Background: Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance. Aim: To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU). Methods: This retrospective observational study was conducted between July 1st, 2017 and February 28th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1st, 2017. Findings: After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05). Conclusion: The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Objective To investigate the predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB (CK-MB) for the prognosis of patients with acute paraquat poisoning.Methods A retrospectively analysis were conducted on 641 patients who were treated at the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from October 2002 to April 2017.The observation end point was that the patients died from paraquat poisoning within 3 months after admission or were still alive within 3 months after paraquat poisoning.The patients' data were retrieved,including general information,the dose of poison,urinary paraquat concentration,arterial blood gas analysis,alanine transaminase (ALT),total bilirubin (TBIL),uric acid (UA),aspartate transaminase (AST),creatine kinase (CK),CK-MB,B type natriuretic peptide (BNP),lactic dehydrogenase (LDH),high sensitivity troponin T (hsTnT),C-reaction protein (CRP) and procaicitonin (PCT).According to the patient's prognosis within 3 months,the patients were divided into a survival group and a non-survival group.The above indicators were compared between the two groups and the diagnostic value of CK-MB for acute paraquat poisoning was analyzed according to the receiver operating characteristics (ROC) curve.Collect the last arterial blood gas analysis,and laboratory test results were analyzed by binary logistic regression analysis to determine the risk factors for death in patients with acute paraquat poisoning.Results Among the 641 patients with acute paraquat poisoning,315 (49.1％) patients survived and 326 (50.9％) died.Compared with the survival group,patients in the non-survival groupthere were older,had a shorter hospital stay,and had a higher oral paraquat dose and urinary paraquat concentration;Lac,TBIL,UA,AST,CK,CK-MB,BNP,LDH,CRP and PCT were higher,while blood gas analysis index were lower in the non-survival group (P＜0.05).Binary logistic regression analysis showed that the dose of paraquat,CK-MB and AST were closely related to the prognosis of patients with acute paraquat poisoning.The optimal cut-off value of ingestion dose,the first urinary paraquat concentration on admission and CK-MB in predicting the prognosis of patients with acute paraquat poisoning were 7 g (AUC=0.918,sensitivity 80.6％,specificity 87.5％,Yoden index 0.681,P＜0.01),5.16 μg/mL (AUC=0.879,sensitivity 93.8％,specificity 70.1％,Yoden index 0.639,P＜0.01),and 18.2 U/L (AUC=0.846,sensitivity 83.9％,specificity 71.9％,Yoden index 0.558,P＜0.01),respectively.Binary logistic regression analysis of the last biochemical indicators of paraquat poisoning showed that the dose of poison,the last CK-MB,the last SCr,urinary paraquat concentration,and the last blood Na+ were closely related to the prognosis of patients with acute paraquat poisoning.Among them,the last CK-MB＞18.05 U/L often indicated poor prognosis (AUC=0.808,sensitivity 79.7％,specificity 65.8％,Yoden index 0.455,P＜0.01).Conclusions In the treatment of patients with acute paraquat poisoning,there are significant differences in extra pulmonary factors such as heart,liver,kidney,electrolytes and inflammatory markers in patients with different prognosis,so the monitoring and follow-up should be improved,in addition to focusing on the presence and treatment of pulmonary fibrosis.In particular,CK-MB is an independent risk factor for the prognosis of acute paraquat poisoning.In the late stage of poisoning,CK-MB,SCr,and blood Na+ have a strong predictive value for the prognosis of the patients,and we should pay attention to the regular follow-up of the above mentioned laboratory items.

Objective To investigate the evaluation value of white blood cell count ( WBC ) for the prognosis of patients with acute paraquat ( PQ) poisoning .Methods The clinical data of 661 patients with acute PQ poisoning admitted to the Emergency Department of the First Affiliated Hospital of Zhengzhou University from March 2013 to April 2017 were retrospectively analyzed . The general information of patients and biochemical indicators 24 hours after admission were collected .The in-hospital death were recorded and patients were followed up by telephone .According to the prognosis within 30 days after poisoning , the patients were divided into survival group and death group .Multivariate logistic regression analysis was used to analyze the independent risk factors of PQ poisoning , and the receiver operating characteristic curve ( ROC ) was drawn for prognosis evaluation .Results Among the 661 patients with acute PQ poisoning , 368 cases ( 55.7％) survived and 293 cases ( 44.3％) died. Multivariate logistic regression analysis showed that hospitalization days , dosage , duration of poisoning , urine PQ concentration, WBC, serum potassium and serum creatinine (Scr) were the independent risk factors.The ROC curve showed that the area under the ROC curve (AUC) of urine PQ concentration and WBC predicting the prognosis of patients with acute PQ poisoning were 0.897 [95％CI(0.873, 0.920), P<0.01], and 0.876 [95％CI(0.850, 0.902), P<0.01].WBC≥15.35 ×109/L was used as the critical value for prognosis . The sensitivity and specificity of survival were 72.7％ and 88.59％, respectively .Conclusions White blood cell count may be a powerful and simple predictor for prognosis of PQ.

Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) on critical patients with non-pulmonary primary disease in the emergency department. Methods The literature of English and Chinese clinical studies on the ECMO treating critical patients with non-pulmonary primary disease published before August 2017 were electronically searched on PubMed, Embase and other databases. The obtained articles were selected, their qualities were strictly evaluated, and the in-hospital survival rate, 3-month, 6-month and 1-year survival rate, as well as the average intensive care unit (ICU) and length of hospital stay were extracted. This meta-analysis were performed using RevMan software (Version 5.0, Cochrane collaboration). Results A total of 11 articles (n=3043) were enrolled including 616 cases of ECMO treatment group and 2427 cases of control group. Fitting results showed that compared with the traditional treatment, application of ECMO can improve the in-hospital survival rate[52.1％(321/616) vs. 32.1％ (780/2427); OR=2.02; 95％CI:1.11-3.67, P=0.02] and the survival rate more than 90 days[42.1％ (61/145) vs. 17.1％ (38/222); OR=3.98; 95％CI:2.30-6.89, P<0.01];and prolong the average length of hospital stay (MD=-5.35, 95％CI:-8.10--2.60, P<0.01) and ICU time(MD=-8.99, 95％CI:-8.20--1.80, P<0.01). Conclusions Meta-analysis of existing studies showed that application of ECMO can improve the short-term and long-term prognosis of critical patients with non-pulmonary primary disease. However, due to the small number of studies and the large heterogeneity of the study population, it is necessary to carry out more, large samples and high quality randomized controlled clinical trials.