目的 探讨通过戴明环(PDCA)管理法多举措对降低新生儿重症监护病房(NICU)多重耐药菌(MDRO)发生的效果.方法 2016年7月—2017年12月,采用PDCA法对NICU院内感染防控和抗菌药物使用进行综合管理,比较干预前后NICU院感发生率、人均抗菌药物费用和抗菌药物使用情况、MDRO检出、MDRO致医院感染等变化情况.结果 干预后,NICU院感发生率由2.03％降到0.75％.人均使用抗菌药物费用由(1266.28±234.54)元降到(906.11±189.24)元(P<0.001);人均使用抗菌药物天数由(10.21±3.64)d降到(8.76±2.81)d(P=0.012);特殊使用级抗菌药物使用率由30.19％降到18.00％(P<0.001).MDRO检出率由37.70％降至4.25％(P<0.001),重点MDRO检出率由23.77％降至0(P=0.001).NICU检出MDRO患者由2.76％降至0.30％(P<0.001),MDRO致医院感染患者由1.31％降至0.15％(P=0.031).结论 PDCA管理法加强院感防控、规范抗菌药物使用后,可明显降低NICU的院感发生和MDRO的检出,抗菌药物使用情况得到明显改善.

目的:探讨多方位心理支持对试管婴儿产妇心理健康的影响.方法:选取2017年1月1日 ～2019年6月30日入院分娩的试管婴儿产妇240例为研究对象,根据区组随机分组法将产妇分为对照组和观察组各120例,对照组分娩至出院期间接受常规护理,观察组分娩至出院期间接受多方位心理支持护理,比较两组抑郁情绪、心理韧性、相关母婴操作与知识的掌握度及生活满意度.结果:护理干预后,观察组症状自评量表(SCL-90)评分低于对照组(P<0.05),心理韧性高于对照组(P<0.05),相关母婴操作技能和健康知识的掌握度高于对照组(P<0.05),生活满意度高于对照组(P<0.05).结论:对试管婴儿产妇提供多方位的心理支持,能有效缓解产妇抑郁情绪,提高其心理韧性和生活满意度,对促进产妇心理健康有积极作用.

目的 观察一种复方过氧乙酸消毒液对消化内镜的现场消毒效果.方法 通过现场消毒试验观察方法,比较一种复方过氧乙酸消毒液与邻苯二甲醛消毒液对消化内镜的消毒效果.结果 采用手工清洗消毒程序,在消毒环节使用浓度2000～3300 mg/L该复方过氧乙酸消毒液对胃镜浸泡消毒5 min,消毒效果合格率为100％;对肠镜消毒效果合格率为90％.用浓度为5000 mg/L邻苯二甲醛消毒液,对胃镜浸泡消毒5 min,消毒效果为100％;对肠镜浸泡消毒5 min,消毒效果合格率为90％.将浸泡消毒时间延长至10 min,两组消毒剂对肠镜的消毒效果合格率均达到100％.结论 该复方过氧乙酸消毒液对胃镜和肠镜均具有良好的消毒效果,但对肠镜消毒需要更长的时间.

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.

在早期经验性抗感染治疗过程中,临床药师结合患者基础疾病、影像学特点、既往治疗情况等分析了患者可能的病原菌及耐药特点,指导了下呼吸道感染患者的抗感染治疗过程;在目标治疗中,通过对感染疾病特点、耐药菌治疗分析,正确诊断和鉴别诊断,协助医生更好地制定了临床治疗策略,在临床治疗过程中及时、有效地进行抗感染治疗,在危重患者的抗感染治疗策略的制定中发挥了重要作用.

随着科学技术的不断提高,医学水平也在不断的进步,对于一些疾病的治疗技术也在不断的提升,其中先兆流产作为妊娠期间一直常见的妇科疾病,这种疾病主要发生在妊娠的28周前,一般都是以下腹疼痛、阴道少量出血,严重的情况下还会伴有小腹坠胀和腰疼.如果不能够及时的对患者进行有效的诊治,将会造成非常严重的后果.在妊娠期间,孕妇的阶段性情绪不稳定会使得自身大脑皮层功能受到影响,导致子宫收缩不稳定,从而加快了胚胎的排出速度,对孕妇的生活质量来说有着极大的影响.

Background: Few data are available on hospital-wide incidence of central line-associated bloodstream infection (CLABSI) rates in patients with central venous catheter (CVC) in China, where many systemic obstacles holding back evidence-based guidelines implementation exist. Methods: This study was conducted prospectively in 2 phases. The baseline and intervention phases were performed in a teaching hospital in China, between January 2017 and October 2018. A systematic quality improvement (SQI) and multidisciplinary teamwork (MDT) CLABSI infection control program was introduced in the intervention phase. In the intensive care units (ICUs) and non-ICUs, CLABSIs were continuously monitored, data collected, then analyzed. Results: After intervention, the CLABSI rate decreased from 2.84-0.56 per 1,000 CVC days in ICUs (P < .001), and from 0.82-0.47 per 1,000 CVC days in non-ICUs (P = .003). The length of time until CLABSI occurrence increased from 8.72-13.60 days in ICUs (P = .046), and from 10.00-12.00 days in non-ICUs (P = .048). The number of multidrug-resistant bacteria isolated from CLABSI episodes decreased both in ICUs and in non-ICUs. Conclusions: The SQI and MDT CLABSI infection control program is effective in reducing hospital-wide CLABSI in patients with CVC, both in ICUs and in non-ICUs. (C) 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

目的 分析多重耐药(MDR)菌引起呼吸机相关性肺炎(VAP)的危险因素及痛原菌情况,以进行风险评估管理并指导合理用药.方法 对2016年9月-2018年3月武汉大学人民医院重症医学科(ICU)VAP患者进行回顾性队列研究,作单因素和logistic回归分析,筛选MDR菌引起VAP的危险因素,并分析ICU中VAP患者的病原菌特点.结果 ICU发生VAP 78例,其中MDR菌引起41例(52.56％).logistic回归分析显示,直接从其他医疗机构转入(OR=36.50)、近90d接受第3和第4代头孢菌素、含酶抑制剂类复合制剂和碳青霉烯类等抗菌药物治疗(OR=24.55)、危重合并感染性休克(OR=12.32)、ICU住院时间≥5 d(OR=12.22)是发生MDR-VAP的独立危险因素.从78例VAP患者中共分离出病原菌121株,多重耐药菌84株,占69.42％.导致VAP的主要病原菌中鲍曼不动杆菌以耐药菌为主,而肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌等是耐药菌还是非耐药菌均有可能,嗜麦芽窄食单胞菌以非耐药为主.结论 ICU中导致YAP的主要病原菌有鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌等,经验用药时对于致病菌的耐药性评价应根据危险因素进行评估,并制定相应的预防与控制策略,并以此为依据规范初始经验性抗感染治疗.

目的:在子宫颈癌围术期护理中采用快速康复护理,并对其应用效果进行分析和探讨.方法:选择本院在2016年4月～2018年8月之间收治的98例子宫颈癌患者,入院后将所有患者应用随机数字表法分为康复组和对比组,各组49例患者.康复组子宫颈癌患者在围术期接受快速康复护理对比组子宫颈癌患者在围术期接受常规护理,比较两组患者术后并发症发生率和负面情绪评分.结果:康复组患者术后并发症发生率明显比对比组低,P<0.05;康复组患者负面情绪评分显著低于对比组,P<0.05.结论:在子宫颈癌患者围术期应用快速康复护理,不仅能有效降低患者术后各项并发症发生情况,也能改善患者情绪,对促进患者康复有重要意义,值得应用.

目的 分析中国医院感染培训相关文献的增长规律、研究热点和前沿,并探索其发展方向.方法 以中国知网(CNKI)为数据来源,利用Excel表格分析文献增长规律,利用CiteSpace可视化软件通过文献关键词共现网络分析方法识别国内医院感染培训研究热点和前沿.结果 共纳入1 267篇文献,文献发表经历了起步期(1991-2003年)、增长期(2004-2013年)和平稳期(2014年及以后)三个阶段,发表刊物以《中华医院感染学杂志》《中医药管理杂志》和《中国感染控制杂志》为主.关键词共现本图谱共识别出131个节点,387条连接线.识别研究热点为:“依从性”、“手卫生”、“手术室”、“医院感染”、“医务人员”、“岗前培训”和“保洁员”,其中心度值均≥0.30.研究热点呈现一定的演变规律,近期以“知识培训”和“基层医疗机构”为研究前沿.结论 中国医院感染培训研究的发展与全国医院感染管理工作的发展密切相关,今后对非专职人员的培训体系尚需完善,对专职人员培训体系及效果评价的研究尚需加强.

Objective To evaluate disinfection efficacy of slightly acidic hypochlorous water (SAHW) on object surfaces of hemodialysis room. Methods 30 dialysis units in the hemodialysis room were dividea into two groups (trichloroisocyanuric acid group and SAHW group) by random number table method, 15 dialysis units in each group. Trichloroisocyanuric acid group disinfected object surface of each hemodialysis unit with trichloroisocyanuric acid containing 500 mg/L available chlorine, and SAHW group disinfected with SAHW. The colony counts on object surface after 4 hour disinfection were detected, the qualified status and killing of multidrug-resistant organisms (MDROs) between two disinfection methods were compared. Results After bedrails, screens of dialysis machine, and knobs of dialysis machine were disinfected by trichloroisocyanuric acid containing 500 mg/L available chlorine and SAHW respectively, the qualified rates of trichloroisocyanuric acid group were 90.00％, 80.00％, and 90.00％ respectively. SAHW group were 100.00％, 96.67％, and 100. 00％ respectively, difference was not significant between two disinfection methods(both P＞0.05). SAHW disinfection testing showed that the killing rates of SAHW to four MDROs were both 100％. Conclusion Disinfection efficacy of SAHW is the same as that of trichloroisocyanuric acid containing 500 mg/L available chlorine, and has high killing effect on the common MDROs in the hemodialysis room.

目的 建立基于风险矩阵的重症医学科医院感染风险评估体系,明确其医院感染管理重点.方法 采用文献回顾与复习的方法形成风险数据库,随后在专家咨询法的基础上明确风险评估量表及得分.在风险矩阵分析法的基础上,通过风险序数、风险矩阵及风险带构建风险评估体系.结果 25个重症医学感染风险纳入本次风险评估中.医务人员(R=18.06)、疾病程度(R=15.33)、侵入性操作(R=15.33)、物体表面(R=14.69)是风险等级较高的风险;医务人员(P=4.17)、侵入性操作(P=4.00)、物体表面(P=3.83)等是风险发生概率较高的风险;经器械传播(C=4.83)、“三管”(C=4.67)、经接触传播(C=4.50)等是风险发生严重性较高的风险.25个风险中,12个风险位于高风险带(LR=20),10个风险位于中风险带(LR=16),3个风险位于低风险带(LR=4).结论 医务人员的标准预防措施执行不到位,患者的病情程度复杂,侵入性操作及环境物体表面清洁消毒不合格是重症医学科发生医院感染的较高危风险.

目的 探索危害分析与关键控制点技术(Hazard Analysis Critical Control Point,HACCP)方法在医院感染风险识别与控制中的应用,掌握重症医学科感染的相关因素和关键控制点,并采取关键控制点技术控制其流行.方法 采用文献复习及临床实证研究建立重症医学医院感染HACCP体系,随后进行HACCP在重症医学的运行、监控及纠偏并对HACCP的实施效果进行评估.结果 基于HACCP方法,重症医学监护室医院感染的关键控制点在于ICU布局及流程、人员管理、中心静脉导管、导尿管、呼吸机、环境物表及床单元.实施HACCP进行控制后,环境卫生学监测结果、手卫生监测结果及三管感染率较之前均有不同程度的改善.干预后手卫生依从性为84.78％(312/368)高于干预前69.84％(220/315)(P<0.001).结论 HACCP在重症医学医院感染控制中应用效果较好,不仅能准确识别重症医学全流程的医院感染风险,进行精准管理,更可防患于未然,做到有的放矢.

Objective To study the changing trend of prevalence rates of healthcare-associated infection (HAI) and antimicrobial use in hospitalized patients in medical institutions of Hubei Province,and provide a scientific basis for improving HAI management.Methods The cross-sectional survey results of HAI in Hubei Province in 2010, 2012,and 2014 were analyzed.Results The prevalence rates of HAI in 2010,2012,and 2014 were 3.48%(1526/43909),3.03%(1919/63320),and 2.86%(2174/76145)respectively,which showed a downward trend,differ-ence was statistically significant(χ2 =36.44,P <0.01).Antimicrobial usage rate decreased from 54.29% (23838/43909)in 2010 to 41.02% (31238/76145)in 2014,difference was statistically significant(χ2 =2194.09,P <0.01).Among patients receiving therapeutic use of antimicrobial agents,the specimen detection rate increased from 30.49% (4297/14091)in 2010 to 52.13% (10556/20248)in 2014 (χ2 =1593.98,P <0.01).Conclusion The prevalence rate of HAI showed a downward trend in Hubei Province,cross-sectional survey on antimicrobial use showed a gradual decrease.

With the advance of science and technology, the endoscopic technique has achieved remarkable progress in clinical practice, which contributes to more simple and accurate diagnosis and treatment of diseases.However, the endoscope-induced nosocomial infection outbroke occasionally and is mainly attributed to the unthorough cleaning and disinfection, which results in the invasion of pathogens that populated on the endoscopes and their accessories into the patients, it has become a issue that attracts the concern of the medical field, patients and social media.Therefore, the operation guidelines for cleaning and disinfection of endoscopes are formulated worldwide.This article explains the Chinese'Technical regulations for cleaning and disinfection of flexible endoscopes' (WS507-2016) in detail by interpreting the drafting task sources, compiling evidence of key contents and illustrations, feasibility of criteria and implementation proposals and illustrates the common problems during the propaganda and implementation of the'Technical regulation'.

Objective To understand the basic situation of healthcare-associated infection(HAI)management and prevention and control of multidrug-resistant organism(MDRO)infection in medical institutions in Hubei Province.Methods Questionnaires were used to investigate the basic situation of HAI management and MDRO infection in 47 tertiary and secondary hospitals in Hubei Province.Results 47 hospital were enrolled in this study,HAI management full-time staff was allocated with a median of 0.90/250 beds;in 2015,the isolation rates of methicillin-resistant Staphylococcus aureus,carbapenem-resistant Enterobacteriaceae,carbapenem-resistant Pseudomonas aeruginosa,carbapenem-resistant Acinetobacter baumannii,and vancomycin-resistant Enterococcus were 39.13%,4.13%,19.44%,63.60%,and 2.77%respectively.47 hospitals all carried out surveillance on MDROs,28(59.57%)hospitals were installed HAI monitoring system software,could directly obtain data through collecting with the laboratory system.The diagnosis of MDRO infection was mainly based on the combined diagnosis by HAI full-time personnel and clinicians(26 hospitals,55.32%).44(93.62%)hospitals regularly convened coordination meeting on prevention and control of MDROs,in 2015,hand hygiene compliance rate were 10.0%-89.2%by self-inspection;42(89.36%)hospitals routinely prescribed isolation orders for patients with MDRO infection,33(70.21%)hospitals conducted environmental clean and disinfection twice a day,24(51.06%)hospitals performed personal protection by using complete set of protective equipment.Conclusion This investigation is helpful for understanding the general situation of HAI management in medical institutions,as well as the detection and control of MDROs in this area,and make continual improvement on the problems and weakness found in the investigated project,so as to promote the development of HAI management in this area.

OBJECTIVE To explore the hotspots of research on international nosocomial infections based on co-occurrence analysis of related literatures published abroad.METHODS The study was based on a variety of English databases, the hotspots of research on international nosocomial infection were identified by means of co-occurrence network analysis of citation and key works by using Citespace visualization software.RESULTS Totally 5986 items were included in the co-occurrence analysis, 490 nodes and 893 links were identified in the citation ring mapping.The core paper clusters of international research on nosocomial infections in nearly past twenty years were formed and mainly represented by 10 references such as Horan TC(citation counts=263).The risk factors(citation counts=513), nosocomial infections(citation counts=480), prevalence(citation counts=288), diseases(citation counts=268), intensive care unit(centrality=0.20), blood stream infections(centrality=0.18)and transplantation(centrality=0.13)were regarded as the identified research hotpots.Additionally, the results indicated that the international research on nosocomial infections showed a certain evolution rule in the recent ten years.CONCLUSION The hotspots of international research on nosocomial infection are similar to the hotspots of research on nosocomial infections in China.The big data and interdisciplinary can provide new ideas for in-depth research on nosocomial infections in China.

Objective To understand the current situation and existing problems in the training of healthcare-asso-ciated infection(HAI)management,and provide scientific basis for strengthening the management of HAI preven-tion and control system.Methods A questionnaire survey was adopted to investigate situation of training on HAI in 15 provincial-level HAI training agencies in China during the past 30 years,and basic condition of training on HAI management in recent 5 years.Results Among 15 provincial-level training agencies,66.67%(n=10)were respon-sible by HAI management quality control centers,80.00% have already conducted training in each city,53.33%carried out training for 10 to 20 times,33.34% performed training for ≤2 times per year.Of 33 728 trainees in 2011-2015,41.30% were 41-50 years old,61.82% were nursing staff,50.56% had bachelor degree,43.96%were with the intermediate professional title.Most trainers were HAI prevention and control experts in their respec-tive province,accounting for 68.07%,the curriculums were mainly designed on professional course,and only 26.78% were involved in management.Conclusion Professional structure of HAI management personnel is not reasonable,faculty is imbalance,knowledge update is lacking,and HAI training and education system need to be improved further.

Objective To understand the status and pathogenic characteristics of healthcare-associated infection (HAI)in cardiovascular surgical intensive care unit (ICU)patients undergoing heart transplantation.Methods Pa-tients who underwent heart transplantation in a hospital between July 1 ,2013 and June 30,2014 were performed targeted monitoring.Results Of 66 patients undergoing heart transplantation,16 developed 18 times of HAI,inci-dence of HAI was 24.24%.Incidence of HAI and ventilator-associated pneumonia(VAP)in patients undergoing heart transplantation were both higher than non-transplantation patients (24.24% vs 6.24%,χ2 =33.718;7.58%vs 1 .72%,χ2 =12.199,respectively,both P <0.001 ).The infection tyes were as follows:lower respiratory tract infection(n=7),VAP (n=6),bacteremia (n=3),superficial incision infection (n =1 ),as well as skin and soft tissue infection (n = 1 ). The isolated pathogens were fungus (n = 8 ),Klebsiella pneumoniae (n = 3 ), Staphylococcus aureus (n=2),Acinetobacter baumannii (n=2),Enterobacter cloacae (n=1 ),Acinetobacter hae-molyticus (n=1 ),and Citrobacter freundii (n =1 ).Conclusion Incidence of HAI is high in patients undergoing heart transplantation,the main infection type is lower respiratory tract infection,the major pathogen is fungus.

目的 介绍国外医用织物洗涤消毒管理体系、技术标准与风险管理要求,简述国外医用织物推荐的洗涤消毒方法与卫生清洁判定标准,分析我国医用织物洗涤消毒管理现状及主要存在的问题;指出全球医用织物洗涤消毒的管理模式正朝着行业规范化和规模化,流程与感控标准化和责任化,行为社会化并更环保,以及设备自动化和节能高效化方向发展.