Objective To investigate the current situation and existing problems of healthcare-associated infection (HAI)management in primary medical institutions in Henan Province.Methods 36 primary medical institutions in 18 regions were investigated with random sampling method,development of HAI management in primary medical institutions before and after 2013 were compared.Results Among 36 primary medical institutions,31 (86.11 %) had cleaning,disinfection,sterilization,and isolation systems,13 (36.11 %)implemented HAI monitoring system, 31 (86.11 %)performed regular training on hand hygiene knowledge,6 (16.67%)allocated antimicrobial manage-ment professionals.The development rates in HAI management group,hand hygiene system,training on related knowledge among staff,HAI monitoring,and antimicrobial management in 36 primary medical institutions before 2013 were all lower than those after 2013 (41 .67% VS 75.00%;2.78% VS 30.56%;22.22% VS 69.44%;5.56%VS 33.33%;25.00% VS 66.67%,all P <0.05).Conclusion HAI management level in primary medical institu-tions has improved than before,but deficiencies still exists and needs further improvement.

Objective To explore the effect of ATP fluorescence detection on on-site monitoring and supervision of healthcare-associated infection management .Methods ATP bioluminescence analyzer was used to detect the con-tamination status of hands of health care workers(HCWs),the object surfaces,and the cleaning tools in all quarters of 2015,the detection results were timely given feedback,and improvement measures were put forward.Results A total of 1 294 specimens were detected,the overall qualified rate was 62.75%.The qualified rates of hands of HC-Ws,object surfaces,and cleaning tools increased from 54.35%,50.30%,and 60.26% in the first quarter to 76.42%,64.80%,and 79.52% in the fourth quarter respectively,tendency chi-square test showed that difference was statistically significant (all P <0.05).The median of relative light unit (RLU)of hands of HCWs,object sur-faces,and cleaning tools were 20.00,85.00,and 35.00,respectively.Conclusion ATP fluorescence detection for on-site monitoring and supervision for cleaning and disinfection effect can promote the continuous quality improve-ment of hand hygiene and environmental cleanliness.

Objective To evaluate the efficacy of hydrocolloid dressings on preventing mechanical phlebitis induced by peripherally inserted central catheter (PICC)in cancer patients. Methods 100 cancer patients with PICC were divided into observation group (n= 50)and control group (n= 50). Hydrocolloid dressing was used in observation group and hot-wet compress was used in control group. Incidence of mechanical phlebitis,comfort degree,and im-plementation time between two groups were compared.Results The incidence of mechanical phlebitis in observation group and control group were 4.0% (2/50)and 22.0% (11/50)respectively,grade of mechanical phlebitis in obser-vation group was significantly lower than control group(P<0.05). The rates of skin irritation,activity limitation, and body exposure in observation group were all significantly lower than control group (0 vs 10 . 0% ,2 . 0% vs 14.0% ,0 vs 16.0% ,respectively,all P<0.05),the implementation time of observation group and control group were (2.8±1.1)and (35.2±7.4)minutes respectively,difference was statistically significant(P<0.05). Conclusion Hydrocolloid dressing can significantly reduce the mechanical phlebitis induced by PICC,enhance pa-tients'comfort degree,and reduce nurses'workload.

Nocardia is a genus of gram-positive,weakly acid-fast,filamentous aerobic actinomycetes,which mainly causes infection in immunocompromised persons. We reported a successfully treated fatal case of severe pneumonia caused by Nocardia farcinica in a hospital,then reviewed 25 domestic and abroad case reports about nocardiosis combined with severe pneumonia occurred since 2006,so as to improve health care workers'cognition on clinical manifestations,image features,pathogenic characteristics,and diagnostic and treatment schemes of se-vere pneumonia caused by Nocardia farcinica.

Objective To investigate the distribution of pathogens and positive alarming time of blood culture,and provide basis for laboratory diagnosis and clinical treatment. Methods Blood specimens from clinical departments in a hospital in May-November 2015 were collected,positive alarming time of blood culture was recorded,species of pathogens were identified. Results A total of 157 pathogenic strains were isolated from blood culture specimens, gram-positive cocci,gram-negative bacilli,and fungi accounted for 31 .85% ,57.32% ,and 10.83% respectively. The median positive alarming time were as follows:Enterobacteriaceae 0.50 day,non-fermenting bacteria 0.63 day, Enterococcusspp. 0.60 day,Streptococcusspp. 0.80 day,Staphylococcusspp. 1.01 days,and fungi 1.44 days, respectively. Conclusion Positive alarming time of blood culture specimens from early to late are as follows:Enter-obacteriaceae,Enterococcus,non-fermentative bacteria,Streptococcus spp.,Staphylococcus spp.,and fungus. Positive alarming time of pathogens causing bloodstream infection are all within 4 days,and most of them are within 1 day.

Objective To analyze drug resistance phenotypes and clinical distribution characteristics of clinically isolated carbapenem-resistant Klebsiella pneumoniae(CRKP),and provide evidence for rational use of antimicrobial agents and control of healthcare-associated infection(HAI). Methods CRKP isolated from inpatients in a hospital in 2013-2015 were collected,sources of specimens and homology of antimicrobial susceptibility of pathogens were analyzed. Results Of 949 non-repetitive strains of Klebsiella pneumoniae,75 (7.90% )were CRKP strains. The detection rates of CRKP from 2013 to 2015 were 1.35% ,7.77% ,and 17.04% respectively,which showed an up-ward trend year by year,difference was statistically significant(P<0.01). The main infection sites of CRKP were respiratory tract and urinary tract,CRKP mainly distributed in intensive care unit(ICU),geriatrics and emergency departments. Susceptibility rates of CRKP to amikacin and trimethoprim/sulfamethoxazole were 57.33% and 48. 00% respectively. 22 (29.33% )cases of CRKP infection were community-acquired and 53 (70.67% )were health-care-associated infection. 18 (24.00% )cases died among 75 CRKP infected patients. According to drug resistance phenotype analysis,there were 5 clones of CRKP strains,mainly distributed in ICU,geriatrics and emergency de-partments.Conclusion The proportion of CRKP infection is increasing year by year,clinical monitoring on CRKP should be strengthened,intensive infection control measures should be tarken,so as to prevent and control the spread and prevalence of CRKP.

Objective To investigate the incidence of surgical site infection(SSI)and compliance to bundle inter-vention measures on SSI following total abdominal hysterectomy in patients in department of gynaecology of a tertia-ry first-lass hospital,and evaluate the efficacy of bundle intervention measures in prevention and control of SSI. Methods From March 2014 to October 2015,all gynecology patients undergoing total abdominal hysterectomy were as targeted monitored subjects,March-September 2014 was baseline investigation stage,October 2014 to Oc-tober 2015 was intervention stage(new bundle intervention measures were performed),compliance to bundle inter-vention measures and incidence of SSI before and after intervention were compared.Results A total of 222 episodes of total abdominal hysterectomy were monitored,the incidence of SSI was 5 .86% ,the operation P75 time were 2 hours. Compared with the baseline stage,the compliance to most traditional intervention measures improved after intervention,the largest increase in the compliance to interventions was follow-up after surgery (increased by 64.16% ),followed by preoperative perineal disinfection(increased by 39.07% )and hand hygiene(increased by 21 .34% ). Compliance to new intervention measures was 100.00% . Incidence of SSI following total abdominal hys-terectomy after intervention was significantly lower than before intervention(2.27% [3/132]vs 11.11% [10/90]), difference was significant (χ2= 7.583,P<0.05).Conclusion Targeted monitoring on SSI following total abdomi-nal hysterectomy can improve compliance to bundle intervention measures and decrease incidence of SSI.

Objective To investigate the direct economic losses caused by healthcare-associated infection(HAI)in patients with acute lymphoblastic leukemia (ALL)and acute non-lymphoblastic leukemia (ANLL).Methods All acute leukemia (AL)adult patients who were admitted to a hematology ward in a hospital between January 201 1 and December 2013 were included in the study,HAI group(case group)and non-HAI group (control group),ALL group and ANLL group were matched respectively in a 1:1 ratio,hospitalization expenses and length of hospital stay were compared.Results A total of 994 patients were included,166 were with ALL,828 with ANLL,there were 181 pairs of case group and control group,and 15 pairs of ALL group and ANLL group. Direct economic los-ses in ALL group and ANLL group were 13 089.0 ￥ and 21 565.0 ￥ respectively ;extension of length of hospital stay due to HAI were 10.5 and 10.0 days respectively,differences were statistically significant between case group and control group (both P<0.05). The total hospitalization expense,as well as fees for bed,consultation,treat-ment,laboratory examination,nursing,medicine,traditional Chinese medicine,and blood transfusion in ANLL group were all higher than ALL group,but there were no significant difference.Conclusion HAI in patients with AL can increase hospitalization cost and prolong length of hospital stay.

Objective To investigate the carriage and homology of carbapenemase genes of multidrug-resistant Acinetobacterbaumannii (MDRAB)in Wujiang area.Methods A total of 44 non-duplicated MDRAB isolated from patients in 3 general hospitals in Wujiang area from January 2010 to December 2013 were collected. Minimum inhibitory concentrations (MICs)were detected,carbapenemase genes OXA-51,OXA-23,OXA-24,OXA-58, IMP,TEM,SHV,and GES were amplified with polymerase chain reaction(PCR),homology of strains was detec-ted with pulsed-field gel electrophoresis (PFGE).Results 44 MDRAB strains were mainly collected from sputum (93.18% ),mainly distributed in intensive care unit (ICU),department of respiratory diseases,and department of neurosurgery,accounting for 45.45% ,27.27% ,and 13.64% respectively;MDRAB were both sensitive to minocy-cline and polymyxin B,resistance rates to piperacillin,ampicillin/sulbactam,ceftazidime,gentamicin,amikacin, and ciprofloxacin were all 100.00% ,resistance rates to imipenem and meropenem were both 97.73% . 44 MDRAB strains were all detected OXA-51,OXA-23 and TEM genes,12 strains were positive for GES gene,1 strain was positive for OXA-58 and SHV respectively,OXA-24 and IMP genes were not found ;MDRAB were divided into 7 types of G-A,which included 19,3,9,3,1,4,and 5 strains respectively,type A was mainly from two large gen-eral hospitals in Wujiang area (Wujiang First People’s Hospital and Shengze Hospital),type B,D and E strains were not detected in Wujiang First People’s Hospital,type E strain was only 1 isolate and was from Yongding Hos-pital,the other types were sporadically distributed.Conclusion Multidrug resistance of clinically isolated Acineto-bacterbaumannii is serious in Wujiang area,OXA-23 and TEM genes are major causes of multidrug resistance in Acinetobacterbaumannii,the main types are A and C,which present clonal spread.

Objective To understand the occupational exposure among medical laboratorians in a hospital,and put forward prevention and control measures.Methods Occupational exposure among medical laboratorians in the department of laboratory medicine of a hospital from January 2011 to December 2014 were analyzed statistically.Results A total of 72 cases of occupational exposure occurred among 217 laboratorians during 4 years,occupational exposure rate was 33.18％,the occupational exposure rate in interns was 46.23％,and in laboratorians with working seniority＜ 1 years was 49.56％.Occupational exposure mainly occurred in outpatient blood collection room(accounting for 38.89 ％),the main occupational exposure types were injuries by blood collection needles,skin contaminated by blood and body fluid(76.39 ％).Occupational exposure rates in medical laboratorians in this hospital during 2011-2014 were 53.66％(22/41),41.67％(20/48),26.23％(16/61),and 20.90％(14/67),respectively,which presented a declining tendency(x2 =12.286,P＜0.01).After occupational exposure,only 23 cases were reported according to the requirements of infection management department,the missing report rate was 68.06％ (49/72),correct handling rate was 80.56％ (58/72).Conclusion Laboratorians should strengthen education and training of healthcare-associated infection management,improve safety and prevention consciousness,standardize handling process,improve consciousness of reporting,so as to reduce the occurrence of occupational exposure and post exposure infection.