This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*

Adult ; COVID-19/prevention & control* ; Cross Infection/prevention & control* ; Female ; Health Personnel/statistics & numerical data* ; Humans ; Male ; Middle Aged ; Respiratory Tract Diseases/virology* ; SARS-CoV-2 ; Taiwan/epidemiology*

Coronavirus Infections ; epidemiology ; prevention & control ; Elective Surgical Procedures ; statistics & numerical data ; Female ; Humans ; Infection Control ; methods ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Male ; Occupational Health ; statistics & numerical data ; Orthopedic Procedures ; methods ; statistics & numerical data ; Outcome Assessment, Health Care ; Pandemics ; prevention & control ; statistics & numerical data ; Patient Safety ; statistics & numerical data ; Pneumonia, Viral ; epidemiology ; prevention & control ; Risk Assessment ; Safety Management ; Singapore ; Wounds and Injuries ; diagnosis ; epidemiology ; surgery

OBJECTIVE: To explore the infection prevention and control strategy of bedside blood purification treatment in corona virus disease 2019 (COVID-19) isolation ward, and to evaluate the effect of infection prevention and control management measures. METHODS: We summarized and analyzed the clinical features, infection status, outcome and infection prevention and control measures of bedside blood purification treatment patients in COVID-19 isolation ward from February 8, 2020 to March 31, 2020, analyzed the COVID-19 cross-infection between the patients and medical staffs, and the blood-borne pathogens cross-infection situation between the patients, and analyzed the effect of bundle prevention and control measures in controlling the occurrence and spread of cross-infection. RESULTS: A total of 101 COVID-19 patients were hospitalized in this COVID-19 isolation ward, of whom 10 patients (9.90%) received bedside blood purification treatment and the blood purification treatment method was continuous hemodialysis filtration (CVVHDF), and the 10 patients received 79 times of blood purification treatment in total. The prevention and control management measures adopted included divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room air purification, object surfaces, medical devices and medical fabrics dis-infection management. There were no occurrence and spread of COVID-19 in the medical healthcare workers and blood-borne pathogens cross-infection in the patients. And all the twice throat swabs (two sampling interval > 1 day) of the medical staffs in COVID-19 virus nucleic acid test were negative. The 2 suspected COVID-19 patients' throat swab virus nucleic acid test and the COVID-19 IgG, IgM were always both negative, the chest CT showed no viral pneumonia. CONCLUSION Bedside blood purification treatment in the COVID-19 isolation ward, the occurrence and spread of healthcare associated infection can be effectively controlled through effective infection prevention and control management, including divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room's air purification, object surfaces, medical devices and medical fabrics disinfection, which can provide experience for diagnosis, treatment and prevention and control of patients in the respiratory infectious disease ward.
Betacoronavirus ; COVID-19 ; Coronavirus Infections/therapy* ; Humans ; Infection Control/statistics & numerical data* ; Pandemics/prevention & control* ; Pneumonia, Viral/therapy* ; SARS-CoV-2

Candida ; pathogenicity ; Cross Infection ; microbiology ; prevention & control ; Gram-Negative Bacteria ; pathogenicity ; Humans ; Intensive Care Units ; statistics & numerical data ; Sepsis ; microbiology ; prevention & control

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
Abdomen ; surgery ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; General Surgery ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; prevention & control ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; prevention & control

No abstract available.
Coronavirus Infections/*diagnosis/epidemiology/*prevention & control ; Cross Infection/*diagnosis/epidemiology/*prevention & control ; Disease Outbreaks/prevention & control/*statistics & numerical data ; Global Health/*trends ; Humans ; Incidence ; Population Surveillance/methods ; Republic of Korea/epidemiology

The total number of new tuberculosis (TB) cases notified in Singapore among citizens, permanent residents and foreigners rose by 46% from 2004 to 2010. During this period, the proportion of foreigners increased from 29% to 47% of the total case burden. In 2008, the TB incidence rate among Singapore citizens and permanent residents increased for the first time in ten years, despite the on-going efforts of the Singapore TB Elimination Programme. Additional measures and resources are clearly needed to curb this rising trend. Pivotal to this is to address TB among foreigners. The political will to battle TB in Singapore must result in action to remove barriers to diagnosis, to enable all TB patients to undergo treatment under directly observed therapy (DOT), and to ensure that all healthcare providers who manage TB patients are responsible and accountable to the public health system.
Directly Observed Therapy ; Emigrants and Immigrants ; statistics & numerical data ; Humans ; Infection Control ; methods ; Singapore ; epidemiology ; Tuberculosis ; epidemiology ; ethnology ; prevention & control

OBJECTIVEThis study aimed to explore the epidemiological factors of an influenza A (H1N1) outbreak in a hospital.

METHODSGeneral data were collected via face-to-face interview and telephone survey. Total 132 individuals including medical and nursing staffs (37), in-patients (39) and patients' family members (56) who were exposed to the pediatric surgery ward during August 11 - 18, 2009, were investigated. The case group included 35 cases according to the diagnostic criteria for influenza A (H1N1). The other 97 persons were grouped as control. A case-control study was then conducted to explore the epidemic factors, and layering analysis was applied to determine the interactions among these factors.

RESULTSThe overall incidence in this study was 26.5% (35/132), which included 12 confirmed and 23 suspected cases, and there was no severe case. The first case was a child with the influenza-like symptoms before admission on August 11. The onsets of these cases were during August 7 - 17. The cases were distributed in 9 of 13 rooms, and there was no room aggregation in the cases distribution (χ(2) = 0.00, P > 0.05). Twelve of 25 oropharyngeal swabs were influenza A (H1N1) nucleic acid positive. The case-control study showed that exposure to the enema room accounted for 93.10% (27/29) in cases and 72.73% (48/66) in control; OR = 5.06, 95%CI = 1.01 - 34.23), long time exposure to ward was 71.43% (25/35) in cases and 44.33% (43/97) in control; OR = 3.14, 95%CI = 1.27 - 7.90), and short distance contact with the nurse LIU (76.46% (26/34) in cases and 50.52% (49/97) in control; OR = 3.18, 95%CI = 1.22 - 8.54) were the risk factors. However, keeping the window open (27.59% (8/29) in cases and 68.18% (45/66) in control; OR = 0.14, 95%CI = 0.05 - 0.39) and hand washing (25.71% (9/35) in cases and 76.29% (74/97) in control; OR = 0.11, 95%CI = 0.04 - 0.28) were the protective factors. The longer time exposure to ward had the higher risk (ratios of cases to control were 4:20 (0 - 1 day), 6:34 (2 - 4 days) and 25:43 (≥ 5 days); χ(2)(trend) = 5.737, P < 0.05). In contrast, hand washing with more frequencies (ratios of cases to control were 26:23 (0 - 1 time one day), 7:9 (2 - 3 times one day) and 2:65 (≥ 4 times one day); χ(2)(trend) = 37.136, P < 0.01) and the longer time window opening (ratios of cases to control were 21:21 (no), 4:13 (a few) and 4:32 (often); χ(2)(trend) = 13.830, P < 0.01) had the lower risk. Nevertheless, layering analysis excluded long time exposure to ward from the risk factors (for individuals with more frequent hand washing, 6.90% (2/29) exposed in cases, 7.14% (1/14) exposed in control, OR = 0.97, 95%CI = 0.06 - 29.51; for individuals keeping window open, 21.21% (7/33) exposed in cases, 8.33% (1/12) exposed in control, OR = 2.55, 95%CI = 0.26 - 60.87), indicating the main risk factors in this outbreak were exposure to the enema room and short distance contagion with the infected nurse.

CONCLUSIONThe influenza A (H1N1) outbreak in this hospital was induced by an inpatient infected with influenza A (H1N1) virus before admission. Infected medical staffs keeping on work and exposure to the same place, e.g.the enema room in this study might spread the influenza A (H1N1) virus, and frequent hand washing and keeping the window open are the most effective and economic methods to prevent influenza A (H1N1) infection.

Adult ; Case-Control Studies ; Child ; Cross Infection ; epidemiology ; virology ; Disease Outbreaks ; statistics & numerical data ; Female ; Hospitals ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; diagnosis ; epidemiology ; virology ; Male ; Occupational Exposure ; Risk Factors

Intensive care unit (ICU) is a place with high risk of nosocomial infections. Effective control of nosocomial infections in ICU brings both social and economic benefits. This article summarizes ten main points in the control strategy of ICU infections.
Cross Infection ; economics ; prevention & control ; transmission ; Humans ; Infection Control ; economics ; Intensive Care Units ; economics ; statistics & numerical data