Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
ObjectiveTo summarize the clinical experience in the prevention and treatment of novel coronavirus (2019-nCoV, SARS-CoV-2) disease (COVID-19) in the department of thoracic surgery of large grade A tertiary hospitals in Wuhan, and to provide feasible clinical practice strategies.MethodsThe clinical data of 41 COVID-19 patients in the department of thoracic surgery of 7 large grade A tertiary hospitals in Wuhan from December 15, 2019 to February 15, 2020 were analyzed retrospectively. There were 20 surgical patients (10 males and 10 females at an average age of 54.35±10.80 years) and 21 medical personnel (7 males and 14 females at an average age of 30.38±6.23 years).ResultsThe main clinical manifestations of COVID-19 patients were fever (70.73%) and cough (53.66%). Normal or reduced peripheral white blood cells and reduced lymphocyte counts were found in the COVID-19 patients, and some patients may have increased C-reactive protein. COVID-19 patients showed limited ground-glass opacities in early chest CT, which was evident in the edge band of lung. The disease could further develop into multiple pulmonary infiltrations, and pulmonary consolidation was found in severe cases. At the time of confirmed diagnosis, most of the medical personnel were ground-glass shadows and unilateral lesions, and even no obvious abnormalities were found in the lungs. The diagnosed COVID-19 patients were transferred to the isolation ward immediately and treated according to the "Diagnosis and Treatment Program of Novel Coronavirus Pneumonia", which was released by the National Health Commission of the People's Republic of China. At the end of follow-up on February 20, 2020, seven surgical patients (35.00%) were discharged and seven (35.00%) were dead, 13 (61.90%) medical personnel were discharged and no death was found.ConclusionsOf all COVID-19 patients in the department of thoracic surgery of hospitals in Wuhan, the proportion of severe degree and mortality in surgical patients are significantly higher than that of the general population, and medical personnel are prone to nosocomial infections. Early oxygen therapy and respiratory support may improve prognosis. During the epidemic period of COVID-19, elective or limited surgery is suggested to be postponed and the indications for emergency operation should be strictly controlled. Emergency operation is suggested to be treated in accordance with tertiary prevention. On the consideration of specialty in the department of thoracic surgery, all people of the ward should be carefully investigated for infection once one case is confirmed with COVID-19. Early detection, isolation, diagnosis, and treatment are the best preventive measures to improve the prognosis of COVID-19.
Objective To scientifically evaluate the nosocomial infection prevention and control ability of respiratory infectious diseases in general hospitals, and to construct a set of quantitative assessment system for the prevention and control ability of respiratory infectious diseases in general hospitals. Methods Papers, standards and guidelines online related to respiratory hospital infections published between January 1, 2010 and December 31, 2023 were selected, and infection control experience was summarized to build a pool of evaluation pionts. Then, this study used experts consultation to select the evaluation pionts, to calculate the weight coefficient and reached a consensus on the quantitative evaluation methods of each evaluation point. Results A total of 27 articles were included. The evaluation system included 17 evaluation points in 4 categories: “Basic management capacity” “Basic conditions of facilities and equipments” “The prevention and control capacity of nosocomial infection” and “The emergency response capacity”. Each evaluation point contained 3 quantitative evaluation indicators. The Cronbach’s α coefficients of the expert questionnaire consultation were 0.914 and 0.883, respectively. The scale-level content validity index was 0.932, and the item-level content validity index ranged from 0.823 to 1. Conclusions The evaluation system constructed in this study can be used for quantitative evaluation and quality self-examination of the prevention and control ability of respiratory infectious diseases in general hospitals. It also contributes to the continuous improvement of the quality of nosocomial infection prevention and control.
Objective To describe the current state of hospital infection prevention and control for flexible endoscope in Shanghai, and analyze the trend of infection prevention and control quality from 2018 to 2022. Methods According to Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS 507－2016), the quality of infection prevention and control for flexible endoscope was divided into seven parts: organizational management, layout, cleaning and disinfection (sterilization) process, environmental disinfection and sterilization, final rinse water, recording and monitoring, and occupational protection. Each quality control item was judged according to the on-site score and the correction opinion, and the item with correction opinion was judged as “unqualified”, otherwise it was “qualified”. The results of the infection prevention and control quality supervision for flexible endoscope from 2018 to 2022 were reviewed and analyzed, and the qualification rates of quality control items for hospitals at different levels and in different years were calculated. Results From 2018 to 2022, the total qualification rates of organization management, final rinse water, environmental disinfection and sterilization, and occupational protection were over 90%, and the total qualification rates of cleaning and disinfection (sterilization) process, and records and monitoring were over 80%. There was no statistically significant difference in the annual qualification rate (P>0.05). The total qualification rate of the layout was 78.19%, which was significantly higher before the outbreak of COVID-19 (2018-2019) than after the outbreak of COVID-19 (2020-2022) (P<0.001). There was no significant difference in the qualification rate of different levels of hospitals in terms of organizational management, layout, cleaning and disinfection (sterilization) process, records and monitoring, or occupational protection item (P>0.05). There were statistical differences in the qualification rates of different levels of hospitals in terms of final rinse water and environmental disinfection and sterilization (P<0.05). Conclusions The infection prevention and control qualification rate of flexible endoscope in Shanghai is high. However, the layout qualification rate after the COVID-19 pandemic is lower than before. There has been no significant trend in the quality of other items in the past five years. Weaknesses in the cleaning and disinfection (sterilization) process, as well as in recording and monitoring, are identified as key areas in management. Targeted training and supervision are recommended to address these weaknesses.
摘要:目的: 探討我院呼吸內科病房老年肺部疾病患者并發真菌感染發病的相關因素,分析其易患因素、臨床特征和治療。 方法 : 采用回顧性調查方法對2002年1月至2008年6月收住內科的經微生物檢查證實49例繼發真菌感染的患者進行分析,并與同期無真菌感染的肺部疾病患者(對照組)比較。 結果 : 在呼吸內科病房中,老年患者院內肺部真菌感染發生率為378%,主要感染部位為泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是繼發院內肺部真菌感染最常見的基礎疾病,其感染因素為長期使用廣譜抗生素(962%)和糖皮質激素(332%)、營養狀況不良(583%)出現低蛋白血癥及合并糖尿病、白細胞減少和侵襲性診療操作等。肺部真菌感染的臨床表現無特異性,確診需結合痰培養,組織病理學和臨床表現來確定,感染菌種以白色念珠菌為主,占626%。氟康唑治療有效率914%。研究組與同期無真菌感染的肺部疾病患者(對照組)比較:病死率分別為612%和082%,兩組治療無效的病例(惡化和死亡病例)比較差異有顯著性。 結論 : 院內真菌是呼吸系統疾病繼發感染的重要病原體,而白色假絲酵母菌是院內肺部真菌感染的主要致病菌,宿主免疫狀態、感染播散和疾病嚴重程度是影響預后的因素。該研究認為老年肺部疾病患者并發真菌感染的相關因素和影響預后的因素對其預防、診斷、治療、改進預后和生存質量有重要的臨床意義。除有效的抗真菌治療外,積極的綜合治療有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.
ObjectiveTo sum up experiences of precaution and provide evidence to prevent such accidents in the future via analyzing the nosocomial infection in newborn babies who were infected by rotavirus. MethodsWe investigated and monitored the 8 cases of nosocomial infection occurred between July 7th and July 14th, 2012 by epidemiologic and environmental hygienic methods, and analyzed the existing risk factors and took measures to control. ResultsThere were 8 nosocomial infected cases among the 45 newborn babies who were hospitalized. The infection rate was 17.8% and the accident lasted for 7 days. The distribution of space, time and population was clustered. Environment and hands were the main media to spread the virus. ConclusionThe accident was a suspected nosocomial infection caused by rotavirus in the hospital. It can be controlled effectively through intensive cleaning and sterilizing, isolated touching, and improving the medical staff's compliance and accuracy rate of hand sanitation.
When a clustered coronavirus disease 2019 epidemic occurs, how to prevent and control hospital infection is a challenge faced by each medical institution. Under the normalization situation, building an effective prevention and control system is the premise and foundation for medical institutions to effectively prevent and control infection when dealing with clustered epidemics. According to the principles of control theory, medical institutions should quickly switch to an emergency state, and effectively deal with the external and internal infection risks brought by clustered epidemics by strengthening source control measures, engineering control measures, management control measures and personal protection measures. This article summarizes the experience of handling clustered outbreaks in medical institutions in the prevention and control of coronavirus disease 2019, and aims to provide a reference for medical institutions to take effective prevention and control measures when dealing with clustered outbreaks.
Objective To preliminarily understand the equipment configuration and information system function improvement of the microbiology laboratory for etiological submission before antibiotic treatment in Chinese medical institutions, and provide a scientific basis for further targeted action work on the rate of etiological submission before antibiotic treatment. Methods A network questionnaire was released in “Sentinel Hospital Information Reporting System of National Hospital Infection Management Professional Quality Control Center” between March 1 and June 21, 2022. The second-level and above hospitals were investigated. Results A total of 783 hospitals were included, of which 765 (97.7%) hospitals had been equipped with microbiology laboratory equipment to varying degrees, and the allocation rate of tertiary hospitals was higher than that of secondary hospitals (P<0.05). The top three items of common pathogenic test were aerobic (98.3%), bacterial smear (97.6%) and fungal smear (95.1%), and the last three items were streptococcus pneumoniae urine antigen (20.4%), silver hexamine staining (19.0%) and gene sequencing (8.9%). The comparison of relevant information system and function improvement among hospitals of different levels showed that tertiary hospitals were superior to secondary hospitals (P<0.05). In different regions, except for the allocation rate of nosocomial infection information monitoring system and rational drug use monitoring system (P>0.05), other relevant systems and functional improvement of hospitals in eastern, central and western regions, the differences were statistically significant (P<0.05). The number of hospitals that could obtain the indicators of “etiological submission rate of inpatients before antibiotic treatment”“etiological submission rate related to hospital infection diagnosis”“etiological submission rate before combined use of key drugs” were 698 (89.1%), 474 (60.5%) and 337 (43.0%), respectively. Among the factors affecting the implementation of special actions, 454 hospitals (58.0%) thought that the information system was not fully functional, 341 hospitals (43.6%) thought that the etiology testing project was not fully carried out, and 148 hospitals (18.9%) thought that the microbiology laboratory testing ability was insufficient. Conclusion All kinds of hospitals at all levels in China, especially specialized and secondary hospitals, need to further improve the configuration of equipment and information system functions in the microorganism laboratory related to aetiology inspection, strengthen the support for microbial inspection, and strengthen information management, monitoring and analysis.
Objective To collect the data of nosocomial infection surveillance in secondary and tertiary medical institutions in Jiangsu Province and conduct comparative analysis among different regions to find out the gaps and provide basis for targeted continuous improvement. MethodsCombined with the requirements of grade hospital evaluation and high-quality development of public hospitals, the data of nosocomial infection incidence in medical institutions of Jiangsu Province in the first quarter of 2023 were collected by autonomous reporting and information capture, and the province was divided into three regions according to location: South Jiangsu, Central Jiangsu and North Jiangsu for analysis, so as to evaluate the regional level. Results A total of 109 medical institutions were included, including 78 tertiary hospitals and 31 secondary hospitals. The overall incidence rate of nosocomial infection was 0.81% (0.90%). The incidence of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinarytract infection (CAUTI) were 0.113‰, 1.553‰ and 0.424‰, respectively. The proportion of prophylactic drugs in Class Ⅰ incision and the incidence of surgical site infection in Class Ⅰ incision were 17.72% and 0.16%, respectively. In the above infection indicators, the incidences of CLABSI and VAP were higher in Central Jiangsu, while the other indicators were higher in South Jiangsu than in Central Jiangsu than in North Jiangsu. The utilization rate of antibiotics and the detection rate of pathogens in inpatients were 41.07% and 41.50%, respectively. Among South, North, and Central Jiangsu, the utilization rate of antibiotics was 41.83%, 41.51%, and 39.51%, respectively (χ2=446.789, P<0.001), and the detection rate of pathogens was 46.09%, 40.94%, and 35.09%, respectively (χ2=3036.865, P<0.001). In the detection rate of drug-resistant bacteria infection, the top 3 were carbapenem-resistant Acinetobacter baumannii (0.067%), carbapenem-resistant Klebsiella pneumoniae (0.031%) and methicillin-resistant Staphylococcus aureus (0.029%). Among them, the infection rate of drug-resistant bacteria in South Jiangsu was significantly higher than that in the other two regions. The detection rates of carbapenem-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were close to each other (83.77% vs. 53.91%), while the detection rates of carbapenem-resistant Escherichia coli (χ2=95.619, P<0.001), carbapenem-resistant Klebsiella pneumoniae (χ2=520.855, P<0.001) and carbapenem-resistant Pseudomonas aeruginosa (χ2=191.918, P<0.001) in South Jiangsu were significantly higher than those in Central and North Jiangsu. Conclusions There are significant differences in nosocomial infection surveillance data of medical institutions in different regions of Jiangsu Province. It is emphasized that targeted quality control feedback, supervision and rectification should be carried out while hospital infection monitoring.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.