui.DESIGN: A randomized and controlled study.SETTING: The department of Physioltherapy, the 458 Hospital of Chinese PLA; Dongfang Hospital Affiliated to Shanghai Tongji University; The department of Histology-embryology, Tongji Medical College of Huazhong University of Science and Technology.MATERIALS: This experiment was processed at Histology-embryology Center of Tongji Medical College of Huazhong University of Science and Technology in March 2002. Total 80 Wistar rats were randomly divided into 8 groups with 10 in each group.METHODS: ① Normal control group: The rats were not given any treatment and killed next day. ② Sham operation group: Only artery was separated, no suture inserted, killed next day. ③ 6, 12 and 24-hour reperfusion groups: The rats' right middle cerebral artery (MCA) ischemia-reperfusion model was made by embolus suture technique, then the rat was killed after 30 minutes' occlusion at MCA and reperfusing respectively 6, 12, 24hours. ④ 6-hour reperfusion + electroacupuncture group: Electroacupuncture was carried out immediately after the model was made, then the rat was killedafter 30 minutes' occlusion at MCA and reperfusion 6 hours (The frequency was 4 Hz-16 Hz. Stimulus intensity increased 1 V per 10minutes and the final intensity was 3V. The stimulus was lasted 30 minutes). ⑤ 12-hour reperfusion + electroacupuncture B group: Electroacupuncture was carried out immediately after the model was made and 8 hours later, then the rat was killed after 30 minutes' occlusion at MCA and reperfusion 12 hours. ⑥ 24-hour reperfusion + electroacupuncture group: Electroacupuncture was carried out immediately after the model was made and 8, 16 hours later, then the rat was killed after 30 minutes' occlusion at MCA and reperfusion 24 hours.MAIN OUTCOME MEASURES: To calculate numbers of microglia and to observe its morphological changes.RESULTS: Data of totally 67 rats was entered the results analysis. No microglia was seen in the normal and sham operation groups. Large quantity of microglia was activated at the border of ischemic area in 6, 12 and 24reperfusion group, their quantity was largely increased, reaching apex at reperfusion 12 hours [(35.38±1.77), (54.25±1.67), (49.29±2.21)/200sights]. The quantity in every 6, 12 and 24 reperfusion + electroacupuncture group was less than that in model group [(32.11±2.80), (50.88±2.64),(45.45±3.95)/200 sights, P ＜ 0.05].CONCLUSION: The microglia in brain is activated after the cerebral ischemia-reperfusion and induces toxic effect on neurons. The electroacupuncture can decrease activation of microglia so as to protect the neurons.

OBJECTIVE To explore a management method for the prevention and control of infectious diseases in hospital. METHODS We applied the PDCA (plan,do,check and action) model to establish a management strategy for the prevention and control of infectious diseases for three years. The components of the management model included providing educational program for medical staff,designing and realizing direct network system for infectious disease reporting,monitoring diagnosed infectious diseases ,analyzing their epidemic tendency,guiding medical staff to prevent and control infectious diseases,and strengthening the surveillance,feedback,rewards and punishment. RESULTS The rate of delayed or missed report of infectious diseases was decreased from 5% to 1.1% by monthly check and from 6.8% to 0% by seasonally cross check. Although 46 cases of AIDS,5 cases of caesarean birth with HIV possitive and 1445 cases of hand-foot-mouth disease were admitted in our hospital,No medical staff and other patients was crossly infected. CONCLUSIONS Our way of management based on PDCA model can strengthen the prevention and control of infectious diseases and assure medical quality and patient safety.

OBJECTIVE To study the distribution and drug resistance of nosocomial infection(NI) pathogens.METHODS The NI pathogens collected between Jan 2002 and Dec 2008 were completely surveyed and analyzed.RESULTS Totally,9518 samples were cultured to find NI pathogens,in which 6703 NI pathogens were isolated.In the pathogens,G-pathogens occupied 59.5%,G+ cocci 25.0%,and fungi 15.5%.The rate of ESBLs in E.coli was reached to 47.8%,and that in K.pneumoniae was 29.4%;The first two predominant G+ pathogens were Staphylococcus aureus(11.7%) and Enterococcus(5.7%).The rate of MRSA in S.aureus was 78.2%,and that of VRE in Enterococcus was 2.3%,The pathogens of fungus were mainly Candida albicans(10.2%).CONCLUSIONS The G-NI pathogens are markedly increased year by year and become the first important instead of G+ cocci,meanwhile the multiple drug resistance and ESBLs pathogens are also markedly increased.

Objective To report a randomized trial in comparing the clinical outcomes of three-port LC versus standard four-port LC. Methods From March 2001 to August 2004, four hundred consecutive patients who underwent elective LC were randomized to receive either the three-port or the four-port technique. All patients were blinded to the type of operation they underwent. Postoperative overall pain and incisional pain at different sites were assessed on the first day after surgery using the Prince-Henry scale. Other outcome measures included length and success of the operation, analgesia requirements, postoperative complications, postoperative stay, and the cosmetic results. Results There was no difference between the two groups in age, sex, weight or other diseases. In terms of outcome, patients in the three-port group had less pain at individual subcostal port sites and better cosmetic results. Success rate, mean operative time, complications, subxiphoid port and overall pain score, analgesia requirements, and postoperative hospital stay were similar between these two groups. Conclusion Three-port LC resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port LC. The three-port technique is as safe as the standard four-port procedure for LC. Thus, it can be recommended as a routine procedure in elective LC.

OBJECTIVE A surveillance study was performed for nosocomial infections in order to investigate the change in antimicrobial resistance of Klebsiella pneumoniae,especially the strains isolated from 1999 to 2004.METHODS K-B test was used for the antibiotics susceptibility test and the results were read based on National Committee for Clinical Laboratory Standards(NCCLS) of the USA.The situation of ESBLs-producing strains of K.pneumoniae was investigated.RESULTS Totally 326 K.pneumoniae strains showed the highest susceptibility to imipenem.Ceftazidime,cefepime,and cefoperazone/sulbactam also showed excellent activity against K.pneumoniae.The prevalence of ESBLs from 326 strains was 20.2%.CONCLUSIONS It is important to study the drug resistance in nosocomial infections by K.pneumoniae.

Objective To probe the prevention and management of complications after laparoscopic cholecystectomy (LC). Methods Retrospective study was performed on 13 000 patients, who underwent LCs from September 1991 to February 2005 at our department. Results The complication rate was 1. 66% (216 patients) including intraabdominal hemorrhage in 21 patients (0. 16%),bile duct injury in 11 (0. 08% ),gastrointestinal perforation in 7(0. 05% ) , bile leakage in 26(0. 20% ) , retained abdominal tumor in 10(0. 08% ) , retained common bile duct stones in 47(0. 36% ) , intraabdominal abscess in 4(0. 03% ) , upper gastrointestinal hemorrhage in 2(0. 02% ) , extensive subcutaneous emphysema in 32 (0. 25% ) , port wound infection in 46(0. 35% ) , incisional hernia in 1 (0. 01% ) and deep vein thrombosis in 9 (0.07%). Six patients died postoperatively. Conclusions LC is a safe technique when up-to-date equipment and meticulous dissection techniques are employed. With the routine procedure, LC can be performed more safely.

OBJECTIVETo evaluate the role of laparoscopic ultrasonography(LUS) in prevention of bile duct injury(BDI) and residual common bile duct (CBD) calculi during complicated laparoscopic cholecystectomy (LC).

METHODSOne hundred and four cases of LC were defined complicated because of anatomic aberrance of the extrahepatic biliary system, unconfirmed exposed cystic duct, suspected CBD calculi or BDI, adhesion or inflammation in the Calot's triangle, acute cholecystitis, and atrophic gallbladder. LUS was performed to scan the extrahepatic bile duct. LC was carried out with assistance of the LUS.

RESULTSAssisted with the LUS demonstrated anatomic relationship between the extrahepatic bile duct and cystic infundibulum or cystic duct, 85 cases of LC were accomplished successfully. 19 were converted to open cholecystectomy because of LUS-indicated potential risk of BDI, CBD calculi, and suspected BDI.

CONCLUSIONSWith the extrahepatic bile duct visualized by LUS and contrast of the cystic infundibulum and cystic duct, operators can precisely identify the anatomic relationships between the cystic infundibulum, cystic duct and extrahepatic bile duct. Preoperatively unpredicted choledocholithiasis may be recognized.

Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Extrahepatic ; diagnostic imaging ; Cholecystectomy, Laparoscopic ; adverse effects ; methods ; Cystic Duct ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Ultrasonography