When a clustered coronavirus disease 2019 epidemic occurs, how to prevent and control hospital infection is a challenge faced by each medical institution. Under the normalization situation, building an effective prevention and control system is the premise and foundation for medical institutions to effectively prevent and control infection when dealing with clustered epidemics. According to the principles of control theory, medical institutions should quickly switch to an emergency state, and effectively deal with the external and internal infection risks brought by clustered epidemics by strengthening source control measures, engineering control measures, management control measures and personal protection measures. This article summarizes the experience of handling clustered outbreaks in medical institutions in the prevention and control of coronavirus disease 2019, and aims to provide a reference for medical institutions to take effective prevention and control measures when dealing with clustered outbreaks.
Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
Objective To describe the current state of hospital infection prevention and control for flexible endoscope in Shanghai, and analyze the trend of infection prevention and control quality from 2018 to 2022. Methods According to Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS 507－2016), the quality of infection prevention and control for flexible endoscope was divided into seven parts: organizational management, layout, cleaning and disinfection (sterilization) process, environmental disinfection and sterilization, final rinse water, recording and monitoring, and occupational protection. Each quality control item was judged according to the on-site score and the correction opinion, and the item with correction opinion was judged as “unqualified”, otherwise it was “qualified”. The results of the infection prevention and control quality supervision for flexible endoscope from 2018 to 2022 were reviewed and analyzed, and the qualification rates of quality control items for hospitals at different levels and in different years were calculated. Results From 2018 to 2022, the total qualification rates of organization management, final rinse water, environmental disinfection and sterilization, and occupational protection were over 90%, and the total qualification rates of cleaning and disinfection (sterilization) process, and records and monitoring were over 80%. There was no statistically significant difference in the annual qualification rate (P>0.05). The total qualification rate of the layout was 78.19%, which was significantly higher before the outbreak of COVID-19 (2018-2019) than after the outbreak of COVID-19 (2020-2022) (P<0.001). There was no significant difference in the qualification rate of different levels of hospitals in terms of organizational management, layout, cleaning and disinfection (sterilization) process, records and monitoring, or occupational protection item (P>0.05). There were statistical differences in the qualification rates of different levels of hospitals in terms of final rinse water and environmental disinfection and sterilization (P<0.05). Conclusions The infection prevention and control qualification rate of flexible endoscope in Shanghai is high. However, the layout qualification rate after the COVID-19 pandemic is lower than before. There has been no significant trend in the quality of other items in the past five years. Weaknesses in the cleaning and disinfection (sterilization) process, as well as in recording and monitoring, are identified as key areas in management. Targeted training and supervision are recommended to address these weaknesses.
摘要:目的: 探討我院呼吸內科病房老年肺部疾病患者并發真菌感染發病的相關因素,分析其易患因素、臨床特征和治療。 方法 : 采用回顧性調查方法對2002年1月至2008年6月收住內科的經微生物檢查證實49例繼發真菌感染的患者進行分析,并與同期無真菌感染的肺部疾病患者(對照組)比較。 結果 : 在呼吸內科病房中,老年患者院內肺部真菌感染發生率為378%,主要感染部位為泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是繼發院內肺部真菌感染最常見的基礎疾病,其感染因素為長期使用廣譜抗生素(962%)和糖皮質激素(332%)、營養狀況不良(583%)出現低蛋白血癥及合并糖尿病、白細胞減少和侵襲性診療操作等。肺部真菌感染的臨床表現無特異性,確診需結合痰培養,組織病理學和臨床表現來確定,感染菌種以白色念珠菌為主,占626%。氟康唑治療有效率914%。研究組與同期無真菌感染的肺部疾病患者(對照組)比較:病死率分別為612%和082%,兩組治療無效的病例(惡化和死亡病例)比較差異有顯著性。 結論 : 院內真菌是呼吸系統疾病繼發感染的重要病原體,而白色假絲酵母菌是院內肺部真菌感染的主要致病菌,宿主免疫狀態、感染播散和疾病嚴重程度是影響預后的因素。該研究認為老年肺部疾病患者并發真菌感染的相關因素和影響預后的因素對其預防、診斷、治療、改進預后和生存質量有重要的臨床意義。除有效的抗真菌治療外,積極的綜合治療有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.
Objective To collect the data of nosocomial infection surveillance in secondary and tertiary medical institutions in Jiangsu Province and conduct comparative analysis among different regions to find out the gaps and provide basis for targeted continuous improvement. MethodsCombined with the requirements of grade hospital evaluation and high-quality development of public hospitals, the data of nosocomial infection incidence in medical institutions of Jiangsu Province in the first quarter of 2023 were collected by autonomous reporting and information capture, and the province was divided into three regions according to location: South Jiangsu, Central Jiangsu and North Jiangsu for analysis, so as to evaluate the regional level. Results A total of 109 medical institutions were included, including 78 tertiary hospitals and 31 secondary hospitals. The overall incidence rate of nosocomial infection was 0.81% (0.90%). The incidence of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinarytract infection (CAUTI) were 0.113‰, 1.553‰ and 0.424‰, respectively. The proportion of prophylactic drugs in Class Ⅰ incision and the incidence of surgical site infection in Class Ⅰ incision were 17.72% and 0.16%, respectively. In the above infection indicators, the incidences of CLABSI and VAP were higher in Central Jiangsu, while the other indicators were higher in South Jiangsu than in Central Jiangsu than in North Jiangsu. The utilization rate of antibiotics and the detection rate of pathogens in inpatients were 41.07% and 41.50%, respectively. Among South, North, and Central Jiangsu, the utilization rate of antibiotics was 41.83%, 41.51%, and 39.51%, respectively (χ2=446.789, P<0.001), and the detection rate of pathogens was 46.09%, 40.94%, and 35.09%, respectively (χ2=3036.865, P<0.001). In the detection rate of drug-resistant bacteria infection, the top 3 were carbapenem-resistant Acinetobacter baumannii (0.067%), carbapenem-resistant Klebsiella pneumoniae (0.031%) and methicillin-resistant Staphylococcus aureus (0.029%). Among them, the infection rate of drug-resistant bacteria in South Jiangsu was significantly higher than that in the other two regions. The detection rates of carbapenem-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were close to each other (83.77% vs. 53.91%), while the detection rates of carbapenem-resistant Escherichia coli (χ2=95.619, P<0.001), carbapenem-resistant Klebsiella pneumoniae (χ2=520.855, P<0.001) and carbapenem-resistant Pseudomonas aeruginosa (χ2=191.918, P<0.001) in South Jiangsu were significantly higher than those in Central and North Jiangsu. Conclusions There are significant differences in nosocomial infection surveillance data of medical institutions in different regions of Jiangsu Province. It is emphasized that targeted quality control feedback, supervision and rectification should be carried out while hospital infection monitoring.
ObjectiveTo optimize procedures of going out for examination for patients with multidrug-resistant organism, strengthen prevention and control management of nosocomial infection, and prevent nosocomial infection.MethodsPatients with multidrug-resistant organism who went out for examination were selected from April to November 2018. April to July 2018 (before implementation) was process construction stage, and August to November 2018 (after implementation) was process optimization implementation stage. In April 2018, process and management system of going out for multidrug-resistant organism patients were formulated, training of transporters was strengthened, and measures such as checklist identification, accompany patients for examination, patient handover, isolation and protection, and disinfection of materials were implemented, to realize the infection prevention and control management in the whole process of going out for multidrug-resistant organism patients. We compared relevant indicators before and after implementation.ResultsA total of 262 cases times of patients with multidrug-resistant organism were included, including 134 cases times before implementation and 128 cases times after implementation. Compared with before implementation, the hand hygiene, wearing gloves, disinfection of inspection instruments and articles, patient transfer, isolation measures in waiting process (special elevator, isolation after waiting for inspection, arrange inspection time reasonably), education and training after implementation improved(P<0.05). Before and after implementation, the Methicillin resistant staphylococcus aureus detection rate difference was statistically significant (P<0.05).ConclusionsThe optimization of procedures of examination for patients with multidrug-resistant organism can increase implementation rate of indirect indicators such as hand hygiene, disinfection of inspection instruments and articles, isolation and protection, education and training in the prevention and control of multidrug-resistant organism in nosocomial infection. And it is important for the prevention and control of multi-disciplinary collaboration of multidrug-resistant organism.
ObjectiveTo explore the risk factors for multiple nosocomial infection in adult hospitalized patients, so as to provide references for the control of nosocomial infection. MethodsThe clinical data of adults hospitalized patients with nosocomial infection in the Second Affiliated Hospital of Fujian Medical University during Jan. 2015 to Dec. 2015 were collected, and the susceptible factors of multiple nosocomial infections referencing to the single nosocomial infection were analyzed. Results1226 cases (1368 case-times) of nosocomial infection were found and the infection rate and the case-time infection rate were 2.24% and 2.49%, respectively. Single factor analysis results showed that the top four risk factors of multiple nosocomial infection included hospital stay ≥30 days (25.5%), first infection time ≥30 days (23.2%), incision type Ⅲ (16.7%), and surgery (13.4%). Logistic regression analysis result showed, after adjusting the influence of age and gender, longer hospital stay was the independent risk factor of multiple nosocomial infection referencing to single nosocomial infection (OR=3.475, 95%CI 2.545 to 4.745). ConclusionLonger hospital stay is the independent risk factor of multiple nosocomial infection of adult hospitalized patients. Measures should be taken to shorten the length of stay in hospital and reduce the exposure to the high-risk environment, so as to reduce the incidence of multiple nosocomial infection.
Objective To explore the application of risk assessment of nosocomial infection control in outpatient departments, so as to find out the high-risk departments and high-risk links of nosocomial infection, and to provide basis for the formulation of nosocomial infection prevention and control measures in outpatient departments. Methods The improved risk assessment tool was used to evaluate the nosocomial infection management risk in the outpatient departments of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. We evaluated risk indicators and risk levels from three dimensions: likelihood of risk occurrence, severity of consequences, and integrity of the current system. Results Among the evaluated outpatient departments, the departments with extremely high risk levels included pediatric fever outpatient department (147.8 points), pediatric outpatient department (141.2 points), emergency internal medicine department (139.4 points), and pediatric emergency department (138.8 points). The departments with high risk levels included internal medicine outpatient department (138.4 points), dermatology outpatient department (136.0 points), otolaryngology-head and neck surgery outpatient department (135.6 points), and ophthalmology outpatient department (134.0 points). The risk assessment scores of 31 outpatient departments showed a normal distribution. The evaluation results of various risk indicators showed that among the 26 risk indicators, there were 2 extremely low risk, 4 low risk, 6 medium low risk, 7 medium high risk, 4 high risk, and 3 extremely high risk. The 3 extremely high risk indicators were lack of nosocomial infection prevention and control knowledge, patients with difficult to identify diseases (air/droplet transmission) seeking medical treatment, and crowded waiting areas for patients. Conclusions The comprehensive risk assessment of outpatient departments can screen out high risk outpatient departments and find out the main risk links. We can concentrate resources on key departments, prevent key risks, and improve the efficiency of nosocomial infection control.
Objective To evaluate the effect of ECRS management model on the quality of prevention and control of hospital infection with multidrug-resistant organisms (MDROs). Methods The data related to the prevention and control of MDROs in the First Hospital of Nanchang in 2020 and 2021 were retrospectively collected. The hospital implemented routine MDRO infection prevention and control management in accordance with the Expert Consensus on the Prevention and Control of Multi-drug Resistant Bacteria Nosocomial Infection in 2020. On this basis, the hospital applied the four principles of the ECRS method to cancel, combine, rearrange and simplify the MDRO infection prevention and control management. The detection rate of MDROs on object surfaces, the incidence rate of hospital infection of MDROs, the compliance rate of hand hygiene, the implementation rate of contact isolation prevention and control measures, and the pass rate of MDRO infection prevention and control education assessment were analyzed and compared between the two years. Results The detection rate of MDROs on the surfaces in 2021 was lower than that in 2020 (9.39% vs. 31.63%). The hospital-acquired MDRO infection rate in 2021 was lower than that in 2020 (1.18% vs. 1.46%). The hand hygiene compliance rates of medical staff, workers and caregivers in 2021 were higher than those in 2020 (90.99% vs. 78.63%, 73.51% vs. 45.96%, 70.96% vs. 33.71%). The implementation rate of contact isolation prevention and control measures in 2021 was higher than that in 2020 (93.31% vs. 70.79%). The qualified rates of MDRO infection prevention and control education in medical personnel, workers and caregivers in 2021 were higher than those in 2020 (96.57% vs. 81.31%, 76.47% vs. 47.95%, 73.17% vs. 34.19%). All the differences above were statistically significant (P<0.05). Conclusion ECRS management mode can improve the execution and prevention level of MDRO hospital infection prevention and control, and reduce the incidence of MDRO hospital infection.