Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.
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.
Objective To explore the prevention and control effect of carbapenem resistant Gram-negative bacillus (CRO) in geriatric ward based on transparent supervision model. Methods Patients admitted to the geriatric ward in the First People’s Hospital of Lianyungang between January 2018 and December 2022 were selected. A transparent regulatory model for CRO was established and implemented in 2019, including the establishment of a regulatory group, the development of cluster prevention and control measures, the implementation of transparent reminder, publicity, supervision and assessment and other management measures. We evaluated the effectiveness by comparing the detection rate and infection rate of CRO before and after the intervention. Results A total of 15015 patients were monitored, and a total of 418 strains of CRO were detected. The incidence rate of noso-comial infection was decreasing year by year（χ2=26.666, P<0.001), and the etiological submission rate of hospitalized patients before antimicrobial treatment had been increasing year by year（χ2=280.320, P<0.001). The detection rate of CRO infection had been decreasing year by year, but the difference was not statistically significant (P>0.05), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia infection (P=0.030). The detection rate of CRO had been decreasing year by year (χ2=33.593, P<0.001), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia (χ2=23.663, P<0.001) and carbapenem resistant Pseudomonas aeruginosa (χ2=14.527, P=0.006).Conclusions By establishing and promoting transparent supervision mode in the geriatric ward, the detection rate and infection rate of drug-resistant bacteria can be significantly reduced, and the prevention and control effect of CRO in the elderly patients in the ward can be effectively improved to ensure the safety of elderly patients.
Objective To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). Methods A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m2, with an average of 26.7 kg/m2. Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson’s test. According to the median BMI of patients (25.81 kg/m2), the patients were allocated into high BMI group (>25.81 kg/m2, n=10) and low BMI group (≤25.81 kg/m2, n=10), and the influencing factors of WBL ratio was analyzed by linear regression. Results There was no significant difference between pre- and post-operation in LDFA and JLCA (P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio (P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference (t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference (t=1.760, P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group (P<0.05), but X was not an influential factor of Y in the high BMI group (P>0.05). Conclusion Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m2.