There is a worldwide consensus that urgent action is needed to prevent and control multi-drug resistant organisms in health care settings, especially carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPsA). In 2017, to focus on this topic, World Health Organization organized experts worldwide to develop guidelines for the prevention and control of CRE, CRPsA and CRAB. In this paper, we introduced the background, development process, main measures, advantages and disadvantages of the guidelines to help infection prevention and control practitioners take actions properly based on the guidelines.
After more than 30 years of localized development of infection prevention and control in China, a prevention and control system in line with China’s conditions has been established. Since the coronavirus disease 2019 pandemic began, with the unprecedented attention paid to healthcare associated infection by health administrative departments at all levels, the awareness of infection prevention and control of various personnel has been continuously strengthened, which has promoted the cross-integration and development of infection prevention and control-related disciplines. However, under the normalized pandemic prevention and control, infection prevention and control work also faces enormous pressure and challenges. This paper summarizes the opportunities for infection prevention and control in the new era, analyzes the current challenges in the field of infection prevention and control, and aims to provide some ideas for the future development of infection prevention and control.
In October 2022, thirteen government departments including the National Health Commission jointly issued the National Action Plan to Combat Antimicrobial Resistance (2022-2025) to proactively address challenges of antimicrobial resistance. In support of the implementation of the National Action Plan in healthcare institutions, the authors put forward following suggestions for prevention and control measures: strengthen construction of supporting systems and disciplines, enhance prevention and control of hospital-acquired infections caused by drug-resistant bacteria, promote precision diagnosis and treatment through diagnostic stewardship, advance rational drug use by performing prescription review, carry out universal and targeted training, establish clinical decision support systems using information technology, improve monitoring and evaluation systems, and enhance multi-source data fusion and application.
Healthcare-associated infection management has advanced rapidly in recent years. With the development of more standards and guidelines, infection control measures become more standardized and evidence-based. Evidence-based measures are increasingly applied in infection control, which promote more studies on the prevention and control of healthcare-associated infections. Furthermore, more new ideas of infection control have emerged, with old ones being challenged. The hand hygiene reform, multidrug-resistant organisms, and surgical site infections become the hot topics in recent years. In addition, whole-genome sequencing also provides more bases for understanding pathogen transmission in hospitals. Based on the high-quality studies published in recent years, this opinion review discusses these hot topics in the prevention and control of healthcare-associated infections.
In recent years, the prevalence of carbapenem-resistant Enterobacterales (CRE) has been remarkably increasing. Infections caused by CRE have significantly increased the burden on patients both medically and economically, and the CRE often leads to outbreaks of healthcare-associated infections. It has now become a global public health concern. Consequently, international organizations and academic societies/associations, including the World Health Organization, have developed corresponding prevention and control guidelines. This article provides a detailed introduction to the background, principles, key understandings, and implementation recommendations of China’s Standard for Prevention and Control of Carbapenem-resistant Enterobacterales (WS/T 826－2023). The aim is to enhance the recognition of healthcare workers and medical administrators to prevent and control CRE and to provide detailed technical guidance for healthcare facilities in responding to the spread of CRE, thus ensuring medical quality and patient safety.
目的 探討腎移植患者非結核分枝桿菌（NTM）病臨床特點及分子診斷。 方法 回顧性分析2011年4月1例皮膚軟組織NTM感染的腎移植患者的臨床特點，并以其病變組織DNA為模板，聚合酶鏈反應（PCR）擴增hsp65基因和rpoB基因序列，測序比對鑒定其NTM菌種。結合文獻復習NTM病及分析分子生物學技術在移植患者NTM感染診斷中的作用。 結果 該腎移植患者系皮膚軟組織胞內分枝桿菌感染，臨床特點與結核病極其相似，難以進行鑒別診斷。PCR擴增、測序的結果顯示hsp65產物和rpoB產物序列與胞內分枝桿菌GeneBank中FJ643456.1及CP003324.1序列100%一致。 結論 NTM病的臨床表現與結核病相似，分子生物學方法鑒定菌種對移植患者胞內分枝桿菌病的診斷有幫助。
ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To explore the application of two methods of direct fecal detection ofClostridium difficilein patients with recurrent inflammatory bowel disease (IBD), including nucleic acid amplification test (NAAT) and enzyme immunoassay (EIA), in order to provide support for hospitals to prevent and control clostridium difficile infection (CDI). Methods Fresh feces of 48 patients with recurrent IBD treated between November 2014 and April 2015 were collected within 48 hours after admission. Anaerobic culture and identification, NAAT and EIA were used to test the same samples. Statistical analysis was performed using Kappa test. Results Among the 48 fecal samples,Clostridium difficilewas negative in 37 and positive in 11 including 2 (4.2%) with toxigenicClostridium difficile characterized as toxin type A+B+. Compared with anaerobic culture and identification, NAAT had a perfect correlation (Kappa=1.00,P<0.05), and EIA had an almost perfect correlation (Kappa=0.89,P<0.05). But EIA toxin test had missed detection of toxigenic samples. Conclusions For patients with recurrent IBD combined with CDI, both NAAT and EIA test may be applied to detctClostridium difficile in feces directly, while NAAT may show a better performance. Samples from highly suspected patients with negative toxin result tested by EIA should be confirmed by other methods such as NAAT.
The quality of disinfectant, disinfection devices and disposable medical devices is closely related to the patients' safety. Hospital infection management department must carry out the audit responsibilities for qualification documents of disinfectant, disinfection devices and disposable medical devices, to guarantee legality, safety and effectiveness of products used in hospital. This paper mainly introduces the implementation of qualification documents audit in West China Hospital, Sichuan University, including system construction, process reengineering, documents audit scope and key points, and document management.