Objective:To investigate the correlation between rectal colonization of carbapenem resistant Klebsiella pneumoniae（CRKP）and bloodstream infections（BSI）using molecular epidemiological analysis. Methods:Patients admitted to the Intensive Care Unit（ICU），Hematology Department，and Neurosurgery Department of the First Hospital of Jiaxing from January 2022 to December 2024，were enrolled. Rectal CRKP colonization screening was performed for all participants，with concurrent monitoring for BSI.Whole genome sequencing of CRKP strains in the intestine and blood flow of patients with CRKP rectal colonization and CRKP-BSI was performed using the Illumina NovaSeq PE150 sequencing platform，and samples were genotyped based on the PubMLST database. MLST 2.0 was applied for multi site sequence typing，VFDB online database was used to analyze virulence genes，ResFinder was used to analyze resistance genes，and whole genome sequences were imported into BioNumerics software for core genome multi site sequence typing and clustering analysis. Using the BacWGSTdb database to construct a phylogenetic tree based on genomic SNPs，and the homology between CRKP rectal fixed plants and corresponding BSI-CRKP infected plants were analyzed.Results:A total of 772 patients were included，including 78 cases with positive results in rectal CRKP colonization screening（10.1%）and 694 cases without rectal CRKP colonization（89.9%）. The CRKP-BSI rate in rectal CRKP colonization patients was significantly higher than that in non-CRKP colonization patients［19.2%（15/78） vs. 5.5%（38/694）， χ2=20.749， P<0.001］. Analysis of CRKP rectal colonization strains and bloodstream infection strains in 15 patients with CRKP rectal implantation and CRKP-BSI revealed that ST11 type was the main strain（ n=10），followed by ST37 type（ n=3），with all carrying multiple β-lactam and carbapenem producing enzyme resistance genes.The distribution of virulence genes showed that CRKP strains carried multiple virulence genes，with iroE being ubiquitous，followed by iucA/ B/ C/ D， rmpA2，rmpA，and iroN. All ST11-type CRKP strains exhibited hypervirulent characteristics. Capsular serotyping analysis showed that the predominant type of CRKP colonization and infection strains was KL64. The results of cgMLST and SNP clustering analysis showed that CRKP rectal fixed plants exhibited homology with blood flow infected plants. Moreover，two clusters of CRKP rectal colonization strains with significant homology were found to cluster together among 15 patients. Conclusions:Rectal colonization of CRKP is an important risk factor for the occurrence of BSI-CRKP in hospitals，and ST11 hypervirulent CRKP is the main type. It is recommended to screen high-risk patients for CRKP to reduce the risk of BSI-CRKP.

Objective:To investigate the correlation between rectal colonization of carbapenem resistant Klebsiella pneumoniae（CRKP）and bloodstream infections（BSI）using molecular epidemiological analysis. Methods:Patients admitted to the Intensive Care Unit（ICU），Hematology Department，and Neurosurgery Department of the First Hospital of Jiaxing from January 2022 to December 2024，were enrolled. Rectal CRKP colonization screening was performed for all participants，with concurrent monitoring for BSI.Whole genome sequencing of CRKP strains in the intestine and blood flow of patients with CRKP rectal colonization and CRKP-BSI was performed using the Illumina NovaSeq PE150 sequencing platform，and samples were genotyped based on the PubMLST database. MLST 2.0 was applied for multi site sequence typing，VFDB online database was used to analyze virulence genes，ResFinder was used to analyze resistance genes，and whole genome sequences were imported into BioNumerics software for core genome multi site sequence typing and clustering analysis. Using the BacWGSTdb database to construct a phylogenetic tree based on genomic SNPs，and the homology between CRKP rectal fixed plants and corresponding BSI-CRKP infected plants were analyzed.Results:A total of 772 patients were included，including 78 cases with positive results in rectal CRKP colonization screening（10.1%）and 694 cases without rectal CRKP colonization（89.9%）. The CRKP-BSI rate in rectal CRKP colonization patients was significantly higher than that in non-CRKP colonization patients［19.2%（15/78） vs. 5.5%（38/694）， χ2=20.749， P<0.001］. Analysis of CRKP rectal colonization strains and bloodstream infection strains in 15 patients with CRKP rectal implantation and CRKP-BSI revealed that ST11 type was the main strain（ n=10），followed by ST37 type（ n=3），with all carrying multiple β-lactam and carbapenem producing enzyme resistance genes.The distribution of virulence genes showed that CRKP strains carried multiple virulence genes，with iroE being ubiquitous，followed by iucA/ B/ C/ D， rmpA2，rmpA，and iroN. All ST11-type CRKP strains exhibited hypervirulent characteristics. Capsular serotyping analysis showed that the predominant type of CRKP colonization and infection strains was KL64. The results of cgMLST and SNP clustering analysis showed that CRKP rectal fixed plants exhibited homology with blood flow infected plants. Moreover，two clusters of CRKP rectal colonization strains with significant homology were found to cluster together among 15 patients. Conclusions:Rectal colonization of CRKP is an important risk factor for the occurrence of BSI-CRKP in hospitals，and ST11 hypervirulent CRKP is the main type. It is recommended to screen high-risk patients for CRKP to reduce the risk of BSI-CRKP.

Objective:To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection.Methods:Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared.Results:Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant ( P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ 2=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ 2=11.49, P<0.01) . Conclusion:FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.

Objective:To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection.Methods:Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared.Results:Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant ( P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ 2=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ 2=11.49, P<0.01) . Conclusion:FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.

ObjectiveTo explore the application effect of continuing nursing based on Omaha system in postoperative rehabilitation of patients with hypertensive cerebral hemorrhage.Methods A total of 37 patients with hypertensive cerebral hemorrhage in neurosurgery department of the First Hospital of Jiaxing from July 2015 to February 2016 were recruited as the intervention group,while 34 patients with hypertensive cerebral hemorrhage from November 2014 to June 2015 were selected as the control group. Patients in the control group received postoperative general nursing for patients with hypertensive cerebral heorrhage. Patients in the intervention group received continuing nursing based on Omaha system beside general nursing which lasted 8 weeks until after discharge. Patients′ behavior,cognition and status were compared between two groups to evaluate the nursing effects.Results Omaha system contains four aspects including environment,psychology and society,physiology and health-related behavior. Nursing problems found in the intervention group were related to previous four aspects. A total of 21 problems were sorted out. The scores of behavior,cognition and status in the intervention group were (2.86±0.23),(2.51±0.53) and (3.39±0.41),which were higher than those in the control group [(2.17±0.54),(1.62±0.49) and (2.44±0.37)] (P<0.05).Conclusions Continuing nursing based on Omaha system shows the common problems in postoperative rehabilitation of patients with hypertensive cerebral hemorrhage and provides standardized proposal for rehabilitation nursing to achieve better nursing effects.

Objective To investigate the role of 2B subunits-containing N-methyl-D-aspartate receptors (NR2B) in the arcuate nucleus in the development of inflammatory pain (IP) in rats.Methods One hundred and eight male Sprague-Dawley rats, aged 9 weeks, weighing 200-250 g, were randomly divided into 4 groups using a random number table: sham operation group (group S, n =47);group IP (n =47);dimethyl sulfoxide control group (group DMSO, n =7);selective NR2B antagonist Ro25-6981 group (group Ro25-6981, n=7).IP was induced by injecting complete Freund's adjuvant (CFA) 0.1 ml into the plantar surface of the left hindpaw.Ro25-6981 400 pmol was injected into the arcuate nucleus at 3 days after CFA injection.Seven rats in each group were selected for measurement of the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) at 1 day before CFA injection (T1) and at 2 days after CFA injection (T2), at 30 min before administration on 3rd day (T3) , at 30 min after administration on 3rd day (T4) , and on 5th day (T5).In S and IP groups, The rats were sacrificed at T1-3 and T5 , and the arcuate nucleus of the hypothalamus was removed for determination of NR2B mRNA expression (by real-time reverse transcriptase polymerase chain reaction) and NR2B and phosphorylated NR2B (p-NR2B) expression (by Western blot).Conclusion Compared with group S, the MWT was significantly decreased, and the TWL was shortened at T2-5 in IP, DMSO and Ro25-6981 groups, and the expression of p-NR2B was up-regulated at each time point (P＜0.05) , and no significant change was found in NR2B protein and mRNA expression in group IP (P＞0.05).Compared with group IP, the MWT was significantly increased, and the TWL was prolonged at T4in group Ro25-6981 (P＜0.05) , and no significant change was found in MWT and TWL at each time point in group DMSO (P＞0.05).Conclusion The activation of NR2B in the arcuate nucleus is involved in the development of IP in rats.

Objective To investigate how to reduce the errors of the nurse dispensing medicine by six Sigma management (SSM), to ensure patient medication safety, and improve the effective medicine treatment. Methods A total of 12 nurses from January 2012 to January 2013 were chosen as the control group, while 12 nurses from June 2013 to June 2014 were selected as the experimental group. The oral medicine dispensing was took three inspections and seven verifications in the control group while SSM was used in the experimental group. The medicine dispensing error and patient′s satisfaction were compared between two groups. Results The error rate in the control group was 2. 112% ,which was higher than 0. 294% of the experimental group (χ2 = 14. 4, P < 0. 05). The satisfaction of medicine dispensing were 98. 57% and 91. 26% in the experimental group and control group (χ2 = 15. 564,P < 0. 05). Conclusions Six Sigma methods can effectively improve the patient′s medication safe and effective medication.

Objective To compare the effect of three fixed methods in patients with lumbar catheters continuous drainage.Methods One hundred and twenty patients with lumbar catheters continuous drainage were chosen and divided into three groups according to the random number table, each with 40 cases.Three groups received the shoulder fixation, lumbar fixation and modified lumbar fixation, respectively.The incidence of complication after catheter, the skin injury in the fixed position and the patients’ satisfaction were compared in three groups.Results The cases of patients with pipe slip were respectively 5,4,0 in three groups, and the cases of patients with poor drainage were respectively 7,6,1, and the cases of patients with puncture point infection were respectively 8,8,2, and the cases of patients with cerebrospinal fluid leak were respectively 5,6, 0, the cases of patients with intracranial infection were respectively 7,9,1, and the differences were statistically significant in three groups (χ2 =5.05,5.01,4.71,6.21,7.13, respectively;P <0.05).The number of changing dressings were respectively (10 ±1.78),(10 ±2.28),(3 ±1.13) in three groups, and the difference was statistically significant (F=23.54,P<0.05).The cases of patients with pressure ulcers were respectively 7,5, 0 in three groups, and the cases of patients with satisfaction were respectively 20, 24, 33, and the differences were statistically significant in three groups (χ2 =7.20,9.64, respectively;P <0.05). Conclusions Application of the modified lumbar fixation can reduce the incidence of complication of lumbar catheters continuous drainage, and reduce the skin injury, and increase the patients’ satisfaction, and is worthy of clinical promotion.