The prevention and control of hospital infection should be precise. Otherwise, a lot of medical resources will be wasted. To achieve accuracy, prevention and control should be considered from the microbial level to enhance its scientific nature. It is specifically reflected in the need of having knowledge of microorganisms, understanding the pathogens of infection and their transmission routes, therefore to carry out prevention and control work contrapuntally. Specific measures include infection surveillance at the microbial level, establishing the idea and habits of infection diagnosis from the microbial level, being familiar with microbial perspective to identify infection risks and vulnerabilities, implementing evidence-based prevention and control measures for different pathogens, encouraging researches on infection control and management at the microbial level, and developing precise prevention and control regulations, standards, or guidelines for specific pathogens.
ObjectiveTo study the current situation and influencing factors of biofilm formation of digestive endoscopy in Zhongshan Hospital, Fudan University.MethodsFrom September 1st to 13th, 2020, ATP fluorescence assay and membrane filtration method were carried out on 130 endoscopes from the Endoscopy Center of Zhongshan Hospital, Fudan University. The type, number, source, duration of use and disinfection times in the past week were collected. Positive culture samples were identified by matrix-assisted laser desorption / ionization time of flight mass spectrometry. Logistic regression analysis was used to explore the factors affecting the formation of biofilms.ResultsThe total qualified rate of ATP assay and bacterial culture was 94.62% and 92.31% respectively. The 10 positive culuture samples were mainly composed of Pseudomonas aeruginosa, Moraxella osloensis, Stenotrophomonas maltophilia, Pseudomonas putida and Micrococcus luteus. Multivariate logistic regression analysis showed that the frequency of disinfection in the past week was associated with positive biofilm culture (P=0.001). The odds ratio of disinfection frequency more than 30 times in past week compared with disinfection frequency less than 15 times was 0.040, and 95% confidence interval was (0.005, 0.295).ConclusionsThe biofilm of digestive endoscopy in the Endoscopy Center of Zhongshan Hospital, Fudan University is mainly formed by aquatic bacteria. The formation biofilm can decrease by increasing disinfection frequency, and attention should be paid to the monitoring of endoscopic biofilm in the future.
Objective To investigate the status of nurses’ cognition of skin test for β-lactam antibiotics in tertiary hospitals in China and its influencing factors. Methods The nurses in the eastern and western regions were selected by stratified sampling and convenient sampling between March and May 2023. A multi-center survey was conducted with the help of the questionnaire star platform using the “Questionnaire on the Cognitive Status of β-lactam Antibiotics Skin Test” developed by the “Guidelines for β-lactam Antibiotics Skin Test (2021 Edition)” issued by the National Health Commission of the reference country. Results A total of 89 tertiary hospitals were surveyed. Among them, there were 27 in the eastern regions and 62 in the western regions; There were 64 comprehensive hospitals and 25 specialized hospitals. A total of 4 241 nurses were included. Among them, 4 151 were females and 90 were males. The scores of nurses’ cognition of skin test of β-lactam antibiotics were (61.47±16.27). The survey results showed that the accuracy rate ranges from 15.52% to 88.98%. Only no routine skin test before cephalosporin administration, judgment of skin test results, and infusion device replacement after allergy were greater than 80%. The results of the logistic regression analysis showed that the nurses with professional titles and antimicrobial management training in the past 2 years were independent influencing factors of nurses’ cognition of skin test of β-lactam antibiotics (P<0.001). Conclusions At present, nurses in tertiary hospitals in China still have insufficient knowledge of skin test of β-lactam antibiotics. It is suggested that hospitals should form corresponding hospital skin test of β-lactam antibiotics standards in combination with guidelines and strengthen training for nurses in this regard, so as to improve nurses’ correct cognition and implementation of skin test of β-lactam antibiotics.
Objective To investigate and analyze the difficulties of nosocomial infection management in different-level medical institutions in Shanghai, and to provide scientific basis for improving the level of nosocomial infection management. Methods A questionnaire was designed to include 10 difficulties in nosocomial infection management such as professional title promotion, salary, and personnel allocation. In October 2023, the Shanghai Nosocomial Infection Quality Control Center, in collaboration with the Shanghai Hospital Association, conducted a questionnaire survey among the heads of nosocomial infection management departments in medical institutions in Shanghai. The scores of difficulties were analyzed by stratification according to hospital level, allocation and changes of full-time personnel. Results A total of 548 questionnaires were distributed, and 530 valid questionnaires were retrieved, with a recovery rate of 96.72%. There were 55 public tertiary, 93 public secondary, 169 public primary and 213 social medical institutions. The rates of full-time personnel allocation meeting standards were 76.36% (42/55), 72.04% (67/93), 31.95% (54/169), and 21.60% (46/213), respectively. There was a statistically significant difference in the rates of full-time personnel allocation meeting standards among different levels of medical institutions (χ2=105.149, P<0.001). There was no statistical difference in the total scores of nosocomial infection management difficulties among different-level medical institutions (F=1.657, P=0.176). There were statistically significant differences in the scores of difficulties in professional title promotion, cumbersome daily norms and requirements, insufficient allocation of full-time personnel, and high personnel turnover (P<0.05). Conclusions The main difficulties in nosocomial management of medical institutions at all levels in Shanghai include the difficulty in career promotion, cumbersome daily norms and requirements, insufficient allocation of full-time personnel and lack of experience. In the future, medical institutions should strengthen the allocation of full-time personnel and enhance their capabilities, provide smooth promotion channels, to promote the high-quality development of nosocomial infection management ultimately.
Objective To understand the current situation of the use and cognition of personal protective equipment (PPE) by healthcare workers in the isolation wards (rooms) during the coronavirus disease 2019 epidemic, and provide data support for the country to further optimize the configuration of PPE and carry out more targeted training and supervision. Methods In March 2020, healthcare workers in isolation wards (rooms) in provinces and cities in the country were investigated by filling in a questionnaire about the use of different levels of PPE. Results A total of 6 859 questionnaires were collected from 29 provinces and cities, containing 5 935 valid questionnaires (86.53%). Among them, there were 448 assisting-Hubei medical team members and 5 487 non-assisting-Hubei healthcare workers. The actual use rate (74.22%) and intended use rate (73.14%) of surgical masks in the cleaning areas were the highest. The actual use rate and intended use rate of working caps in potentially contaminated areas and contaminated areas were higher than 90%. There were various combinations of protective articles, and there were significant differences between actual use and intention (P<0.05). Except for the boot covers (single layer) in the cleaning areas, the working caps, isolation clothing and boot covers (double layer) in the potential pollution areas, and the protective face screens, working caps, three-layer shoe covers and single/double/three-layer boot covers in the pollution areas-splashing operations (P>0.05), the actual utilization rates of protective articles of the assisting-Hubei medical team members were generally higher than those of the non-assisting-Hubei healthcare workers (P<0.05). Conclusions The instructions for the use of PPE in different areas and operations should be further refined, and standardized training should be increased. The phenomenon of non-standard use of protective equipment should be reduced, and a safety barrier should be provided to the healthcare workers.
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.
ObjectiveTo investigate the educational background of practitioners from the hospital infection control departments located in the mainland of China and reveal the necessity and employment prospects of setting up a major of hospital infection control for a bachelor degree in universities.MethodsA self-designed questionnaire was used to conduct an online survey on the Shanghai International Forum for Infection Control and Prevention and the WeChat group of nosocomial infection control from March 12th to March 25th, 2018. The convenient sampling method was used to investigate the leader of infection prevention and control department in each hospital. The survey included the regional distribution, attention on nosocomial infection control, existing staff structure, future staff needs and employment prospects of hospitals in 2018, and the attention on nosocomial infection control in the same period in 2014.ResultsA total of 1 654 questionnaires were obtained, from 30 provincial-level regions, including 103 maternal and child health hospitals, 143 other special hospitals, 258 hospitals of traditional Chinese medicine, and 1 150 general hospitals. Hospitals upgraded more attention on nosocomial infection control in 2018 than in 2014 [(3.76±0.98) vs. (2.94±1.14) points; t=-36.112, P<0.001]. Currently, there were 5 068.5 labors engaged in nosocomial infection control. The educational background of the current practitioners was mainly nursing [60.52% (3 067.5)]. In the next 5 years, 83.50% (820/982) of the hospitals that had recruitment plans planed to recruit graduates specialized in the hospital infection control, and respectively, 44.86% (742/1 654) and 17.35% (287/1 654) of the respondents believed that the employment prospects of graduates with bachelor degree specialized in the hospital infection control were good or very good.ConclusionThere is a tremendous demand for the graduates specialized in the hospital infection control, and it is imperative to set up this undergraduate major.
Ventilator-associated pneumonia (VAP) is a kind of pneumonia that occurs when artificial airway (tracheal intubation or tracheotomy) is established and mechanical ventilation is accepted. The occurrence of VAP will significantly prolong the ventilation time and hospitalization time of patients, increase the mortality rate and the medical burden. In order to effectively prevent and reduce the occurrence of VAP, the Society for Healthcare Epidemiology of America released the Strategies to Prevent Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute-Care Hospitals: 2022 Update, which is an update of the 2014 version. In order to facilitate the reading and understanding of the medical workers, this article will interpret the infection prevention and control strategies of adult VAP and ventilator-related events.
Objective To analyze the drug resistance genes, virulence genes and homologies of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonized and infected patients in surgical intensive care unit based on whole genome sequencing. Methods Whole genome sequencing analysis was performed on CRKP infected strains isolated from the Department of General Surgery Intensive Care Unit and the Department of Liver Surgery Intensive Care Unit of Zhongshan Hospital, Fudan University in March 2021 and CRKP colonized strains isolated from the above departments between January and March 2021. The drug resistance genes, virulence genes and homologies of the strains were analyzed. ResultsA total of 16 CRKP strains were included, including 10 colonized strains and 6 infected strains. Except for the β-lactamase drug resistance gene CTX (16.7% vs. 100.0%, P<0.05), there was no significant difference in the detection rate of other drug resistance genes between CRKP infected strains and colonized strains (P>0.05). The cluster analysis of drug resistance genes of some strains was relatively close. Whole genome sequencing analysis showed that CRKP strains carried a variety of virulence genes, and the detection rates of entB, irp2, iroN, and rmpA genes were 100.0%, 87.5%, 37.5%, and 62.5%, respectively. There was no significant difference in the detection rate of virulence genes between CRKP infected strains and colonized strains (P>0.05). Homology analysis showed that some strains had close homologous relationships, and there was the possibility of cross transmission. Conclusions Some of CRKP infection strains and colonization strains in surgical intensive care unit patients have the risk of cross transmission. In the future, we should strengthen the prevention and control of nosocomial infection to reduce the incidence of infection.
Objective To investigate the current status of occupational environment support, occupational satisfaction, and job competence of hospital infection prevention and control personnel, and to explore the mediating effect of occupational satisfaction on the relationship between occupational environment support and job competence, in order to provide reference and guidance for effectively improving the job competence of hospital infection prevention and control personnel. Methods A survey questionnaire was distributed to various levels and types of medical institutions in Shanghai through the platform of the Shanghai Hospital Infection Quality Control Center. The questionnaire included the Occupational Environment Support Scale, Occupational Satisfaction Scale, and Job Competency Assessment Scale. The mediating effect of occupational satisfaction on the relationship between occupational environment support and job competency of hospital infection prevention and control personnel was analyzed. Results A total of 1027 hospital infection prevention and control personnel from 728 medical institutions participated in this survey, with 989 valid questionnaires and an effective response rate of 96.3%. There were statistically significant differences in the job competency scores of hospital infection prevention and control personnel based on gender, years of experience in infection control work, professional background, highest education level, professional title, job nature, type of medical institution, and annual income (P<0.05). The total score of job competence for hospital infection prevention and control personnel was 301.0 (267.5, 326.0), the total score of occupational environment support was 21.44±3.66, and the total score of occupational satisfaction was 19.25±2.78. The occupational environment support of hospital infection prevention and control personnel was positively correlated with occupational satisfaction and job competence (r=0.373, 0.339; P<0.001), and occupational satisfaction was positively correlated with occupational environment support (r=0.547, P<0.001). The mediating effect of job satisfaction on the occupational environment support and job competence was 0.085, accounting for 22.8% of the total effect. Conclusion Occupational satisfaction partially mediates the relationship between occupational environment support and job competence, and the mediating effect is significant.