Objective To investigate the nursing clinical practice of ICU ventilator-associated pneumonia(VAP)prevention and control of tertiary hospitals in China,and analyze relevant countermeasures.Methods A self-designed questionnaire consisted of 3 parts and 26 items.A questionnaire survey was conducted among nurses in 380 ICUs in 194 tertiary hospitals in 26 provinces from September 1 to 15,2021,using the convenient sampling method.Results A total of 380 valid questionnaires were collected,with an effective rate of 100%.In the system process,369(97.11%)ICUs had files to prevent VAP;291(76.58%)ICUs had a checklist of measures to prevent VAP clustering;274(72.11%)ICUs had continuous improvement projects about VAP in the last 3 years.In the aspect of body position management,semi-decubitus position was the first choice for the patients with invasive mechanical ventilation of 338(88.95%)ICUs.For nursing operation,224(58.95%)ICUs used Subglottic suction,and 128(33.68%)among them used air shock to remove the retention on the balloon;normal saline is still routinely injected before sputum aspiration in 72(18.95%)ICUs.In terms of balloon pressure monitoring,253(66.58%)ICUs did the oral care 3-4 times a day.In the balloon pressure monitoring,313(82.37%)ICUs use airbag pressure gauges to intermittently monitor airbag pressure;293(77.11%)ICUs replaced the ventilator pipeline once a week.There are significant differences in the current practice status of different types of ICUs in terms of compliance strategies for bed head lifting,subglottic secretion drainage,airbag pressure monitoring,and oral care(P<0.05).Conclusion At present,the relevant systems and procedures to prevent VAP have been improved,but the specific prevention and control measures need to be further unified.Therefore,it is suggested to analyze the weak links of VAP nursing prevention and control practice in various medical structures,carry out relevant training and quality control for the weak links,and further improve the working mechanism of continuous quality improvement,thus effectively reduce the incidence of VAP.

Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

Objective:To explore the current status of nursing practice in the prevention and control of ICU catheter-associated bloodstream infection (CLABSI) in domestic ClassⅢ Grade A hospitals, evaluate the weaknesses in nursing practice, and discuss the common problems.Methods:On March 1, 2017, the ICUs of totally 55 hospitals from 16 Provinces /Municipalities /Autonomous Regions nationwide where the members of the Hospital Infection Committee under the Chinese Nursing Association worked were selected by convenient sampling and investigated with a self-designedquestionnaire on implementation of best practices for catheter-related bloodstream infections. Before the survey, the investigators participating in the survey were trained. Totally 134 questionnaires were recovered, accounting for a recovery rate of 100%. Totally 117 of them were valid, with a valid recovery rate of 87%.Results:In the 117 ICU, totally 71 (60.68%) ICUs filled in the incidence of CLABSI, and 18 (15.38%) data came from their departments. In the central venous catheterization (CVC) process, 65 (55.56%) ICUs were supervised; 109 (93.16%) ICUs used special puncture bags; 74 (63.25%) ICUs used sterile surgical gowns; 26 (22.22 %) ICUs used sterile towels to cover the whole body; and 13 (11.11%) ICUs used Statlock to fix the catheter. In the CVC maintenance process, the frequency of transparent dressing replacement was within 7 days in 106 (90.60%) ICUs; the frequency of gauze replacement was 1 to 2 days in 44 (37.61%) ICUs; 22 (18.80%) ICUs used disposable prefilled liquid flushing tube; 103 (88.03%) ICUs replaced infusion sets every 24 h during continuous transfusion; and 13 (11.11%) ICUs adopted chlorhexidine for sponge bath. 97 (82.91%) ICUs did not have procedures for using infusion connectors, and the nurses of 28 (23.93%) ICUs did not know the type of connectors used.Conclusions:At present, the clinical nursing measures to prevent and control CLABSI are quite different. It is recommended to standardize guidelines, conduct high-quality research, and strengthen personnel training.

Objective To analyze retrospectively the cardioversion for paroxysmal supraventricular tachycardia (PSVT) in emergency department in order to explore rational guidance for the diagnosis and treatment for PSVT.Methods A retrospective analysis of PSVT patients in the emergency department admitted from June 2015 to December 2015 was carried out.First,all the patients were divided into two groups according to the cardioversion achieved by Valsalva's maneuvre or not.Forty patients were enrolled in study.There were 11 patients got cardioversion successfully achieved by the Valsalva's maneuvre and 29 patients failed to get cardioversion.Then,comparisons of demographics,vital sign,serum CTNI,potassium and NTproBNP level were carried out between these groups of patients using statistical analysis.The categorical variable was expressed in percentage and the continuous variable was described by mean±standard deviation and the comparisons of parameters were conducted by group t-test and chi-square test.Results The success rate of PSVT maneuvre cardioversion was 27.5％.In addition,there were no significant differences in demographics vital sign,TNI and NTproBNP between the two groups while there were significant differences in serum potassium level between the two groups [(3.8±0.4)mmol/L vs.(3.5±0.35)mmol/L P＜0.05].There was no significant difference in successful rate of cardioversion between the standard Valsalva's maneuvre(n=6) the modified Valsalva's maneuvre(n=5).The second-line treatment mainly included propafenone,adenosine,electroversion,verapamil and amiodarone.The propafenone was the most common second-line agent used for PSVT cardioversion accounting for 58.6％.Conclusions The success rate of Valsalva's maneuver cardioversion was low.Keeping properly a higher level of serum potassium could increase the success rate of cardioversion by Valsalva's maneuvre.

Objective To observe the role of dendritic cells (DC) in lipopolysaccharide (LPS)-induced myocardial dysfunction in mice. Methods Eighty wild type male C57BL/6 mice were divided into four groups, according to random number table method: sham group, DC inhibitors in control group (VAG539-sham group), LPS sepsis model group (LPS group) and DC inhibitors pretreatment group (VAG539-LPS group), 20 in each group. The cardiac dysfunction model of sepsis mice was established by LPS intraperitoneal injection; the sham group was injected with the same dose of normal saline. VAG539-sham group and VAG539-LPS group were injected with the DC inhibitor VAG539 (30 mg/kg, twice per day, for 2 days) before injection with normal saline or LPS, respectively. Ten mice in each group were used to observe the 14-day survival rate. Mean arterial pressure (MAP) of the remaining 10 mice was measured through the small animal tail artery cannula; the cardiac function [including the heart rate (HR), left ventricular ejection fraction (LVEF) and short axial shortening rate (FS)] were evaluated by small animal echocardiography; the aggregation and maturation of myocardial DC were detected by flow cytometry; and serum inflammatory factors [including tumor necrosis factor-α (TNF-α), interleukins (IL-12, IL-6)] were detected by enzyme linked immunosorbent assay (ELISA). Results Compared with sham group, the 14-day cumulative survival rate in LPS group was significantly reduced, while HR, MAP, LVEF and FS were significantly decreased, and the number of DC in myocardial tissues was significantly increased, and the levels of serum inflammatory factors were increased significantly. The 14-day cumulative survival rate in VAG539-LPS group was significantly higher than that in the LPS group (55% vs. 15%, P < 0.05). Compared with LPS group, after pretreatment by VAG539, the HR, MAP, LVEF and FS were significantly increased [HR (bpm): 610±25 vs. 556±28, MAP (mmHg, 1 mmHg = 0.133 kPa): 68±6 vs. 42±2, LVEF: 0.48±0.02 vs. 0.30±0.03, FS: (34±3)% vs. (14±2)%, P < 0.05]; the number of DC in myocardial tissue was significantly decreased from 6.5% to 3.7%; the level of serum inflammatory factors were significantly decreased [TNF-α(ng/L): 192.00±25.45 vs. 291.34±23.12, IL-12 (ng/L): 58.44±12.37 vs. 78.43±11.24, IL-6 (ng/L): 46.97±8.12 vs. 149.12±15.45, all P <0.05]. Conclusion Sepsis can cause cardiac dysfunction, and it can play an important role by inhibiting the DC cell function of myocardium and reducing the expression of inflammatory factors.

Objective To investigate the current situation of clinical practice of nosocomial infection on nurses from medical institutions so as to provide evidences for policy administrative department to formulate nursing-related nosocomial infection prevention and control, and implement best practice for nosocomial infection.Methods Epidemic disease cross-sectional study was conducted in July 2015. Nosocomial Infection Specialized Committee of Chinese Nursing Association organized medical institution of each province and city, municipality and direct-controlled municipality to carry out investigation at a random date. The investigation content included basic information medical institutions and nursing staffs and three key sites of nosocomial infection (catheter-related bloodstream infection, catheter-associated urinary tract infection and ventilator-associated pneumonia).Results A total of 122 medical institutions from 15 provinces and cities/municipalities/direct-controlled municipalities were involved in the investigation. A number of 11437 questionnaires were collected. On the investigation day, the utilization rates of central venous catheter (CVC), indwelling catheter, trachea cannula/ tracheotomy breathing machine were 2.7%, 4.3% and 1.0%. In terms of patients with indwelling central venous catheter, 44.2% patients had the catheter position of subclavian vein; the proportion of using chlorhexidine sanitizer for puncture skin sterilization was 5.4%; the proportion of no indication and non-renewal of catheter was 41.2%. In terms of patients with indwelling catheter, the proportion of collecting urine sample via cutting off the connection between catheter and urine collection bag was 39.0%; the proportion of patients with conducted bladder irrigation was 22.1%. In terms of patients with trachea cannula/tracheotomy breathing machine, 68.7% of patients used semi-reclining position; the proportion of using chlorhexidine oral cavity solution was 40.1%.Conclusions "Distance" and "gap" exist in clinical practice and best infectious control practice. The sanitation administrative department should formulate corresponding policy and index system to carry out the best clinical practice of nosocomial infection prevention and control on nursing staff.

Objective To study the nursing status of the patients with mechanical ventilation in China. With the reference literature and guidelines, seeking and providing the best evidence and the basis for best practice nursing about mechanical ventilation. Methods We use the convenience sampling method that under the organization and call of the hospital infection nursing professional committee from China nursing association from July to September 2015. 87 hospitals of 13 provinces were selected, and the self-designed questionnaires were used to survey the status of 948 patients with mechanical ventilation. Results For the position management, 26.9% of patients were supine position;69.6% of patients used semireclining position;26.9% of patients had orders about position management. For the oral nursing, 4.0% of patients were 1 times/day;49.7%of patients were 2 times/day;43. 7% of patients were 3 to 4 times/day; 37. 5% of patients used chlorhexidine solution to cleaning the oral cavity;39.3% of patients used normal saline; 84.8% of patients had orders about oral care. For the airbags secretion clean, 78.6% of patients used methods to attract the airbags secretion. For the replace the outside line, 77.8% of patients were 1time/week;5.4% of patients were 1 time/2 weeks;1.1%of patients were 1time/4weeks;3.8% of patients were no indications and no replacement. For the prevention of peptic ulcer, 56.5% of patients used medicine to prevent peptic ulcer. Conclusions Clinical nurses hadn′t achieve unified norms and standards in nursing for patients with mechanical ventilation. There was also existing great gap between guideline recommendations and clinical practice. Currently, the biggest challenge of clinical workers is how to introduce the best evidence to clinic effectively.

Objective To study the relationships of health risk factors and health-related presenteeism in medical personnel of a tertiary grade A hospital. Methods A literature review and expert consultation were used to identify 14 health risk factors included in the survey, and the Michigan's Health Risk Appraisal Questionnaire was modified. Medical personnel of a tertiary grade A hospital in Beijing were selected for this cross-sectional study, including doctors, nurses, medical technicians, pharmacists, as well as scientific researchers, and staff members responsible for education, medical affairs, journal editors and other work. Physical measurement and questionnaire survey were conducted to collect demographic data, distribution of health risk factors of medical staff, and productivity information. Results Among 14 health risk factors, pressure or stress had the highest proportion (80.2%), followed by poor quality of sleep (63.7%), high blood lipid (33.8%), low physical activity (30.9%), and unreasonable diet (29.6%). Medical staff of different ages( c 2=16.141, P=0.001) and different occupations( c 2=15.982, P=0.003) had different probability of presenteeism. Medical staff under 30 years of age were most likely to be presenteeism (38.3%). The probability of presenteeism in nurse was the highest(56.2%). Under a high pressure and taking relax medicine seemed more likely to be presenteeism. Conclusion In the 14 kinds of health risk factors, pressure and taking relax medicine in medical staff may be associated with health-related presenteeism.

Objective To study about the cardiac function of the mice suffering from sepsis induced by lipopolysaccharide (LPS) so as to probe the physiopathologic mechanism of the cardiac dysfunction of the mice.Method Sixty male C57BL/6 mice of eight weeks old were randomly (random number) divided into four groups:one control group (n =15) and three experimental groups (n =15 in each group).The mice of control group received intra-peritoneal injection of normal saline (10 mg/kg) while the mice of experimental groups got intra-peritoneal injection of LPS (10 mg/kg).The cardiac function of mice (n =12) was determined by echocardiography 6 h,12 h and 24 h later,respectively.The heart,kidney and lung tissues of mice (n =6) were stained with Haematoxylin-Eosin (HE) staining after embedding with paraffin for observing the histopathological changes under optic microscopy.The expressions of PECAM-1 and α-SMA of the heart tissue of mice (n =3) in three groups determined by immunohistochemical method.The RT-PCR method was used to test the expressions of VEGF (vascular endothelial growth factor) and HIF-α (hypoxia-inducible factor) of the myocardium of mice.In addition,the Western blot method was employed to test the levels of p53 and HIF-1α proteins in myocardium of mice,while ELISA was utilized to detect the level of tumor necrosis factor-α (TNF-α) and the interleukin-6 (IL-6).The data were analyzed by independent samples of t-test and one-way ANOVA respectively.Results The experiment result proved that the thickness of anterior wall of left ventricle of mice during systolic and diastolic periods increased and the inner diameter of the left ventricle also increased during the diastolic period in mice of the experimental group,while the stroke volume decreased compared with the control group (P ＜ 0.05).The immunohistochemical method showed that the new vessels of the mice' s heart in experimental groups increased compared with the control group (P ＜ 0.05).RT-PCR showed the expressions of VEGF and HIF-1α of the mice heart of experimental group increased (P ＜ 0.05) and Western blot showed the levels of HIF-1 α and p53 proteins in experimental groups increased significantly compared with the control group.The experimental group had higher levds of VEGF,HIF-1α,and IL-6 were evidenced by using ELISA than those of the control group (P ＜ 0.05).Conclusions The lipopolysaccharide can lead to cardiac dysfunction.In this process,myocardium angiogenesis and apoptosis phenomenon coexists,as VEGF and HIF-1α participating in angiogenesis,whereas BAX and p53 playing a role in the process of apoptosis.