Although proper donning and doffing of personal protective equipment (PPE) is critical for infection prevention, detailed characterization of problems encountered during these processes in real-world settings during large-scale infectious disease outbreaks remains insufficient. This study aimed to analyze the characteristics and distribution of interception problems in the process of donning and doffing process in a large cabin hospital during the 2022 COVID-19 pandemic in Shanghai. A prospective, real-world study was designed to collect and analyze data on irregularities observed during personal protective equipment (PPE) donning procedures in cabin hospital operations. The proportion of problems encountered during donning PPE was 5.29% (246/4,652), while during doffing PPE, it was 8.44% (382/4,525) (P < 0.001). The primary problem during donning PPE was related to problems with protective clothing, followed by problems with respirators. There was no significant difference in problem distribution among different posts (P = 0.459). The problems related to protective clothing mainly focused on loose fitting around the head and neck, making them prone to exposure during donning (56.25%, 99/176) and contamination of the inner surface of protective clothing during doffing (46.43%, 91/196). Respirator-related problems included failure of the seal test during donning PPE (61.54%, 24/39) and shifting or loosening of the respirator during PPE doffing (73.68%, 14/19). These findings identify critical gaps in PPE procedures and highlight the need for targeted training to address these issues, thereby reducing the risk of infection among healthcare personnel in mobile cabin hospitals.

ObjectiveMalnutrition is closely associated with poor clinical outcomes; however, its prognostic value in patients with infective endocarditis (IE) undergoing surgical treatment remains unclear. This study aimed to investigate the association of three objective nutritional indices (PNI, CONUT, and HALP) with in-hospital all-cause mortality in surgically treated patients with IE.MethodsIn this retrospective study, clinical data were collected from 450 patients with IE who underwent surgical treatment at Jiangsu Provincial People’s Hospital over 14 years. Patients were categorized into a non-survivor group (n = 42) and a survivor group (n = 408). Nutritional status was assessed using the PNI, CONUT, and HALP scores. Stepwise-adjusted multivariate logistic regression models and receiver operating characteristic (ROC) curve analyses were used to evaluate the independent prognostic value and discriminatory performance of these nutritional indices for in-hospital all-cause mortality.ResultsThe in-hospital all-cause mortality rate in this cohort was 9.33%. Preoperative malnutrition risk was common among patients with IE, with nutritional risk identified in 44.00 and 75.11% of patients according to the PNI and CONUT criteria, respectively. Compared with survivors, non-survivors had significantly poorer baseline nutritional status. After adjustment for confounding factors, each one-unit increase in the PNI was associated with a 7% lower risk of in-hospital all-cause mortality (OR = 0.93, 95% CI: 0.89–0.98, p = 0.009). Similarly, each one-unit increase in the HALP score was associated with a 4% lower risk of in-hospital all-cause mortality (OR = 0.96, 95% CI: 0.93–0.98, p = 0.001). In contrast, each one-unit increase in the CONUT score was associated with a 16% higher risk of in-hospital all-cause mortality (OR = 1.16, 95% CI: 1.03–1.32, p = 0.017). A prognostic model incorporating these nutritional indicators showed good discrimination (AUC = 0.839) and acceptable predictive accuracy (Brier score = 0.063).ConclusionPreoperative malnutrition risk is highly prevalent among patients with IE undergoing surgery and is an independent predictor of postoperative in-hospital all-cause mortality. Routine use of objective nutritional scoring tools, including the PNI, CONUT, and HALP, may improve preoperative risk stratification. Early nutritional assessment and targeted intervention for patients at moderate-to-severe nutritional risk may provide meaningful clinical benefits.

Whether 3.0 g cefuroxime (CXM) prophylaxis before cardiac surgeries effectively avoided postoperative pneumonia (POP) and fever (POF) compared with 1.5 g is debatable, which needed to be confirmed by evidence-base medicine. A total of 301 patients who underwent CXM perioperative prophylaxis before cardiac surgeries from Jan 2023 to Dec 2023 at the First Affiliated Hospital of Nanjing Medical University were incorporated in a nested case-control study. The patients were divided into the 1.5 g (n = 170) and 3.0 g (n = 131) groups according to the first dosage of prophylactic CXM. Outcomes included POP and POF. Risk and stratification analysis was performed for the effect and modification of different dosages of CXM on outcomes. The risk of POF in 3.0 g group (67, 51.15%) was higher than 1.5 g group (52, 30.59%) unadjusted (OR = 2.38, 95%CI:1.48 ~ 3.81, P < 0.001) or adjusted (OR = 2.38, 95%CI:1.36 ~ 4.14, P = 0.002) for the confounding variables. There was no significant difference in POP between the two groups unadjusted (OR = 1.26, 95%CI:0.62 ~ 2.55, P = 0.522) or adjusted (OR = 1.03., 95%CI:0.48 ~ 2.20, P = 0.945) for the confounding variables. The results of stratification analysis showed two different dosages of CXM didn’t generate modification on the other risk factors of POF. 3.0 g CXM prophylaxis before cardiac surgeries didn’t decrease the incidence of POP but increased the risk of POF compared with 1.5 g. However, limited by underpowered sample size and the overly broad research population, the conclusions needed to be validated by a prospective cohort study.

There is a lack of a universally accepted standard or guideline for the frequency of disinfection in purified water pipelines. Furthermore, there is no standardized method for detecting microorganisms in the final rinse water utilized for endoscope cleaning.This study aims to examine the current management and microbial monitoring practices concerning the final rinse water used for flexible endoscope cleaning in medical institutions. A questionnaire was designed using a convenience sampling method to gather data on the maintenance and microbial monitoring of final rinse water for flexible endoscopes in 290 medical institutions across Jiangsu Province, China. Purified water is used for endoscope rinsing by 93.45

Postoperative pneumonia (POP) frequently complicates cardiac surgery that involves cardiopulmonary bypass (CPB). This study aimed to assess the diagnostic utility of procalcitonin (PCT) for identifying pneumonia after CPB-assisted cardiac surgery. Patients diagnosed with POP were enrolled in the retrospective matched case-control study and were admitted to a Grade III general hospital in Nanjing in 2023. POP diagnosis was determined based on a combination of clinical and microbiological criteria.PCT and white blood cell count (WBC) data were systematically collected from day 1 (T1) to day 5 (T5). Receiver operating characteristic (ROC) curve analysis and subject operating characteristics were utilized to evaluate the diagnostic performance of biomarkers. At the same time, a binary logistic regression model was developed to identify factors that influence the diagnosis of POP. The study included 220 age- and sex-matched patients, comprising 56 individuals with POP and 164 uninfected patients constituting the non-POP group. ROC curve analysis revealed that serum PCT concentration exhibited an AUC > 0.7 from day 2 to day 5, whereas other indices demonstrated AUCs < 0.7 at these time points. Univariate and multivariate analyses highlighted serum PCT concentration on day 2, WBC count on day 5, the PCTT4-T1 variation rate, and days of mechanical ventilation as significant predictive factors for POP diagnosis, each demonstrating statistical significance (P < 0.05). The calculated AUC was 0.837 (95

Background:Postoperative infection remains a serious problem for patients undergoing open-heart surgery and is associated with poor prognosis and mortality. Aim:To determine the incidence, characteristics and associated risk factors for nosocomial infections in adult cardiac surgery patients and to develop a nomogram prediction model. Methods:Data were retrospectively collected from patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) at a tertiary hospital in 2023. Patients were divided into an infected group (N = 130) and a non-infected group (N = 192). Multivariate logistic regression analysis was used to analyse the independent risk factors for healthcare-associated infections after cardiac surgery under CPB. Results:Of the 1584 patients, 130 (8.21%) developed postoperative infections (infection group). Lower respiratory tract was the most common site of infection (N = 74, 56.9%), while Gram-negative bacteria were the predominant isolates overall (N = 81, 62.3%). Among the Gram-negative bacteria, Acinetobacter baumannii was the most frequently identified, whereas Staphylococcus aureus was the leading strain among Gram-positive bacteria. Multivariate logistic regression analysis of the 322 patients included in the study revealed that CPB duration, American Society of Anaesthesiologists score, procalcitonin concentration on the first postoperative day, monocyte:lymphocyte ratio, preinfection mechanical ventilation duration, and preinfection central venous catheterization duration were the six independent predictors of postoperative infection. The area under the receiver operating characteristic curve was 0.824 (0.778-0.870), and the model showed good predictive performance. Conclusion:A nomogram has been developed to predict postoperative infection via commonly available data. This tool could assist clinicians in optimising the perioperative care of patients undergoing cardiac surgery with CPB, but further external validation is needed.

Objectives: The study aims to investigate whether bathing with 2% chlorhexidine gluconate (CHG) re-duces the incidence of surgical site infection (SSI) in patients undergoing routine pancreatic surgery. Methods: A randomized controlled trial was conducted at a large-volume pancreatic centre between 1 January 2021 and 31 December 2022. Patients undergoing clean-contaminated pancreatic surgery were enrolled and randomized into an intervention arm (bathing with a 2% CHG wipe) and a control arm (routine care, soap, and water). The primary outcome was the incidence of SSI after pancreatic surgery within 30 days. Results: Overall, 614 patients (intervention arm, 311; control arm, 303) were included in intention-to-treat analysis. In tollal, 8.8% (54/614) patients developed SSL. The incidence of SSI in the intervention arm was 6.8% (21/311) and 10.9% (33/303) in control arm, and the difference did not reach the level of statistical sig-nificance (p 0.070). The time to SSI was significantly extended when patients were in the intervention arm (log-rank test. p 0.047). The intervention did not significantly reduce the incidence of healthcare-associated infection, hospital-acquired pneumonia, and bloodstream infection. No adverse events were observed. However, in the per-protocol analysis among 519 patients, the intervention arm showed a significantly lower incidence of overall SSI than that of those in the control arm (21/272, 7.7% vs. 33/242, 13.4%, p 0.036). Discussion: Bathing with 2% CHG could potentially reduce the incidence of SSI for the patients scheduled to undergo pancreatic surgery for which further well-designed clinical trials are warranted. Wen-Sen Chen, Clih Microbiol Infect 2025:31:825 (c) 2025 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights arq reserved, including those for text and data mining. Al training, and similar technologies

A persistent fever following cardiovascular surgery presents a significant clinical challenge and often leads to adverse patient outcomes. This study aims to develop a nomogram predictive model for persistent postoperative fever, which could serve as a valuable tool for clinicians in making diagnostic and treatment decisions. The medical records of patients who underwent cardiovascular surgery at the First Affiliated Hospital of Nanjing Medical University in 2023 were retrospectively analysed. The patients were divided into two groups based on whether their body temperature remained above 38℃ for three consecutive days after surgery: the persistent fever group and the control group. Independent risk factors for persistent postoperative fever were identified through univariate and multivariate logistic regression analyses. A predictive nomogram model was then developed and validated. The study involved 343 patients who underwent cardiovascular surgery, revealing an overall postoperative fever rate of 70.55

Objective: To investigate adherence to intravascular catheter (IVC) insertion and maintenance guidelines in Chinese tertiary hospitals. Methods: A cross-sectional questionnaire survey of adult inpatients with IVC placements was conducted from July to September 2022 in 20 tertiary hospitals in China. One clinical staff member from each department in each hospital was assigned to participate in the survey. Questionnaires were uniformly collected and reviewed after three months. Results: This study included 1815 cases (62.69%) of central venous catheter, 471 cases (16.27%) of peripherally inserted central catheter, 461 cases (15.92%) of PORT, and 147 cases (5.08%) of haemodialysis catheter insertions. Statistically significant differences in compliance were observed across the four IVC types, specifically in relation to the insertion checklist, standard operating procedure, and insertion environment (P<0.05). Practice adherence during IVC maintenance differed significantly across the four IVC types in aspects such as availability of IVC maintenance verification forms, daily scrubbing of the catheterized patients, and catheter connection methods (P<0.05). A total of 386 (13.34%) patients developed fever, 1086 (37.53%) were treated with therapeutic antibiotics, 16 (0.55%) developed central-line-associated bloodstream infections, two (0.07%) developed local skin infections, and six (0.21%) developed deep vein thrombosis. Conclusions: Adherence to guidelines regarding insertion and maintenance differed across the four IVC types; there is a gap between the recommended measures and the actual operation of the guidelines. Therefore, it is necessary to further enhance training and develop checklists to prevent central-line-associated bloodstream infections. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Background Currently, different guidelines recommend using different methods to determine whether deduplication is necessary when determining the detection rates of multidrug-resistant organisms (MDROs). However, few studies have investigated the effect of deduplication on MDRO monitoring data. In this study, we aimed to investigate the influence of deduplication on the detection rates of MDROs in different specimens to assess its impact on infection surveillance outcomes. Methods Samples were collected from hospitalized patients admitted between January 2022 and December 2022; four types of specimens were collected from key monitored MDROs, including sputum samples, urine samples, blood samples, and bronchoalveolar lavage fluid (BALF) samples. In this study, we compared and analysed the detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CRECO), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and methicillin-resistant Staphylococcus aureus (MRSA) under two conditions: with and without deduplication. Results When all specimens were included, the detection rates of CRKP, CRAB, CRPA, and MRSA without deduplication (33.52%, 77.24%, 44.56%, and 56.58%, respectively) were significantly greater than those with deduplication (24.78%, 66.25%, 36.24%, and 50.83%, respectively) (all P < 0.05). The detection rates in sputum samples were significantly different between samples without duplication (28.39%, 76.19%, 46.95%, and 70.43%) and those with deduplication (19.99%, 63.00%, 38.05%, and 64.50%) (all P < 0.05). When deduplication was not performed, the rate of detection of CRKP in urine samples reached 30.05%, surpassing the rate observed with deduplication (21.56%) (P < 0.05). In BALF specimens, the detection rates of CRKP and CRPA without deduplication (39.78% and 53.23%, respectively) were greater than those with deduplication (31.62% and 42.20%, respectively) (P < 0.05). In blood samples, deduplication did not have a significant impact on the detection rates of MDROs. Conclusion Deduplication had a significant effect on the detection rates of MDROs in sputum, urine, and BALF samples. Based on these data, we call for the Infection Prevention and Control Organization to align its analysis rules with those of the Bacterial Resistance Surveillance Organization when monitoring MDRO detection rates.

Objectives Whether 3.0 g CXM prophylaxis before cardiac surgery can effectively avoid POP and persistent POFcompared with 1.5 g is debatable, which needs to be confirmed by evidence medical research. Methods A total of 301 patients who underwent CXM prophylaxis before cardiac surgery from Jan 2023 to Dec 2023 at the First Affiliated Hospital of Nanjing Medical University were incorporated in a nested case-control study. The patients were divided into the 1.5 g (n=170) and 3.0 g (n=131) groups according to the dosage of prophylactic CXM. Outcomes included POP and persistent POF. Risk andstratification analysis was performed for the effect andmodification of different doses of CXM on outcomes. Results The incidence of persistent POF in 1.5 g group (52, 30.59%) was lower than that in 3.0 g group (67, 51.15%) unadjusted (OR=2.38, 95%CI:1.48~3.81, P<0.001) or adjusted (OR=2.38, 95%CI:1.36~4.14, P=0.002) for the confounding variables. There was no significant difference in POP between the two groups unadjusted (OR=1.26, 95%CI:0.62~2.55, P=0.522) or adjusted (OR=1.03., 95%CI:0.48~2.20, P=0.945) for the confounding variables. The results of stratification analysis defined that two different dosages of prophylactic CXM didn’t generate effect modification on the risk factors of persistent POF. Conclusions 3.0 g CXM prophylaxis before cardiac surgery didn’t decrease the incidence of POP but increased the risk of persistent POF compared with 1.5 g. Given the facts, this study may point the solution of CXM preoperative prophylaxis for cardiac surgery.

目的 分析非多药耐药菌(Non-MDRO)型耐碳青霉烯类铜绿假单胞菌(CRPA)的临床分布特点,并提出其分层防控模式的建议.方法 选择南京医科大学第一附属医院2020年1月-2022年6月临床标本中分离的CRPA、耐碳青霉烯类肠杆菌目细菌(CRE)、耐碳青霉烯类鲍氏不动杆菌(CRAB)为研究对象,根据MDRO定义,将其分别分为Non-MDRO组和多药耐药菌(MDRO)组,对比分析Non-MDRO组比例.分析Non-MDRO组CRPA临床分布、影响因素以及耐药性特点.结果 医院感染重点监测的MDRO,针对铜绿假单胞菌(PA),2015年之前均为多药耐药铜绿假单胞菌(MDR-PA),2015年之后则都是CRPA;CRPA中Non-MDRO占比62.15％(770/1 239),CRE 和 CRAB 中 Non-MDRO 占比则分别为 0.51％(9/1 758)和 0.91％(21/2 308);Logistic 多因素分析结果显示年龄和病区分布是Non-MDRO型CRPA的影响因素(P＜0.05);CRPA中Non-MDRO组耐药率低于MDRO组(均P＜0.05),其中Non-MDRO组除了对碳青霉烯类药物耐药率较高外,其余抗菌药物耐药率均低于20％.结论 非MDRO型CRPA基数较大,危害较小,且占据一定的防控资源,建议根据情况对CRPA进行分层防控管理,即耐药菌并不多见、防控资源宽松的医疗机构可以将CRPA全部纳入常规重点监测菌,而对于部分耐药菌泛滥、防控资源紧张的大型三甲医院,则可以将重点监测菌中的CRPA更改为MDR-PA或难治型耐药菌(DTR)-PA.

OBJECTIVE To retrospectively analyze the result of active screening for surgery patients of otolaryngology department in 8 consecutive years so as to provide basis for formulating screening methods based on the result. METHODS From Jan 2013 to Dec 2020, the clinical data were collected from the patients who were hospitalized in otolaryngology department of The First Affiliated Hospital of Nanjing Medical University by Xinglin Nosocomial Infection real-time monitoring system, the distribution of the isolated pathogens was observed, and the influencing factors for the nosocomial infection were analyzed. RESULTS The positive rate of active screening of pathogens was 12.60%（980/7775） among the hospitalized patients of otolaryngology department in the 8 consecutive years, and the isolation rate of multidrug-resistant organisms（MDROs） was（126/980）. Totally 1 062 strains of pathogens were isolated, 686（64.60%） of which were gram-positive bacteria, 326（30.69%） were gram-negative bacteria, and 50（4.71%） were fungi. Among 126 strains of MDROs, there were 110 strains of methicillin-resistant Staphylococcus aureus（MRSA）, 7 strains of carbapenem-resistant Pseudomonas aeruginosa（CRPA）, 6 strains of carbapenem-resistant Acinetobacter baumannii（CRAB） and 3 strains of carbapenem-resistant Enterobacteriaceae（CRE）. The positive rates of pathogens and MDROs were associated with the age and type of disease（P＜0.05）; the incidence of nosocomial infection was associated with the gender, age and isolated pathogens（P＜0.05）; the occurrence of nosocomial infection in the patients was associated with the gender, more than 65 years of age, nasopharyngeal diseases and use of antibiotics（P＜0.05）. CONCLUSION It is necessary to pay close attention to the active screening of pathogens for the male elderly patients with nasopharyngeal diseases in otolaryngology department and rigidly implement the prevention measures so as to reduce the incidence of nosocomial infection.

Nosocomial infection caused by carbapenem-resistant Klebsiella pneumonia (CRKP) infection has become a global public health problem. Human NK and NKT cells in peripheral immune responses are recognized as occupying a critical role in anti-bacterial immunity. Through performed scRNA-seq on serial peripheral blood samples from 3 patients with CRKP undergoing colonization, infection, and recovery conditions, we were able to described the immune responses of NK and NKT cells during CRKP infection and identified a mechanism that could contribute to CRKP clearance. The central player of CRKP infection process appears to be the NKT subset and CD56hiNKT subset which maintained immune competence during CRKP colonization. With time, CRKP leads to the loss of NK and CD160hiNKT cells in peripheral blood, resulting in suppressed immune responses and increased susceptibility to opportunistic infection. In summary, our study identified a possible mechanism for the CRKP invasion and to decipher the clues behind the host immune response that influences CRKP infection pathogenesis.

目的 探讨急性Stanford A型主动脉夹层(AAAD)术后患者发生呼吸机相关肺炎(VAP)的危险因素,分析感染病原菌分布.方法 选取南京医科大学第一附属医院2015年4月-2020年10月行A型夹层标准术且术后使用机械通气的139例患者,根据是否出现VAP分为感染组(n=35)和非感染组(n=104),对年龄、性别、住院天数、呼吸机支持天数、使用呼吸机次数、是否行急诊手术等多项临床病例资料进行病例对照分析,探索危险因素,分析病原菌分布特点.结果 单因素分析显示高龄、长时间机械通气、频繁气管插管可能会增加术后VAP感染概率;多因素分析显示机械通气时间延长(OR=1.197,95％CI:1.102～1.299)是A型夹层标准术后发生VAP的独立危险因素.机械通气时间越长,感染风险越高,尤其是>10 d的患者,VAP发生率>70％.术后发生VAP的病原菌主要为鲍氏不动杆菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌,耐药菌主要为泛耐药鲍氏不动杆菌(MDR-AB)、耐碳青霉烯铜绿假单胞菌(CR-PA)和肺炎克雷伯菌(CR-KP).结论 临床需积极采取预防措施,降低VAP感染风险,防治多药耐药菌感染,尤其尽可能缩短机械通气时间,改善预后.

目的 比较4种消毒方式对医疗机构物体表面消毒效果.方法 随机选取医疗机构常见物体表面40份,每份分4个区域,以4种消毒方式进行现场试验,比较消毒效果.方式1:一次性纸巾蘸取次氯酸消毒液直接擦拭物表;方式2:一次性纸巾蘸取清水擦拭物表达到去污效果后,再使用次氯酸消毒液喷洒消毒物表;方式3:一次性纸巾蘸取84泡腾片溶液擦拭物表;方式4:使用复合双链季铵盐化合物消毒湿巾擦拭物表.结果 消毒方式1～4回收菌量对数值由消毒前1.67(1.31～2.26)、1.87(1.26～2.47)、1.49(1.23～2.05)、1.77(1.25～1.97)降至消毒后的 0.15(0～0.84)、0(0～0.53)、0(0～0.78)、0(0～0.78),差异均有统计学意义(P值均＜0.05).消毒前、后各组回收菌量对数值分布差异均无统计学意义(P值均＞0.05).消毒方式2和方式3平均杀灭对数值＞1,为消毒合格,方式1和方式4均＜1,为不合格.结论 采用去污后再使用次氯酸喷洒消毒与84泡腾片消毒液擦拭消毒均合格,优于直接使用次氯酸消毒液擦拭消毒及使用复合双链接铵盐化合物消毒湿巾擦拭消毒.

Purpose To improve the ability of infection prevention and control (IPC) of medical staff during the COVID-19 epidemic period, the “four-step” mode of whole staff training and assessment was used. Methods During the period from March 9 to March 18, 2020, 5425 medical staff from The First Affiliated Hospital of Nanjing Medical University were selected as the objects of this study. There are four stages in the training assessment mode. The first stage is the basic assessment stage; the second stage releases the electronic version of the knowledge point manual; the third stage conducts online exercises; the fourth stage conducts the final assessment. Results In the first stage, the participation rate of medical staff was 95.04%. In the fourth stage, the participation rate of medical staff was 98.01%. The average score of female medical staff in the first stage and the fourth stage was higher than that of males (P< 0.001). The average score of medical staff under 30 years old in the first stage and the fourth stage was higher than that of other age groups (P< 0.05). In the fourth stage, the correct rate of each part of exercises in the knowledge points of IPC was higher than that in the first stage (P< 0.001). In the two stages, the two parts of “COVID-19 prevention and control” and “multi-drug resistant bacteria prevention and control” had the highest accuracy, while the “disinfection and sterilization” and “infectious disease management” had the lowest accuracy (P< 0.001). Conclusion The “four-step” infection control training assessment mode has realized “full participation” and “effective training”, and the level of medical staff’s IPC has been significantly improved.

Purpose: To improve the ability of infection prevention and control (IPC) of medical staff during the COVID-19 epidemic period, the "four-step" mode of whole staff training and assessment was used. Methods: During the period from March 9 to March 18, 2020, 5425 medical staff from The First Affiliated Hospital of Nanjing Medical University were selected as the objects of this study. There are four stages in the training assessment mode. The first stage is the basic assessment stage; the second stage releases the electronic version of the knowledge point manual; the third stage conducts online exercises; the fourth stage conducts the final assessment. Results: In the first stage, the participation rate of medical staff was 95.04%. In the fourth stage, the participation rate of medical staff was 98.01%. The average score of female medical staff in the first stage and the fourth stage was higher than that of males (P< 0.001). The average score of medical staff under 30 years old in the first stage and the fourth stage was higher than that of other age groups (P< 0.05). In the fourth stage, the correct rate of each part of exercises in the knowledge points of IPC was higher than that in the first stage (P< 0.001). In the two stages, the two parts of "COVID-19 prevention and control" and "multi-drug resistant bacteria prevention and control" had the highest accuracy, while the "disinfection and sterilization" and "infectious disease management" had the lowest accuracy (P< 0.001). Conclusion: The "four-step" infection control training assessment mode has realized "full participation" and "effective training", and the level of medical staff's IPC has been significantly improved.

Background: Recently, several studies have reported that the host immune response can be related to the RANKL/RANK/OPG signaling pathway. However, the associations of TNFSF11, TNFRSF11A, and TNFRSF11B gene polymorphisms in the RANKL/RANK/OPG pathway with hepatitis C virus (HCV) infection outcomes remain unclear. Methods: In this case-control study, 768 persistent HCV infection and 503 spontaneous HCV clearance cases, and 1,259 control subjects were included. The Taman-MGB probe method was utilized to detect TNFSF11 rs9525641, TNFRSF11A rs8686340, and TNFRSF11B rs2073618 genotypes. The distribution of three single nucleotide polymorphisms (SNPs) genotypes was analyzed using stata14.0. Results: SNPs rs9525641, rs8086340, and rs2073618 genotype frequencies followed the Hardy-Weinberg natural population equilibrium (p = 0.637, 0.250, and 0.113, respectively). Also, rs9525641 was significantly associated with HCV chronicity risk in recessive (OR = 1.203, 95% CI: 1.018-1.420, p = 0.030) and additive models (OR = 1.545, 95% CI: 1.150-2.075, p = 0.004). The stratified analysis showed that rs9525641 variant genotypes were associated with HCV chronicity among people older than 50 years (OR =1.562, 95% CI: 1.079-2.262, p = 0.018), females (OR = 1.667, 95% CI: 1.145-2.429, p = 0.008), ALT <40 U/L (OR = 1.532, 95% CI: 1.074-2.286, p = 0.018), and AST < 40 U/L (OR = 1.552, 95% CI: 1.095-2.201, p = 0.014). Conclusion: TNFRSF11 rs9525641 was significantly associated with HCV chronicity in the Chinese population.

通过系统梳理国家相关规范对内镜中心建筑布局的要求,分析内镜中心布局的要点,并结合内镜中心图纸审核的经验以及案例,提出相关建议.