Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

Objective:To study the risk factors of metabolic bone disease (MBD) associated fracture in very low birth weight premature infants.Methods:From January 2012 to December 2019, premature infants (gestational age <32 weeks, birth weight <1 500 g) were admitted to our hospital and followed-up regularly for 1.5 years (once every month within first 6 months, then once every 3 months). The infants were assigned into two groups according to X-ray diagnosis: the fracture group and the non-fracture group. The clinical data of the two groups were compared and the risk factors of fracture were analyzed.Results:A total of 62 preterm infants with MBD were included in this study, including 11 in the fracture group and 51 in the non-fracture group. The risk factors of MBD associated fracture included intrauterine growth restriction (IUGR), birth weight <1 000 g, gestational age, respiratory support duration and total parenteral nutrition (TPN) duration ( P<0.05). Logistic regression analysis showed that IUGR ( P<0.05, OR=2.159, 95% CI 1.536~2.759) and TPN duration ( P<0.05, OR=1.143, 95% CI 1.042~1.270) were independent risk factors for fracture. Serum alkaline phosphatase (ALP) in the fracture group was significantly higher than the non-fracture group and 25(OH)VitD was significantly lower than the non-fracture group ( P<0.05). Conclusions:IUGR and TPN duration are risk factors for MBD associated fracture in preterm infants. As biochemical markers of bone metabolism, ALP and 25(OH)VitD levels have clinical value predicting MBD associated fracture.

Objective To understand the expiration date of alcohol-based hand disinfectant after it is opened for use,and provide reference for rational clinical application of alcohol-based hand disinfectant.Methods 20 bottles of the same brand alcohol-based hand disinfectant which opened at the same time by the clinical departments were selected as the study object,hand hygiene compliance in theses departments ranked fourth from the end in the hospital,specimens were taken on the first day after opening,and repeated every 10 days until the disinfectant was used up.Hand specimens were also taken after disinfected by disinfectant.Qualified condition of disinfectant and hand specimens was detected.Results A total of 98 disinfectant specimens were collected,by naked eye observation,20 bottles of alcohol-based hand disinfectant were free of discoloration,precipitation,and suspended matter during the whole study period.The qualified detection rates of alcohol-based hand disinfectant within 60 days after opening were all 100%.44 hand specimens were taken and detected after disinfection,3 of which were unqualified(all were disinfected by alcohol-based hand disinfectant 50 days after opening),then detected again after disinfected by the same batch of disinfectant,all were qualified,which suggested that unqualified detection result of hand specimens was not due to disinfectant.Conclusion Alcohol-based hand disinfectant still has a good bactericidal effect on the sixth day after opening.

Objective To summarize the effectiveness in monitoring activities for healthcare-associated infection (HAI)in China in the past 30 years,explore the changing trend in HAI monitoring,find a new model for the moni-toring of HAI in China.Methods A total of 194 comprehensive hospitals and military hospitals in 13 provinces (au-tonomous regions,municipalities)were selected,questionnaire survey was adopted to investigate the situation of HAI monitoring.Results Of 194 hospitals,184 (94.85%)had available data after being checked,incidence of HAI in secondary and tertiary hospitals were 0.78% and 1.58% respectively,difference was significant (P <0.01).Monitoring was divided into two stages,cumulative percentage of each monitoring activity before 2006 and during 2006-2016 were respectively as follows:environmental hygiene were 73.91% and 100.00%,disinfection ef-ficacy 69.57% and 97.28%,overall comprehensive monitoring 64.67% and 98.91%,surgical site infection(SSI) 13.04% and 94.57%,ICU HAI 4.89% and 87.50%,neonatal HAI 1.75% and 60.82%,multidrug-resistant or-ganisms(MDROs)5.43% and 95.65%,hand hygiene compliance 2.17% and 93.48%,antimicrobial agents 15.22% and 87.50%.The reporting rate of HAI outbreak in tertiary hospitals was higher than secondary hospitals (33.33% [n=37]vs 16.44%[n=12],P =0.01).Conclusion The monitoring of HAI in China starts late,but develops rapidly,defects still exist in HAI monitoring system,reporting rate of HAI cases is still high,reporting rate of HAI outbreak is low.

Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in Xiangya Hospital,and provide reference for preventing and controlling HAI.Methods The cross sectional surveys on preva-lence rates of HAI,cross-sectional antimicrobial use,and bacterial detection among all hospitalized patients on the given days in 2000-2014 (except 2006)were carried out by combination of bedside investigation and medical record reviewing.Results The prevalence rates of HAI in 2000-2014 decreased from 6.30% to 3.91%,difference was statistically significant (χ2 = 35.14,P < 0.001 );prevalence rates of community-associated infection(CAI)were 15.61%-15.76%,there was no significant difference among each year.General intensive care unit (ICU)had the highest prevalence rate;respiratory tract was the most common site of both HAI and CAI;urinary catheterization rate showed a decreased tendency,arteriovenous catheterization rate showed a increased tendency,difference were both significant(χ2 = 5.21,96.24,respectively,both P <0.001).In 2008 - 2014,pathogenic detection rates for specimens from patients receiving therapeutic antimicrobial agents were 36.37%-44.51%,from patients with HAI were 34.00%-44.99%,detection rate of pathogens causing HAI were 41.57%-68.48%,all showed a increased tendency,difference was significant (χ2 = 22.78,10.03,26.49,respectively,all P < 0.001 ).Gram-negative bacteria were the main pathogens causing infection;both cross sectional and combination antimicrobial usage rates declined (P < 0.05 ).Conclusion Prevention and control of HAI,and antimicrobial management has achieved preliminary success,prevalence rate of HAI and cross sectional antimicrobial usage rate declined obviously,the main pathogen is gram-negative bacteria,and the major infection site is lower respiratory tract.

Objective To investigate the current situation of healthcare-associated infection(HAI)management in grassroots medical institutes in a province.Methods Forty-six grassroots medical institutes in 13 cities of the prov-ince were selected randomly for the survey,questionnaires about the current situation of HAI management in grass-roots medical institutes were filled out,and related data were analyzed.Results Forty-four qualified questionnaires were adopted for analysis,and 2 unqualified questionnaires from public hospitals were excluded.HAI management in 44 medical institutes (100.00%)was in the charge of major leaders in medical institutes.Only 2 institutes(4.55%) set up independent HAI management departments,and 10 institutes(22.73%)established basic regulations and po-sition responsibilities of HAI management,38.67% of medical institutes established regulations of HAI prevention and control in key departments and responsibilities for key positions.The score for the establishment of basic regu-lations and position responsibilities of HAI management in village clinics was lower than the other medical institutes (F =5.762,P <0.01 ).Except aseptic technique,the core regulations of HAI management weren’t implemented well in village clinics compared with the other institutes(P <0.05).Conclusion Organizational settings,HAI man-agement of key departments,and core regulations of HAI management are not performed well in grassroots medical institutes in this province.Village clinics perform the worst in HAI management among all types of grassroots med-ical institutes.More measures,including education and surveillance,should be taken to improve HAI management in grassroots medical institutes.

Objective To investigate the present incidence and the risk factors of retinopathy of prematurity (ROP).Methods The clinical data of 1 356 premature infants who were born in our hospital from Dec 2008 to Feb 2011 with birth weight of 2 500 g or less and gestational age of 37 weeks or less were analyzed retrospectively,and divided into ROP group(n =208) and without ROP group(n =1 148).They were screened for ROP from 4 ～ 6 weeks of chronological age or 32 weeks of postmenstrual age.Results In 1 356 cases,there were 208 cases with ROP,the incident rate was 15.34％,of which 36 cases were severe diseases (2.65％).Compared with the infants without ROP,the development of ROP was correlated with birth weight [(1 528 ±243) g vs (1 960 ± 187) g],gestational age [(30.92 ±0.72) weeks vs (32.87 ± 1.28) weeks],oxygen uptake time ＞ 8 d (123 cases vs 865 cases),pulmonary surfactants (18 cases vs 216 cases),septicemia (42 cases vs 154 cases),in utero distress (63 cases vs 511 cases) and anemia (64 cases vs 237 cases) (P ＜ 0.05).Logistic regression analysis suggested that birth weight,gestational age,oxygen uptake time ＞8 d,septicemia and pulmonary surfactants were significant risk factors associated with the development of ROP(P ＜ 0.05).Meanwhile,there were significant differences in the incidence of infants with ROP at different birth weight and different gestational age (P ＜ 0.05).Conclusion The birth weight and gestational age are lower,the incidence of ROP is higher and the disease is more serious.The probability of ROP,particularly severe ROP,is highest in the most immature infants while it is lower in the least immature ones.

Objective To evaluate the demands of patients with benign prostatic hyperplasia (BPH) and its influencing factors. Methods One thousand five hundred and twenty-seven patients (≥60 years old) with BPH in 26 hospitals of 9 cities were selected in the study by using stratified random sampling method. The demands of patients with BPH and its influencing factors were evaluated by rank sum test and rank correlation analysis. Results In 1527 BPH patients, most patients thought that doctors' communication with them before opening examination items (1297/ 1527,84.9%),health guidance for BPH progress(1310/1527,85.8%), BPH diagnosis(1279/1527, 83.8 %) and BPH treatment(1329/1527,87. 0%) were necessary. Doctors'communication with them before opening examination items, health guidance for BPH progress, BPH diagnosis and BPH treatment showed significant statistical difference among patients with different age, medical care, the lasting time of clinical symptoms, diagnosis time, international prostate symptom scores and quality of life scores (all P<0. 05). While in patients with different nation, retirement status, marital status, living style and average family income, there were no significant statistical difference in needing the doctors'communication with them before opening examination items, health guidance for BPH progress, BPH diagnosis and BPH treatment(all P>0.05). Conclusions Patients with BPH have a higher demand for treatment. The demand degree is related with age group, health care, the lasting time of clinical symptoms, diagnosis time, international prostate symptom scores and quality of life scores. Most patients have desire to accept health guidance.