Background Application of accumulated experience and management measures in the prevention and control of coronavirus disease 2019 (COVID-19) has generally depended on the subjective judgment of epidemic intensity, with the quality of prevention and control management being uneven. The present study was designed to develop a novel risk management system for COVID-19 infection in outpatients, with the ability to provide accurate and hierarchical control based on estimated risk of infection. Methods Infection risk was estimated using an auto regressive integrated moving average model (ARIMA). Weekly surveillance data on influenza-like-illness (ILI) among outpatients at Xuanwu Hospital Capital Medical University and Baidu search data downloaded from the Baidu Index in 2021 and 22 were used to fit the ARIMA model. The ability of this model to estimate infection risk was evaluated by determining the mean absolute percentage error (MAPE), with a Delphi process used to build consensus on hierarchical infection control measures. COVID-19 control measures were selected by reviewing published regulations, papers and guidelines. Recommendations for surface sterilization and personal protection were determined for low and high risk periods, with these recommendations implemented based on predicted results. Results The ARIMA model produced exact estimates for both the ILI and search engine data. The MAPEs of 20-week rolling forecasts for these datasets were 13.65% and 8.04%, respectively. Based on these two risk levels, the hierarchical infection prevention methods provided guidelines for personal protection and disinfection. Criteria were also established for upgrading or downgrading infection prevention strategies based on ARIMA results. Conclusion These innovative methods, along with the ARIMA model, showed efficient infection protection for healthcare workers in close contact with COVID-19 infected patients, saving nearly 41% of the cost of maintaining high-level infection prevention measures and enhancing control of respiratory infections.

Toward the end of 2022, the cessation of China's "dynamic zero-COVID policy" had led to a notable outbreak of SARS-CoV-2 infections and a substantial number of severe cases and deaths were reported, which raised serious concerns. Concurrently, our study identified a significant increase in the incidence of indeterminate results from the Interferon-γ Release Assay (IGRA) among hospitalized patients during this period. Peripheral T cells from these individuals were unable to produce measurable levels of IFN-γ upon stimulation with the PHA mitogen. This indeterminate IGRA results emerged as a potential risk factor for increased mortality among severely affected elderly COVID-19 patients, contributing to an understanding of the observed excess mortality. The deep serum proteomic analysis elucidated a dysfunctional immune response and defect in cardiac function of those patients. A predictive panel including IGRA results significantly enhanced the accuracy of predicting mortality outcomes in COVID-19 cases (AUC = 0.9762). We also extended the relevance of indeterminate IGRA outcomes as a risk factor for mortality to elderly non-COVID-19 respiratory infections, providing valuable prognostic insights into this type of disease and informing targeted and effective therapeutic interventions for similar outbreaks in the future.

In December 2022, China ceased the zero-COVID-19 policy, resulting in an increase in hospitalizations and deaths due to COVID-19, particularly among the elderly population. Predicting non-survivors aims to identify high-risk patients and enable targeted interventions to improve survival rates. Additionally, understanding factors affecting prognosis provides essential insights for further research and optimization of treatment strategies. We applied 4D-DIA mass spectrometry for serum proteome analysis and provided a comprehensive characterization of disease features in elderly patients within the Chinese population. Our study elucidated that immune disorders, lung damage, and cardiovascular disorders are predominant causes of death in these patients. Compared to clinical indices, proteomic analysis is more sensitive in tracing these disorders. We also provided a prediction panel for survival outcomes of elderly patients using levels of CXCL10, CXCL16 and IL1RA, which were validated by ELISA. These biomarkers will help improve predictive efficacy for survival outcomes in elderly patients.

The establishment of healthcare-associated infection（HAI） prevention and control emergency system for respiratory infectious diseases is the basis for large general hospitals to start emergency mechanisms smoothly and quickly in response to the outbreaks of respiratory infectious diseases, and achieve the “transformation of epidemic prevention” mode, thus can greatly reduce the risk of HAI in general hospitals during the outbreaks of respira-tory infectious diseases. Based on the practical experience of the prevention and control of severe acute respiratory syndrome coronavirus 2（SARS-CoV-2） infection, relevant standards, norms, guidelines, documents, and combined with risk assessment, this study preliminarily explores and establishes a four-level emergency management system for general hospitals to respond to HAI of respiratory infectious diseases. The emergency system consists of four-level organizational system: the emergency command center, HAI management and collaborative departments, joint inspection teams, department leaders and grid administrators. The hospital leadership is responsible for the overall deployment. The emergency command center is responsible for unified coordination. Responsibilities of each department are clearly defined, and the hospital-wide grid mechanism of the prevention and control is activated. The joint inspection team supervises the implementation of various prevention and control measures, and the hospital quickly converts to the “epidemic prevention and control” emergency status, while ensuring the orderly conduct of daily diagnosis and treatment work.

目的 研究失效模式与效应分析法(FMEA)用于中心手术室全流程医院感染风险管理的效果,优化手术室医院感染管理策略.方法 采用头脑风暴法、文献Meta分析法查找中心手术室医院感染的重点风险点,依据重点风险点对医院感染影响的严重度(S)等级、发生率(O)等级、可探测度(D)等级3个维度进行定量分析及评分,计算风险优先系数RPN值,针对RPN值>125的风险点采取干预措施进行风险控制,并对风险控制效果进行评价.结果 从建筑布局及设施不规范、环境控制不合理、物品管理不合格、人员管理不符合要求及操作管理不规范等 5 方面筛出 49 个风险点,对其中9个RPN值>125的重点风险点采取控制措施.经过风险控制,重点风险点RPN值均<125,9 项失效模式总体RPN值由1578降至666,下降率为57.8％,风险控制效果良好.结论 应用失效模式与效应分析法可有效控制中心手术室重点风险.

Hospital evaluation is an important starting point for the health administrative department to perform its supervision function and promote the high-quality development of the hospital. Medical institutions should continuously improve their core competitiveness through the whole process of evaluation. The hospital accreditation has put forward strict requirements for the quality of hospital infection management. The hospital infection management should be carried out by focusing on the main purpose and standard requirements of the hospital accreditation. Firstly, we should intensify the awareness of the bottom line of the law and the spirit of awe. Secondly, we should achieve ′four matchings′ as the foundation of nosocomial infection management. Finally, we should also achieve ′ four improvements′ and create a safety culture for infection control so as to meet the high-level development of nosocomial infection management.

目的 了解北京市三级综合医院的医院感染组织建设、开展医院感染管理工作、专职人员配备情况,为进一步开展工作提供依据.方法 采取分层抽样的方法,对北京市27所三级综合医院2019年、2021年开展医院感染管理工作及2018年、2019年和2021年的医院感染监测情况进行了调查.结果 调查的27所三级综合医院,均建立了三级医院感染管理组织,进行了医院感染管理制度的制定和修订、组织落实各项感控制度、开展了医院感染监测以及各类人员培训等工作.专职人员配备较充足,其中从事感控时间在5年之内的人员比例高,2019年为46.3％,2021年达到了55.5％.结论 北京市三级综合医院医院感染管理组织体系健全,规范开展了医院感染管理工作,医院感染信息化建设稳步发展,需要进一步加强感控专职人员岗位培训.

目的:研究构建医学生医院感染防控临床思维能力评价体系,为医学生医院感染防控临床思维能力的教学提供可借鉴依据.方法:应用文献研究方法及文献质量评定方法构建医院感染防控医学生临床思维评价指标草案,经研究小组讨论、内容分析及专家函询建立医学生医院感染防控临床思维评价体系.结果:专家函询问卷回收率100.0％,专家权威系数平均值为0.82.一级指标一致性检验比率(CR)为0.0499,二级指标一致性检验比率(CR)为0.0000～0.0790,一致性可接受,各因素权重分布合理;形成一级指标3项、二级指标13项,所构建的指标体系逻辑一致性较好.结论:该研究构建的医学生医院感染防控临床思维评价体系具有可靠性、科学性及实用性,为医院感染防控临床思维能力的教育及改革教学模式提供可借鉴的依据.

目的 建立综合医院发热门诊医院感染风险评估体系,通过风险评估实现风险精准控制,降低医患双方医院感染的发生风险.方法 基于医疗失效模式与效应分析法(Healthcare failure mode and effect analysis,HFMEA),对某三级甲等综合医院发热门诊进行定量医院感染风险评估,建立评估体系,定期进行风险评估,查找需重点干预控制的风险点,针对性制定精准控制措施,并对控制效果进行评价,循环进行,持续改进.结果 发热门诊风险评估体系包括建筑布局与设施是否符合传染病防控要求、医院感染防控相关制度与流程是否完善、人员管理及防护是否恰当、物品管理是否合法合规、环境清洁与消毒是否规范、医疗流程是否符合医院感染防控要求等;新型冠状病毒肺炎疫情初期对发热门诊进行第一轮风险评估,查找风险点44个,其中需采取措施重点干预控制的风险点8个.经过实施针对性改进措施,改进周期结束后,进行第二轮风险评估,对控制效果进行评价,风险控制效果良好.结论 基于HFMEA建立综合医院发热门诊定量风险评估体系并定期进行风险评估,可及时发现发热门诊潜在医院感染风险,实现发热门诊医院感染的精准防控,大大降低传染病医院内交叉感染风险,防患于未然.

目的 基于诊断相关分组分析方法,探究神经系统疾病医院感染的疾病负担.方法 回顾性收集2019年北京市某三级甲等综合医院主要诊断类别为神经系统疾病及功能障碍的全部病例的诊断相关分组信息和医院感染信息,基于诊断相关分组,采用时间消耗指数和费用消耗指数,比较医院感染组与非医院感染组住院时间及住院费用差异,并进一步分层分析各诊断相关组的医院感染疾病负担情况.结果 神经系统疾病及功能障碍组患者中医院感染组病死率为3.78％,平均住院日为21.98 d,例均费用为10.52万元,均高于非医院感染组(P＜0.001);时间消耗指数为1.56、费用消耗指数为1.93,分别为非医院感染组的1.73倍和2.17倍.时间消耗差异最大的诊断细分组为BV16(癫痫病＜17岁,不伴合并症与伴随病)组(Z=2.854,P=0.004),其医院感染组平均住院天数为非医院感染组2.64倍;费用消耗差异最大的诊断细分组为BR33(颈部血管疾患,伴合并症与伴随病)组(Z=1.972,P=0.049),其医院感染组例均费用为非医院感染组的11.90倍.结论 医院感染显著增加神经系统疾病的疾病负担,基于诊断相关分组方法可更加准确细化评价医院感染疾病负担.

目的 建立一套适合于医疗机构门诊医护人员呼吸道感染的风险评估体系.方法 利用头脑风暴法、文献荟萃法识别风险点,利用风险散点图对风险点进行分类和评价,利用层次分析法计算风险点权重值.结果 风险评估体系包含诊疗过程、环境和布局、人员防护、应急处置四个风险类别,共计18个风险点.结论 此研究构建的风险评估体系有助于对门诊医护人员呼吸道感染风险进行针对性的分类管理.

Background: In the pandemic of COVID-19, due to asymptomatic patients and high personnel fluidity in outpatient clinics, health care workers (HCWs) in outpatients were facing severe threat from infection. There is an urgent need for a risk assessment to recognize and prevent infection risks. Purpose: To establish a semi-quantitative risk assessment model on COVID-19 infections for HCWs in outpatient departments, and apply it to practices. Further to provide infection risk management strategies to reduce infection threats in the post-pandemic of COVID-19. Methods: We used the method of Brainstorm, Literature study and Analytic Hierarchy Process (AHP) for risk factors selection and model construction, we also created corresponding indicators for each risk factors, in order to collect data in assessment practice. Results: Eighteen risk factors were recognized and selected for model construction, by scatter plot, these risk factors had been classified into four parts, spanned the scopes of diagnosis and treatment, environment, personal protection and emergency handling, with specific management suggestions provided. In the practice, outpatient clinics were divided into three risk levels, 5 clinics in high risk level, 9 in medium risk level and 11 in low risk level. Conclusion: A proper comprehensive risk assessment model for COVID-19 infections has been successfully established. With the model, the ability to COVID-19 prevention in outpatients can be easily evaluated. The strategies on disinfection, surveillance and personal protection were also valuable references in the post-pandemic of COVID-19.

目的 建立契合医院感染防控实际的绩效评价体系,用于科学评价医院感染防控工作.方法 应用头脑风暴法、文献荟萃法等建立指标池,通过咨询专家组完成指标的筛选、层次构建、评价和权重计算.结果 成功构建医院感染防控绩效评价体系,包含一级指标3个、二级指标17个、三级指标27个.咨询信度Cronbach'sα系数为0.901,内容效度指数为0.800～1.000.结论 构建的医院感染防控绩效评价体系可对医院感染管理工作进行科学、客观地评价.

目的 促进医院各科室/部门的医院感染防控工作模式,从"被动迎检"向"主动自查与持续改进"转变,筑牢院感防控网底.方法 2019年某院积极借鉴城市网格化管理理念,利用信息化支撑,进行了医院感染防控网格化体系的建立和实践.通过划分感控网格,设定网格员、优化质量考核指标体系等一系列工作,建立了医院感染防控网格化体系,通过工作实践,进行了优化和改进.结果 防控网格化体系的建立,提升了全院各科室/部门的主动自查与持续改进能力,巩固了院感防控的网底,提升了医院感染管理效率,推进了医院感染督导工作的管理.结论 在新冠疫情防控期间,医院感染防控网格化体系发挥了重要作用,全院各科室/部门以感控网格为单元,践行"主动自查与持续改进"的管理理念,严格落实各项防控措施,实现了新冠疫情防控期间医务人员和患者的零感染.

目的 建立科学、客观、个性化医技科室医院感染防控绩效评价体系,用于管理医技科室医院感染防控工作.方法 应用头脑风暴法、文献荟萃法等建立指标池,通过咨询专家组完成指标筛选、层次构建、评价和权重计算.结果 构建医技科室医院感染防控绩效评价体系,包含一级指标4个、二级指标22个、三级指标29个.其中二级指标分共性指标8个,个性指标14个.咨询信度Cronbach'sα系数为0.869,效度KMO值为0.867,Bart-lett球形检验2值为1097.9(P<0.001),信度、效度较高.结论 医技科室医院感染防控绩效评价体系具有较高的科学性和实用性,可为医技科室精准防控提供评价参考.

Abstract Background We analyzed the results of a 3-year surveillance study on the epidemiological and clinical characteristics of healthcare associated-infections (HAIs) in elderly inpatients in a large tertiary hospital in China. Methods Real-time surveillance was performed from January 1, 2015 to December 31, 2017. All HAIs were identified by infection control practitioners and doctors. Inpatient data were collected with an automatic surveillance system. Results A total of 134,637 inpatients including 60,332 (44.8%) elderly ≥60 years were included. The overall incidence of HAI was 2.0%. The incidence of HAI in elderly patients was significantly higher than that in non-elderly patients (2.6% vs. 1.5%, χ2 = 202.421, P < 0.01) and increased with age. The top five sites of HAIs in the elderly were the lower respiratory tract, urinary tract, blood stream, antibiotic-associated diarrhea, and surgical site. The five most common pathogens detected in elderly HAI patients were Candida albicans, Klebsiella pneumonia, Acinetobacter baumannii, Escherichia coli, and Pseudomonas aeruginosa. The incidence of ventilator-associated pneumonia in the elderly was lower than in the non-elderly, catheter-associated urinary tract infections were more common in elderly patients, and the rate of central line-associated bloodstream infection was similar between groups. The numbers of male patients and patients with comorbidities and special medical procedures (e.g., intensive care unit admission, cerebrovascular disease, brain neoplasms, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, malignant tumor, malignant hematonosis, and osteoarthropathy) were significantly higher in the elderly group, but the number of patients who underwent surgery was lower. Conclusion We observed a significantly higher overall incidence of HAI in elderly inpatients ≥60 compared to non-elderly inpatients < 60 years, but the trend was different for device-associated HAIs, which was attributed to the higher rates of comorbidities and special medical procedures in the elderly group. The main HAI sites in elderly inpatients were the lower respiratory tract, urinary tract, and bloodstream, and the main pathogens were gram-negative bacilli and Candida albicans.

目的 建立消毒供应中心(Central sterile supply department,CSSD)医院感染风险监测与管理机制,优化医院感染管理策略,将医院感染预防与控制的关口前移.方法 基于失效模式与效应分析法(Failure mode and effect analysis,FM EA),对首都医科大学宣武医院CSSD医院感染风险进行识别、定量分析及评价,查找需采取干预措施进行控制的重点风险,制定改进措施进行风险控制,并对控制效果进行评价,建立消毒供应中心风险监测和管理机制.结果 CSSD医院感染风险管理体系包括建筑布局不合理、人员管理不符合要求、操作流程不规范、设备运行失效及清洗消毒灭菌效果监测不合格等五大方面26个风险点;其中需采取措施进行控制的风险点7个.经过实施针对性改进措施,风险控制效果良好.结论 基于FMEA对消毒供应中心进行定量风险评估,建立医院感染风险管理机制,可及时发现CSSD潜在感染风险,有效去除重大医院感染风险.

目的 观察不同消毒方法 对呼吸机管路的清洗消毒效果.方法 采用ATP生物荧光法和细菌培养法,对某医院使用后呼吸机管路消毒效果进行观察.结果 两组不同的清洗消毒方法对呼吸机管路清洗消毒后,检出细菌数均<2.0 cfu/件,ATP生物荧光法检测RLU值均<70,消毒效果合格率均达到100％.结论 采用全自动清洗机清洗和复方过氧乙酸消毒剂浸泡后手工清洗消毒法,对呼吸机管路清洗消毒均达到消毒合格要求.本研究结果显示手工清洗消毒法对小批量呼吸机管路再处理综合性价比更高.

Background: This study aimed to investigate the Hospital-Acquired Conditions (HACs) and find deficits in our hospital, so as to improve the incidence of HACs in China from our retrospect. Methods: We conducted statistics on the incidence and the percentage of HACs, and managed the cost and length of stay of the 950 patients went through HACs in our hospital from 2016 to 2018. Results: The overall incidence was 0.571%. The two most common conditions with the most cost were deep vein thrombosis (DVT) and pulmonary embolisms (PE) (351), and surgical site infections (SSI) (143), which were followed closely by manifestations of poor glycemic control (53), vascular catheter–associated infections (VCAIs) (52), stage III and IV pressure ulcers (49), catheter-associated urinary tract infections (CAUTIs) (33), and falls and trauma (30). Iatrogenic pneumothorax with venous catheterization (7) only occupied small portions. Blood incompatibility and air embolism didn’t happen in the three years. Conclusions: From the comparison of three years, the condition decreased in 2017, while met a higher increase in 2018. This may relative to the launch of medical reform in 2017. Chinese hospitals still need to investigate the HACs, give adaptable emphasis and concern to improve, and promote the overall level of medical management.

目的 设计一套适用于医疗机构门诊医护人员呼吸道感染风险的量化评估体系,并用于风险评估的实践.方法 以首都医科大学宣武医院门诊各科室为研究对象,首先利用头脑风暴法、文献荟萃法和专家咨询法识别门诊医护人员呼吸道感染风险点,形成风险评估体系的基本框架,之后利用层次分析法计算各风险点权重,设计量化评分指标用于评估实践.最后根据评估结果利用加权秩和比法划分门诊科室风险等级.结果 共识别出风险点18项,分为"诊疗过程"、"环境和布局"、"人员防护"和"应急处置"四大类.其中权重最大的风险点为"诊疗过程中包含呼吸道近距离(或喷溅)操作".量化评分指标含单项选择4个、多项选择2个、比值指标12个.实践结果显示,25个门诊科室可分为高风险等级5个,中风险等级9个,低风险等级11个,其中高风险科室为:急诊科、儿科、口腔科、耳鼻喉-头颈外科和呼吸与危重症医学科.结论 本研究构建了一套适用于医疗机构门诊医护人员呼吸道感染风险的量化评估体系,实践结果可用于针对性风险管理.