目的 调查北京市医院门诊区环境表面洁净度情况,为有效防控医院感染提供参考.方法 采用ATP生物荧光检测法对22家三级医院门诊区自助设备和诊室内高频接触物体表面采样.比较不同类型医院的不同物体表面洁净度合格率差异,分析门诊量与物体表面洁净度的相关性.结果 医院门诊区高频接触物体表面总合格率为84.60%,其中诊室洁净度合格率最高(88.65%),自助售卖机和自助挂号机的合格率较低,分别为76.47%和82.23%.综合医院洁净度合格率高于专科医院(92.07%vs 79.20%).物体表面洁净度合格的医院门诊量较大,综合医院门诊自助挂号机和专科医院门诊检验结果打印机洁净度与门诊量的关联性最强(Eta2=0.592和0.524).结论 医院应提高门诊区卫生消毒管理水平,根据门诊量调整高频接触物体表面消毒频次,并加大环境卫生监测力度.

近年来SARS、甲流、禽流感,尤其是新冠病毒感染疫情的暴发,多重耐药菌等医院感染问题的日益严重,体现出切断物理传播途径,防止医患、医源性环境与外部环境的交叉感染至关重要,凸显了开展落实标准预防及分级防护的重要性.

目的 通过对北京地区2012年1月至2017年12月实施全膝关节置换术患者的信息进行分析,探讨该地区全膝关节置换术手术部位感染率及相关危险因素,为手术部位感染的防控提供依据.方法 研究数据来源于北京医院感染监控管理系统,对80所二级及以上医疗机构全膝关节置换术患者开展前瞻性目标监测.本研究共监测全膝关节置换术患者11 148例,其中男2 225例,女8 923例;年龄＞75岁患者1 667例,≤75岁患者9 481例.采用SPSS 20.0软件对手术部位感染情况进行统计分析,并对手术感染的危险因素行Logistic多因素回归分析.结果 共发生手术部位感染28例,感染率为0.25％.多因素logistic回归分析显示,手术时间长、引流、医院级别低是全膝关节置换术手术部位感染发生的独立危险因素.手术持续时间＞90 min的患者相较于≤90 min的患者,手术后感染的风险有所增加(OR=4.509,95％CI:1.349～15.070);三级医院相比二级医院的手术患者,手术后感染的风险有所降低(OR=0.214,95％CI:0.099～0.461);引流可增加手术部位感染的风险(OR=6.619,95％CI:1.948～22.487).结论 北京医院感染监控管理系统开展的全膝关节置换术手术部位感染目标性监测可作为其他机构监测工作的参考;手术部位感染的发生受多因素的影响,需要采取综合性的手术部位感染防控措施来降低感染风险,确保手术患者安全.

The pandemic of coronavirus disease 2019 (COVID-19) has added many challenges to the hosting of Beijing 2022 Olympic Winter Games. Effective prevention and control of epidemics was one of the important measures to ensure the success of the Games. By meeting the requirements of international games, work plans were precisely formulated, sampling and testing were effectively performed, and precise management was carried out. A total of 1 859 423 tests for the Olympic-related personnel were performed and 437 samples were tested positive. The achievements of the work included high effecient sampling and testing, no biosafety accidents, timely sample collection, detection and result reporting according to the requirements of the Games, as well as no infection among sampling and testing personnel. The sampling and of nucleic acid testing in this Winter Games innovated the management methods for large international games, and accumulated working experience. The sampling and testing capabilities, quality control and biosafety management, and logistics support capabilities of all the testing institutions were exercised and improved. These will provided experience for the nucleic acid testing of mass gathering events or large-scale nucleic acid testing in future.

Objectives: This study aims to explore the high-risk factors of carbapenem-resistant Enterobacteriaceae (CRE) infection of hospitalised patients in high-risk departments.Methods: This study is a multicentre, retrospective study. CRE screening positive patients from 1 Jan-uary 2016 to 31 December 2018 of high-risk departments in five tertiary first-class teaching hospitals in Beijing collect the patients' CRE test specimen information, CRE infection information and outcomes. The patients were divided into a colonisation group and an infection group for comparative analysis. A logis-tic regression model was established to explore the risk factors of CRE infection. Subgroup analysis was conducted according to invasive procedures and the type of the infection.Results: In total, 344 patients were included in this study, including 85 (24.71%) colonisation and 259 (75.29%) infection; 36.09% CRE colonisation converted to infection, and the mean conversion time from colonisation to infection was 6.5 (4.0, 18.8) days. Renal disease, granulocytosis, invasive procedures and the time from hospital stay to positive CRE were the risk factors for CRE infection. The subgroup analysis showed that the rate of CRE infection in the invasive group was higher than in the non-invasive group ( P < 0.001), and the rate of exacerbation or death in the invasive group was also higher than in the non-invasive group ( P = 0.019). The average length of ICU and hospitalisation in the healthcare-associated infection group were significantly higher than those in the community infection group, but there was no difference in the proportion of final exacerbation or death between them ( P = 0.727).Conclusion: Kidney disease, granulocytosis, invasive procedures and CRE detection time are the risk fac-tors for CRE infection. Carrying out CRE screening in patients as early as possible and taking effective intervention measures in time to avoid adverse consequences is all important.(c) 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

目的 构建适宜北京市血液透析室的医院感染质量控制体系,评估北京市血液透析室医院感染防控关键点的薄弱环节,为进一步完善质量控制中心医院感染质量控制能力与水平提供帮助.方法 在肾内科专家、医院感染控制专家及医政管理专家共同参与下,根据国家卫生管理部门制定的医院感染管理规范及血液透析标准操作规程,确定调查内容与环节并形成现场医院感染质量控制体系,其核心内容包括8个关键维度:机构与人员资质;透析室布局与结构;管理制度;职业防护及手卫生规范;重点血液传播性疾病的管理;感染控制措施的落实;各功能区感染防控管理;安全复用,共计43个感染控制检查专项,其中包含91个感染控制风险行为(点),采用调阅档案、现场考试与现场观察相结合的方法,于2017年11月～2018年1月对北京市辖区内血液透析室进行调查与分析.结果 ①共调查北京市辖区内122家血液透析室,总体医院感染检查得分为94.6分,其中三级医疗机构中的血液透析室得分为95.0分;二级医疗机构中的血液透析室得分为93.4分;一级医疗机构中的血液透析室得分为90.8分.②在上述8个维度中得分排名较低的3位分别为:透析室布局与结构(89.3分)、感染控制措施的落实(91.3分)、机构与人员资质(92.8分).③医院感染防控最薄弱环节的检出率前3位为:消毒隔离的风险行为(点)(29.5％)、基础设施不完善的风险行为(点)(26.2％)、治疗准备室区域的风险行为(点)(26.2％).结论 血液透析室的布局与结构、感染控制措施的落实、各功能区域感染防控管理等3个维度是北京市血液透析室中医院感染风险行为(点)的高发环节,血液净化质量控制中心在未来质量控制以及各血液透析室日常管理过程中应强化这3个维度的督导与管理.

目的 调查北京地区乳腺癌根治手术后手术部位感染(SSI)发病率及其危险因素.方法 通过北京医院感染监控管理系统,对全市83所二级及以上医疗机构进行乳腺癌根治/改良根治术前瞻性监测,应用SPSS 20.0软件对SSI情况进行描述分析及logistic回归分析.结果 共纳入2012—2017年监测数据库中8248例病例,发生SSI 62例,发病率为0.75％.糖尿病、手术后入住过ICU、手术时长和ASA评分是乳腺癌根治/改良根治术患者SSI的危险因素.糖尿病患者相较于非糖尿病患者SSI的风险增加(OR=2.99,95％CI:1.33～6.73);术后入住过ICU的患者发生SSI的风险是未入住过ICU的5.72倍(OR=5.72,95％CI:1.68～19.45);手术时间每增加1 h,术后感染的风险增加27％(OR=1.27,95％CI:1.11～1.46);ASA评分每高一个级别,SSI的风险将增加54％(OR=1.54,95％CI:1.01～2.35).结论 多中心大样本的目标监测提示2012—2017年北京地区乳腺癌手术后SSI发病率较低.糖尿病、入住过ICU、手术时间和ASA评分应作为预判SSI的重要因素,在综合考虑影响患者SSI的因素后制定个性化预防策略.

医疗机构感染防控是医疗质量的重要保障.信息技术应用为医疗机构感染防控的高效便利提供了重要工具.各级医疗机构感染监测的指标如何实现同质化,实现从信息系统过程数据中直接提取数据,并通过组合计算出定义明确的监测结果,迫切需要出台相关规定.历经多轮多方面征求意见,不断完善标准内容,于2021年4月国家卫生健康委正式发布了强制性卫生行业标准《医疗机构感染监测基本数据集》(WS 670-2021),从而可以实现医疗机构内、区域医疗机构甚至全国医疗机构之间的医疗机构感染监测数据比较.本文将从标准的起草背景、起草目的 、起草依据和标准内容及实施建议等方面进行解读,以帮助医疗机构相关人员提高对标准的理解和认知,推动标准的正确贯彻与落实.

目的 分享在武汉新冠肺炎定点医院降低新型冠状病毒传播风险的工作策略.方法 总结分析在开展新型冠状病毒医院感染防控工作中,制定并执行的方案、措施和流程的可操作性及科学性.结果 构建应急时期的院感防控组织管理体系和制度体系,规范在病例识别和管理流程中伴随的隔离布局,通过执行标准预防以及呼吸道传染病预防措施,充分保障医务人员职业健康安全是疫情防控攻坚阶段的三个必要环节.结论 目前疫情应对进入最吃紧的关键时期,做好院内感染防控对提高收治率和治愈率、降低新发医院感染发病率和疾病病死率具有重要意义.

新型冠状病毒肺炎(简称“新冠肺炎”)流行期间,综合医院内高风险区域(接诊新型冠状病毒肺炎确诊或疑似病例区域)空气和物体表面终末消毒成为确保医院环境安全的重要手段,实施有效的终末消毒可以降低医院内病毒传播风险.根据新冠肺炎相关规范和指南规定,含氯消毒剂、二氧化氯、过氧化氢和过氧乙酸为四类对新型冠状病毒有效的常用消毒剂.

Objective:To learn the application of nosocomial infection prevention and control measures as stipulated in COVID-19 emergency plans by medical institutions at all levels in the region, for the purpose of strengthening epidemic prevention and control.Methods:During March 12-13, 2020, customized questionnaires were used to learn from 186 hospitals and medical institutions regarding the basics of their nosocomial prevention management departments, emergency plan application and revisions made. Comparison of the ratios or constituent ratios were tested with χ2 test, while the continuous variables analysis between groups was verified with one-way ANOVA. Results:77.53% of the medical institutions had set up independent nosocomial infection management departments, and 87.30% of the institutions were qualified. 80% of the medical institutions had in place emergency plans for respiratory infectious diseases, but 98.05% of them had revised their plans during the pandemic, with an average of 10.85 newly added and revised provisions. Only 30.11% of emergency planed provide for clearly graded early warning.Conclusions:Efforts should be upgraded to develop an emergency prevention and control system for infection prevention and control in epidemics, and improve technical support for infection prevention and control in the system; to strengthen the clearly-graded early warning and graded responses in a scientific manner; and conduct regular drills, revise plan to ensure its applicability.

目的 了解我国医用织物管理现状及相关人员对医用织物相关标准规范的知晓与理解情况.方法 利用自行设计调查问卷,通过金数据工具,借助微信向全国医疗机构和社会化洗涤服务机构从事医用织物洗涤消毒操作或管理的相关人员公开发布,由参加调查者自愿回答,并从医用织物处理情况、对相关标准规范知晓情况、对医用织物相关概念的认知情况等方面完成现状调查.结果 共2 072名人员参加调查,其中1 978名、94名分别来自医疗机构和社会化洗涤服务机构.有833名(42.11％)来自医疗机构的参加调查者选择了社会化洗涤服务机构,中南地区选择社会化洗涤服务机构的比例(63.06％)高于其他地区.参加调查者对WS 310.1-2016等3项卫生行业规范知晓度最高,为93.58％;对YY/T 0506.1等6项相关标准知晓度最低,为55.12％;院感专职人员知晓度总体高于医疗机构非院感专职人员;多数(43.82％)通过培训班知晓了解.68.82％认为WS/T 508-2016中的“医用织物”包含了《医疗消毒供应中心基本标准(试行)》中称的“软器械”;44.88％认为“软器械”的提法不能准确表达需最终灭菌的手术衣、手术铺单等可重复使用织物的实际描述.关于手术衣、手术铺单等的相关管理和建筑布局,83.30％认为其包装灭菌及无菌物品存放区需要达到WS 310.1-2016的规定要求,75.87％认为其洗涤去污区需要达到WS 310.1-2016的规定要求,82.29％认为其洗涤消毒后应再灭菌.关于手术衣、手术铺单等医用织物的灭菌,57.87％认为可由通过审批的区域化医疗消毒供应中心按要求进行灭菌,84.41％认为可由医用织物洗涤服务机构按要求洗涤消毒后再送通过验收审批的医疗机构消毒供应中心(CSSD)或区域化医疗消毒供应中心进行后续灭菌.结论 随着我国医疗机构对社会化服务需求的增多,规范社会化服务机构行为的相应标准规范也随之发布,为减少理解偏差,在需进一步明确与修订相关术语定义和规定的同时,应重点加强现行相关标准的宣贯与推广应用,以适应国情、不断满足我国医疗服务发展的需要.

为了解新型冠状病毒感染肺炎疫情期间医院终末消毒情况及其实际意义,普及不同类型空气和物体表面消毒设备适用条件,提高新型冠状病毒肺炎期间医院消毒设备使用效率,减少医院内病毒传播风险,本文总结了消毒设备发展情况及医院现有消毒效能,以期让更多的医务人员了解和掌握消毒实施方法和注意事项. 此次疫情中,医院环境终末消毒常用过氧化氢、二氧化氯气体,以及超紫光消毒设备进行空气消毒;用含氯消毒剂或二氧化氯液体擦拭,以及便携式喷雾设备进行物体表面消毒.

目的 分析新冠肺炎疫情防控医务入员防护标准及感染现状,了解北京地区医务人员职业安全防护情况,为科学、规范、安全地开展疫情防控提供建设性意见.方法 梳理国家发布的医务人员安全防护法律法规、指南标准,完善地区医务人员个人防护指导原则,通过现场观察和工作人员访谈形式了解本地区医务人员个人防护用品使用现状及问题.结果 文件研究发现我国缺少医务人员安全防护方面的政策实施细则.疫情期间紧急下发系列文件,有待结合实际梳理统一.20所医疗机构调查显示大部分医疗机构能按照感染暴露的风险为临床配备防护用品.结论 应加快我国医务人员职业安全体系建设和安全防护用品标准体系发展,根据不同暴露风险进行防护,加强分区管理,避免个人防护用品过度使用.

目的:了解我国1986-2016年医院手卫生工作推进情况.方法:采用分层抽样的方法,通过回顾性调查全国14个省、直辖市、自治区和解放军的200所医院手卫生工作制度制订和修订等各项工作开展情况和开始开展的年份,分析我国手卫生相关工作的推进情况及趋势.结果:99.50％(199所)的医院建立了手卫生制度、使用速干手消毒剂、开展手卫生培训工作、全院手卫生督导工作.97.00％(194所)的医院开始使用干手纸巾,83.50％(167所)将手卫生工作纳入医院绩效评估,84.50％(169所)开展了手卫生知识知晓率调查,90.50％(181所)开展了手卫生依从性调查,其中2009年和2012年新开展各项工作的医院最多.结论:我国手卫生推进的各项措施已在全国范围内推行;且政策导向明显影响各项工作的推进.

国外标准将重症监护病房(ICU)、易感染患者病房、空气传染病隔离病房作为医院重点用房作出规定,但国内标准只有这方面的零碎内容.国内至2009年累计血液病患者以百万计,呼吸道感染占院内感染比例高达40％,与外国以泌尿系统感染为首不同.ICU是各医院普遍设置的用房.从防护角度出发,一是正压防护患者,二是负压防护环境,故新编国家标准定名为《医院洁净护理与隔离单元技术标准》.

Healthcare associated infection (HAI) is known to increase the economic burden of patients while the medical cost due to MDRO HAI is even higher. Three hundred eighty-one multidrug resistance organisms (MDROs) healthcare associated infection (HAI) case-patients and three hundred eighty-one matched control-patients were identified between January and December in 2015. The average total hospitalization medical cost of the case group was $6127.65 and that of the control group was $2274.02. The difference between the case group and the control group was statistically significant (t = 21.07; P < 0.01). The attributable cost of MDRO HAI was $3853.63. The direct medical costs due to different MDRO infections were different. The increased medical costs of CR-AB, CR-KP, and CR-PA were significantly higher than that of MRSA, MRSE, ESBL E. coli, and ESBL Kp (P < 0. 05). Among the subitem expenses, the drug cost increased the most (the average cost was $1457.72), followed by the treatment fee and test fee; the differences were statistically significant (P < 0.01).

Healthcare-associated infections (HAIs) not only bring additional medical cost to the patients but also prolong the length of stay (LOS). 2119 HAI case-patients and 2119 matched control-patients were identified in 68 hospitals in 14 primary sampling provinces of 7 major regions of China. The HAI caused an increase in stay of 10.4 days. The LOS due to HAI increased from 9.7 to 10.9 days in different levels of hospitals. There was no statistically significant difference in the increased LOS between different hospital levels. The increased LOS due to HAI in different regions was 8.2 to 12.6 days. Comparing between regions, we found that the increased LOS due to HAI in South China is longer than other regions except the Northeast. The gastrointestinal infection (GI) caused the shortest extra LOS of 6.7 days while the BSI caused the longest extra LOS of 12.8 days. The increased LOS for GI was significantly shorter than that of other sites. Among 2119 case-patients, the non-multidrug-resistant pathogens were detected in 365 cases. The average increased LOS due to these bacterial infections was 12.2 days. E. coli infection caused significantly shorter LOS. The studied MDROs, namely, MRSA, VRE, ESBLs-E. coli, ESBLs-KP, CR-E. coli, CR-KP, CR-AB, and CR-PA were detected in 381 cases (18.0%). The average increased LOS due to these MDRO infections was 14 days. Comparing between different MDRO infections, we found that the increased LOS due to HAI caused by CR-PA (26.5 days) is longer than other MDRO infections (shorter than 19.8 days).

目的 了解我国医院病区手卫生设施设置基本现状.方法 2016年采用多中心研究方式,抽取全国14个省(市、自治区)不同级别(省、地、县)医院及军队医院,对其病区的手卫生设施进行现场调查,分析比较2010、2016年不同病区不同区域手卫生设施配备情况.结果 与2010年相比,2016年医院洗手池的总设置率从69.30％上升至77.20％(χ2=37.68,P<0.01);2016年医院病区水龙头开关以感应式为主(39.39％),其次为手拧式和脚踏式,分别占29.65％和17.67％;干手方式以纸巾为主,占77.30％.使用纸巾干手所占比率从2010年的38.45％上升至2016年的77.30％,自然晾干所占比率从18.65％ 降至8.04％.医院速干手消毒剂总配置率从2010年的50.47％上升至2016年的75.64％,差异有统计学意义(χ2=402.46,P<0.01).2016年不同病区不同区域速干手消毒剂配置率比较,差异均具有统计学意义(呼吸内科:χ2=69.49,P<0.01;普通外科:χ2=66.97,P<0.01;ICU:χ2=88.52,P<0.01).速干手消毒剂的配置率以治疗室配置的比率最高(呼吸内科、普通外科、ICU的治疗室分别达89.50％、88.50％和88.54％),普通病区患者房间内和病区走廊配置率较低(60％左右).除病区走廊配置率在56.25％外,ICU其他区域速干手消毒剂配置率均在80％以上.结论 与 2010 年相比,2016 年医院病区洗手池与速干手消毒剂的配置率有所提高,水龙头开关与干手方式有所改进,但各病区区域手卫生设施配置不均,与医院感染防控要求尚有一定距离,仍应继续改进手卫生设施.