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Risk factors for healthcare-associated infection in patients after extracorporeal membrane oxygenation procedure

Weiying ZENG ; Guosui XIAO ; Zhenfeng ZHONG ; Lijuan RONG

Chinese Journal of Infection Control.2014;(4):212-214. doi:10.3969/j.issn.1671-9638.2014.04.005

Objective To realize the incidence of healthcare-associated infection(HAI)in patients after receiving extracorporeal membrane oxygenation(ECMO)procedure,and to evaluate the related factors for HAI.Methods Clinical data of patients receiving ECMO from January 2003 to December 2012 were collected and analyzed retro-spectively.Results Of 43 patients receiving ECMO,15 (34.88% )developed 24 times(55.81% )of HAI. The main HAI site was lower respiratory tract(n= 12,50.00% ),followed by blood stream(n= 6,25.00% ),skin and soft tis-sue(n= 5,20.83% ).A total of 28 isolates of pathogens were detected,gram-negative bacilli were 19(67.86% )iso-lates,gram-positive cocci 7(25.00% ),and fungi 2(7.14% );pathogens were mainly isolated from specimens of sputum(n= 12,42.86% ),blood (n= 9,32.14% )and wound secretion(n= 6,21 .43% ). The incidence of postopera-tive HAI in ECMO patients was related with patients’age,duration of ECMO,complication,mechanical ventila-tion,tracheal intubation or tracheotomy,and indwelling urinary catheter.Conclusion HAI in patients receiving EC-MO is high,hospital should take corresponding prevention and control measures targeting to the related risk factors of infection,so as to reduce the incidence of HAI after the ECMO.

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Difference in drug resistance of pathogens causing early-and late-onset ventilator-associated pneumonia in an intensive care unit

Shuke JIANG ; Biaofeng LUO ; Rongming LI ; Xiaoyan CHEN ; Chunfeng LI ; Yongnan XU ; Lin LI ; Zhenkai TAO

Chinese Journal of Infection Control.2014;(4):208-211. doi:10.3969/j.issn.1671-9638.2014.04.004

Objective To study the incidence of ventilator-associated pneumonia(VAP)and antimicrobial resistance of pathogens in an intensive care unit(ICU).Methods The occurrence of VAP in hospitalized patients with mechan-ical ventilation>48 hours between January 2011 and December 2012 were investigated,species and antimicrobial re-sistance of pathogens causing early onset-VAP (E-VAP,mechanical ventilation≤4 d)and late-onset VAP(L-VAP, mechanical ventilation>4 d)were compared.Results A total of 1 76 patients were investigated,incidence of VAP was 44.32% (78 cases);With the prolongation of mechical ventilation,incidence of VAP increased gradually (χ2=52.561,P<0.001).The incidence of L-VAP was significantly higher than E-VAP (58.33% [70/120]vs 14.29%[8/56])(χ2= 30.02,P<0.001).A total of 178 pathogens were isolated,gram-negative bacteria,gram-positive bac-teria and fungi were 104(58.43% ),46(25.84% ),and 28(15.73% )isolates respectively;97(54.49% )multidrug-resistance/pandrug resistance organisms (MDRO)were isolated. MDRO isolation rate in L-VAP patients was high-er than E-VAP patients([58.86% ,n= 93]vs [20.00% ,n= 4]),resistance rate of major pathogens causing L-VAP was significantly higher than E-VAP patients(allP<0.05).Fungi infection only occurred in L-VAP patients,the total antimicrobial resistance rate was 12.14% .Conclusion The prolongation of mechanical ventilation can increase the incidence of VAP,and resistance rate of pathogen in L-VAP is high.

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Current status and management strategies on central sterile supply depart-ments inmedical institutes

Ping CHEN ; Ding LIU

Chinese Journal of Infection Control.2014;(4):203-207. doi:10.3969/j.issn.1671-9638.2014.04.003

Objective To realize the current status of central sterile supply departments(CSSDs)in hospitals,and provide the basis for making improvement measures.Methods Field investigation was adopted to study the resource distribution,personnel structure,and the quality of medical instrument cleaning in 78 hospitals in Chongqing.Re-sults Qualified results of 78 hospitals was 24.36% (19/78),basically qualified rate 52.56% (41/78),unqualified rate 23.08% (18/78);inspection results of different types of hospitals were significantly different(Hc= 16.643,P=0.002),qualified hospitals mainly concentrated on city- and county-level hospitals.Unqualified rate of CSSD con-struction area was 78.21% (n= 61),unqualified rate of personal allocation was 75.64% (n= 59),concentrated man-agement of operating rooms and CSSDs was 52.56% (n= 41),mainly concentrated on city- and county-level hospi-tals;decentralized management accounted for 47.44% (n= 37),58(74.36% )hospitals used repeated cleaning stain-less steel tables for receiving,50% didn’t install automated cleaning machine and drying cabinet,42.31% (33/78) performed manual cleaning,40(51.28% )didn’t equip with water treatment system;12(15.38% )hospitals used patched or worn clothing for packing,47 didn’t equip with hard metal container,37(47.44% )had no heat sealing machine,21(26.92% )had no detection equipment for cleaning quality,41(52.56% )had no low temperature sterili-zation instruments;52(66.67% )hospitals performed biological monitoring on high pressure steam sterilizer.Conclu-sion Clean and disinfection equipments in CSSDs in city- and county-level hospitals are well-appointed,procedures of clean and disinfection are standard,and can achieve the standard of clean quality;while hospitals affiliated to fac-tories and private hospitals are not well-appointed,procedures of clean and disinfection are not standard. Construc-tion of CSSD should be standard,so as to ensure the effectiveness of clean,disinfection and sterilization of surgical instruments.

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Difference in antimicrobial resistance ofAcinetobacter baumannii isolated from patients at different wards

Bangfen YE ; Xiaohui GUO

Chinese Journal of Infection Control.2014;(4):239-241. doi:10.3969/j.issn.1671-9638.2014.04.013

Objective To investigate the difference in healthcare-associated infection (HAI)status and antimicro-bial resistance of Acinetobacterbaumannii(A.baumannii)isolated from different wards,so as to provide evidence for effective prevention and therapy for HAI caused by A.baumannii.Methods Clinical data of 446 A.baumannii isolates from hospitalized patients between January 2012 and July 2013 were analyzed retrospectively. Results The majority of 446 A.baumanniiisolates were from patients admitted to intensive care unit (ICU,n= 236,52.92% ), followed by departments of respiratory diseases(n= 55,12.33% )and neurosurgery (n= 48,10.76% ),and the strains were mainly isolated from sputum specimens (94.62% ).Antimicrobial susceptibility testing with 13 kinds of commonly used antimicrobial agents showed that antimicrobial resistance of A.baumanniifrom ICU were highest, susceptibility rates were all<20% ,the next were from department of neurosurgery,susceptibility rates were all<30% ,while susceptibility rates of A.baumanniifrom department of respiratory diseases were all >50% .Conclu-sion The difference in antimicrobial resistance of A.baumanniifrom different wards varied significantly,antimi-crobial resistance of A.baumanniifrom ICU is most serious.

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Detection of four infection indicators in 28165 patients before transfusion and surgery

Jinfeng CHENG ; Xiying CAI

Chinese Journal of Infection Control.2014;(4):222-225. doi:10.3969/j.issn.1671-9638.2014.04.008

Objective To investigate the detection results of HBsAg,anti-HCV,anti-Treponema pallidum anti-body (anti-TP )and anti-HIV in patients before transfusion and surgery. Methods Four infection indicators of 28 165 patients were detected by enzyme-linked immunosorbent assay from June 2011 to May 2012,results were an-alyzed statistically.Results Of 28 165 patients,total positive rate was 12.15% (n= 3 422),the positive rate of HB-sAg,anti-HCV,anti-TP and anti-HIV was 8.69% (n= 2 447),1.31% (n= 368),2.07% (n= 583),and 0.09% (n=24)respectively. The positive rate of HBsAg,anti-HCV and anti-HIV in male was higher than female (χ2 was 36.64,28.95,and 4.82,respectively,allP<0.05).In different age groups,positive rate of all indicators in<20 age group was lowest,while positive rates of HBsAg,anti-HCV,and anti-HIV were highest in 20-39 and 40-59 age groups,anti-TP was highest in ≥60 age group.Conclusion Detection of bloodborne pathogens before transfusion and surgery is helpful for realizing infection status of patients before transfusion and surgery.

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Immunization status,epidemiological and clinical characteristics of measles in hospitalized children in 2009-2013

Biquan CHEN ; Chunqin XIA

Chinese Journal of Infection Control.2014;(4):218-221. doi:10.3969/j.issn.1671-9638.2014.04.007

Objective To realize the clinical and epidemiological characteristics of measles,and explore effective measures to control measles epidemic.Methods Clinical data of 554 hospitalized measles children between January 2009 and December 2013 were analyzed retrospectively.Results All children had fever,cough,and skin rash,507 (91.52% )had typical clinical manifestations of measles,47(8.48% )had mild manifestations;the major population were children aged≤6 months(n= 176,31.77% )and 7-8 months (n= 346,62.45% );132 (23.83% )children had contact history of confirmed measles,19(3.43% )measles children’s mothers also developed measles (all were cases of 2013),227 (40.97% )children had history of repeated infusion or hospitalization in large medical institutes dur-ing the measles incubation period (all were cases of 2013,there were measles children who had infusion or hospitali-zation in the same hospital during the same period). The peak incidence of measles usually occurs in January-May. Conclusion Intensive immunization of measles for young women of reproductive age and vaccination with“pre-mea-sles vaccine”for early infancy,and strengthening the medical management of fever outpatients are important meas-ures to prevent measles epidemic.

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Ward round presided over by hospital director to improve health care workers’hand hygiene compliance

Hui LIU ; Shenwen HE ; Yumei ZHOU

Chinese Journal of Infection Control.2014;(4):249-251. doi:10.3969/j.issn.1671-9638.2014.04.016

Objective To investigate the influence of participation of healthcare-associated infection (HAI)man-agement department in ward round presided over by hospital director on hand hygiene compliance of health care workers (HCWs)in a basic-level hospital.Methods Implementation of hand hygiene in January-June 2012 (control group :HAI management department didn’t participate ward round)and January-June 2013 (trial group :HAI management department participated ward round)were investigated,the compliance of hand hygiene of two groups of HCWs and consumption of hand hygiene products of each department were compared.Results HAI case rate in trail group was significantly lower than control group (1.49% vs 2.01% )(χ2= 4.31,P<0.05);HCWs’hand hy-giene compliance rate was significantly higher than control group (71 . 56% [3 249/4 540 ]vs 44. 00% [1 914/4 350]),hand hygiene compliance rates in nurses were higher than doctors of both groups(χ2= 151.30,179.92, respectively,bothP<0.001),hand hygiene compliance rate in trial group from high to low was department of pedi-atrics,obstetrics and gynecology,surgery,and internal medicine. The consumption of rapid hand disinfectant of trail group and control group was 5.38mL/bed-day and 1.88 mL/bed-day respectively,the consumption of hand sanitizer was 11.51 mL/bed-day and 7.03 mL/bed-day respectively.Conclusion Hand hygiene checked during the ward round presided over by hospital director can improve HCWs’hand hygiene compliance,reduce the incidence of HAI,and ensure medical safety.

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Distribution and antimicrobial resistance of Pseudomonas aeruginosa in a county-level hospital

Yunchao JI ; Rong RAO

Chinese Journal of Infection Control.2014;(4):246-248. doi:10.3969/j.issn.1671-9638.2014.04.015

Objective To analyze the distribution and antimicrobial resistance of Pseudomonasaeruginosa(P. aeruginosa)in a county-level hospital,provide reference for rational antimicrobial use,and promote the control and prevention of healthcare-associated infection (HAI).Methods Data of P.aeruginosaisolated from patients in a hospital between 2010 and 2012 were analyzed statistically.Results A total of 369 P.aeruginosaisolates were iso-lated,strains were mainly from specimens of sputum(n= 234,63.41% ),urine(n= 41,11.11% )and wound(n= 28, 7.59% );most strains were from intensive care unit(n= 146,39.56% ),respiratory diseases department(n= 51, 13.82% )and neurosurgical department(n= 37,10.03% ).P.aeruginosastrains were not resistant to polymyxin B;the resistance rates to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were all low(6.81% -22.73% );from 2010 to 2012,resistance rates to antimicrobial agents (except polymyxin B) increased with varying degrees,some antimicrobial agents showed statistical difference(P<0.05).Conclusion P. aeruginosais mainly isolated from respiratory specimens,mainly distributed in departments with serious patients;and resistance to most antimicrobial agents is high,resistance tendency is increasing,surveillance should be intensi-fied.

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Clinical distribution of multidrug-resistant organisms in a comprehensive hospital

Luchi LI ; Hui SHEN

Chinese Journal of Infection Control.2014;(4):242-245. doi:10.3969/j.issn.1671-9638.2014.04.014

Objective To realize the characteristics of clinical distribution of multidrug-resistant organisms (MDRO)in a hospital,and take specific measures for the prevention and control of infection.Methods Surveillance data of 891 MDR isolates detected in a hospital between January 1 and December 31,2012 were analyzed retrospec-tively.Results Of 891 MDR isolates,extended-spectrumβ-lactamase (ESBL)-producing Escherichiacoli ranked first(342,38.39% ),followed by ESBL-producing Klebsiellapneumoniae(195,21.89% ),MDRAcinetobacterbau-mannii(185,20.76% ),methicillin-resistantStaphylococcusaureus(138,15.49% ),MDRPseudomonasaeruginosa (27,3.03% ),ESBL-producingProteusmirabilis(2,0.22% ),and ESBL-producing Klebsiellaoxytoca(2,0.22% );Bacteria mainly concentrated on general intensive care unit(ICU)(163,18.29% ),department of neurology(136, 15.26% ),general surgery(103,11.56% ),neurosurgery(85,9.54% ),and respiratory diseases department(71, 7.97% ).The most common bacteria isolated from sputum was MDR Acinetobacterbaumannii(242,50.63% ),and mainly concentrated on general ICU;the most common bacteria isolated from urine was ESBL-producing Escherich-iacoli(141 ,80.57% ),mainly concentrated on the departments of neurology and urology. Conclusion MDRO infec-tion in this hospital mainly concentrate on lower respiratory tract and urinary system. Monitor on high-risk depart-ments and vulnerable patients should be intensified,targeted preventive measures should be stressed to curb MDRO infection and spread.

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Species and drug resistance of Mycobacterium isolated from sputum smear positive patients

Miqin XU ; Zhilin NIU ; Meiying WU

Chinese Journal of Infection Control.2014;(4):236-238. doi:10.3969/j.issn.1671-9638.2014.04.012

Objective To study the species and drug resistance of Mycobacterium isolated from patients with spu-tum smear positive for acid-fast bacillus in Wuj iang city,and provide reference for the prevention and control of tu-berculosis. Methods Sputum specimens with positive smear were cultured,isolated bacteria were identified and performed drug susceptibility testing,drug resistance among different species of strains and between patients with initial and repeated treatment were compared.Results A total of 1 03 Mycobacterium isolates were included in the study,13 of which were nontuberculous Mycobacterium,drug resistance rate was 100.00% ,multidrug resistance (MDR)rate was 84.62% ;90 isolates were Mycobacteriumtuberculosis,81(90.00% )of which were Mycobacteri-umhominis. Drug resistance rate of Mycobacteriumtuberculosiswas 35.56% ,MDR rate was 14.44% . Of 70 ini-tially treated tuberculosis patients with positive sputum smear,14(20.00% )were resistant to drugs,MDR rate was 4.28% (3/70);Of 20 repeatedly treated tuberculosis patients with positive sputum smear,18(90.00% )were resist-ant to drugs,MDR rate was 50.00% (10/20).Conclusion Mycobacteriumtuberculosisis the major isolated strain from patients with positive sputum smear. Drug resistance and MDR rates of nontuberculous Mycobacterium are very high. Drug resistance and MDR rates of Mycobacteriumtuberculosisin repeatedly treated patients are higher than initially treated patients.

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