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Objective To investigate postoperative infection rates of patients with different types of incisions and different risk indexes of operation in a tertiary hospital in Chengdu City through carrying out targeted monitoring of surgical incision,in order to determine important interventions for infection control.Methods The data about operating rooms in the hospital monitored in this study was collected via the Donghua software electronic information system,and the situation of postoperative infection of incision wounds was analysed as well.Results Among the 1 331 cases of patients,the total infection rate of postoperative incisions was 0.60％.The type Ⅰ,type Ⅱ and type Ⅲl/Ⅳ incision infection rate was 0.31％,0.69％ and 1.78％,respectively.The infection rate of patients whose surgical risk score was 0,1 point and ≥2 points was 0.13％,0.84％ and 1.74 ％,respectively.By Fisher exact test,there were statistically significant differences in postoperative infection rates among patients with different types of surgical incision and those with different surgical risk index scores(P＜0.05).Conclusion The postoperative infection rates of patients with type Ⅲ/Ⅳ incision and those with surgical risk index score≥2 points are the highest.It is necessary to emphasize and strengthen the intervention on controlling postoperative infections,effectively reduce the postoperative infection rate through active monitoring,in order to improve the quality of medical hospital treatment and ensure patients'safety.
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Objective To monitor ventilator-associated event (VAE) for the first time in an intensive care unit (ICU) in China,understand the applicability,incidence,and clinical significance of VAE in China.Methods Targeted monitoring on VAE was performed among patients ≥18 years and with mechanical ventilation (MV)＞2 days in the ICU of a hospital between January 2014 and September 2015,incidence of VAE was calculated,and patients were grouped according to whether or not they had VAE,prognostic factors were analyzed statistically.Results A total of 1 004 patients were monitored,the total hospital stay was 13 795 days in patients who used ventilator,307 (30.58％) cases of VAE occurred,incidence of VAE per 1 000 ventilator-days was 22.25.Univariate analysis showed that patients with VAE had longer length of ICU stay and MV,and higher mortality rate than patients without VAE when they moved out of ICU (all P＜0.05).Multivariate logistic regression analysis showed that VAE was independent risk factor for length of ICU stay,duration of MV,as well as mortality when patients moved out of ICU(all P＜0.05).Conclusion Judgment of VAE is based on MV parameters,it is more objective and accurate.There is a high incidence of VAE among ICU patients,it may lead to poor clinical outcomes,and has good values for the targeted monitoring on ICU patients in large comprehensive hospitals of China.
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Objective To investigate the effect of preoperative chlorhexidine bath for reducing the incidence of sur-gical site infection(SSI)in patients undergoing spinal surgery.Methods All patients who undergoing spinal surgery (with no implants)in the department of neurosurgery of a hospital between January 2013 and December 2014 were monitored,the selected patients were divided into control group (January-December of 2013,no intervention meas-ures were taken)and trial group(January-December of 2014,1 .8%-2.2% chlorhexidine bath for two nights before operation),incidence of SSI between two groups of patients before and after intervention was compared,interven-tions effect was evaluated.Results A total of 1 043 patients undergoing spinal surgery were enrolled,41 (3.93%) had SSI,incidence of SSI rates in control group and trial group were 6.47% and 2.34% respectively,the difference was statistically significant (P=0.001).According to the incidence of SSI in control group,actual infected patients in trial group were 27 less than the anticipated patients with infection.The average hospitalization expense in SSI group and non-SSI group were ￥33 641 .00 and ￥23 072.50 respectively,each patient could save ￥10 568.50 on average.Therefore,through the intervention measures,￥285 349.50 of hospitalization expense could be saved. Except ￥2 100 of trial material cost and ￥12 820 of manual labour cost,￥270 429.50 of social cost was ultimately saved.The mean length of hospital stay in control group and trial group were 10 (8-12)days and 9 (8-12)days respectively,rank test showed that the difference was not statistically significant (Z = - 0.68,P = 0.50 ). Conclusion Chlorhexidine bath intervention can not only reduce SSI rate,but also save the expense of hospitaliza-tion,whether it can shorten the length of hospital stay needs to be further studied.
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Objective To explore the risk factors and prognosis of hospitalized patients with bloodstream infection due to carbapenem-resistant Acinetobacter baumannii (CRAB).Methods 163 patients with CRAB bloodstream in-fection from 2010 to 2013 were conducted retrospective case-control study,68 patients with bloodstream infection due to carbapenem-susceptible Acinetobacter baumannii (CSAB)during the same period were as control group. Results The independent risk factors for CRAB bloodstream infection were stay in intensive care unit(ICU)(OR, 1 .27[95%CI ,5.55-22.89])and emergency department(OR,3.57 [95%CI ,1 .67 -7.62])before infection.Pa-tients with CRAB bloodstream infection had lower 28-day survival rate than those with CSAB bloodstream infection (66.17% vs 96.95%,χ2 =15.71 ,P <0.001 ).The independent risk factors for influencing prognosis of Acineto-bacter baumannii bloodstream infection were infection of CRAB (HR 95% CI ,3.01 -67.28),blood disease(HR 95%CI ,3.77-25.97),cardiac insufficiency(HR 95%CI ,2.10-20.41),stay in ICU(HR 95%CI ,1 .01 -5.28), and age(HR 95%CI ,1 .01 -1 .04).Conclusion The independent risk factors for CRAB bloodstream infection are stay in ICU and emergency department before infection,CRAB bloodstream infection is risk factor for influencing prognosis of patients.
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Objective To understand the impact of methicillin-resistant Staphylococcus aureus (MRSA)blood-stream infection on the length of hospital stay,hospital mortality,and poor prognosis of patients.Methods 357 patients with Staphylococcus aureus (S .aureus)bacteremia in a hospital between January 1 ,2009 and December 31 , 2013 were surveyed and analyzed retrospectively.Results Of 357 patients,91 were infected with MRSA and 266 with methicillin-susceptible S .aureus (MSSA).The length of hospital stay was statistically different between MR-SA and MSSA group(29 d vs 23 d,P <0.01);before infection,length of hospital stay of MRSA group was longer than MSSA group(P <0.01 );after infection,length of hospital stay was not statistically different between two groups(17 d vs 16.5 d,P = 0.92 ).Mortality of MRSA group and MSSA group was not statistically different (13.19% vs 9.02%,χ2 =1 .28,P =0.26).The incidence of poor prognosis of MRSA group was higher than MSSA group(29.67% vs 16.92%,χ2 =6.85,P =0.01 ).Multivariate analysis results showed that MRSA infection was independent risk factor for poor prognosis (P <0.01).Conclusion MRSA infection doesn’t contribute to the pro-longation of hospital stay,but MRSA bloodstream infection is a risk factor for poor prognosis of patients.
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Objective To explore strategies and measures to improve hand hygiene (HH)compliance and correctness of health care workers (HCWs)in a large hospital.Methods The WHO multimodal hand hygiene improvement strategy was adopted by healthcare-associated infection(HAI)management department of a hospital,measures consisted of five key com-ponents,including:system change,education and training,evaluation and feedback,reminders in the workplace,and insti-tutional safety climate.HH compliance and correctness of HCWs were observed by infection control practitioners,HH compliance and correctness in January-June of 2012 (pre-intervention)and January-June of 2014 (post-intervention)were compared,effectiveness of intervention strategies were evaluated.Results HH compliance rate and correctness rate of post-intervention were both higher than pre-intervention (75.92% [8 369/11 023]vs 53.67% [5 127/9 553],P 0.05).Except ‘after body fluid exposure’, HH compliance rates of the other four indications for HH before and after intervention were significantly different(all P <0.001).Conclusion HH compliance and correctness of HCWs can be improved after adopting WHO multimodal hand hy-giene improvement strategy.
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OBJECTIVE To investigate the prevalence of nasal colonization among health care workers(HCWs).METHODS Nasal swabs from 93 ICU workers and 98 other clinical workers were cultured and isolated and the tests of antibiotic susceptibility were performed by using paper diffusion method.RESULTS In total,214 isolates of 8 species from 191 health care workers were recovered,of which 187 isolates were coagulase-negative Staphylococcus(CNS)(the carriage rate of 93.71%) and 8 isolates were Staphylococcus aureus(the carriage rate of 4.19%).While the total Gram-negative bacteria carriage rate was 14.14%(27 isolates).The most frequent CNS species were S.epidermidis and S.haemolyticus.The antibiotic susceptibility profiles of S.aureus and CNS differed sharply: all 8 S.aureus strains were resistant to penicillin but were fully susceptible to oxacillin,in contrast,most of CNS were resistant to both penicillin and oxacillin.The carriage rate of CNS(60.2%)and Gram-negative bacteria(26.9%)in HCWs of ICU were higher than other HCWs(P
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A study on phenylketonuria (PKU) has been carried out in China-Japan Friendship Hospital since 1984. The results revealed that: (1) Totally 603 patients with PKU were diagnosed and treated in the hospital from October 1984 to September 2002. Among which 136 cases were identified by neonatal screening and treated within 3 months. One hundred and ninety-five cases were treated when the children were 3-12 months of age. Another 272 PKU children were diagnosed when they were more than 1 year old. All of these late-treated cases had some signs and symptoms of PKU. Mental retardation was found in 467 cases and various patterns of seizures in 119 cases. After treatment with low-phenylalanine diet, the follow-up for early-treated patients revealed that their physical and mental developments were normal. In late-treated patients, abnormal behaviour was significantly improved and their developmental quotient were elevated. Prenatal gene diagnosis of PKU risk foetus in 22 PKU families was successfully performed. (2) Urinary pterins obtained from 369 HPA patients were measured by HPLC. Twenty two patients with BH4 deficiency have been recognized. Six single base mutations were detected in 18 unrelated northern Chinese BH4 deficiency families, and the mutations at nucleotides 259C-->T and 286G-->A were common mutations. Eighteen BH4 deficient patients were treated with BH4, L-dopa and 5-hydroxytryptophan, and the results were satisfactory. (3) The abnormal rate of EEG was high in untreated patients with PKU, mainly showing epileptiform discharges and partly showing background activity abnormality. The most frequent finding was patchy areas of increased signal intensity in white matter on MRI in the brain of PKU patients, while delayed myelination and brain agenesis were often detected. After dietary treatment, follow-ups with EEG and MRI revealed that the abnormalities were decreased significantly. (4) The relationship between genotype and intellectual phenotype was examined in 29 late-treated patients with classical PKU. It was found that the genotype of 22 patients were compatible with intellectual phenotype and not well matched in 7 cases. The result indicate that the genotype was well matched with intellectual phenotype in classical PKU patients.
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Child, Preschool , Female , Humans , Infant , Male , Biopterins , Electroencephalography , Follow-Up Studies , Genotype , Magnetic Resonance Imaging , Mass Screening , Phenylketonurias , Genetics , Therapeutics , Phosphorus-Oxygen Lyases , Point MutationABSTRACT
OBJECTIVE To enhance the rational usage of antibiotics by comprehensive interventional measures in clinics.METHODS Several interventional measures have been adopted in our hospital since January 2001: to(establish) expert team on antibiotics usage and administration consultation;constitute antibiotics use criteria(suitable) for each clinical specialty;train and examine the usage of antibiotics;censor the distribution of pathogen and drug-resistance variance.Then 10% of the discharged medical records in 2000,2002 and 2004 were drawn out respectively to analyze the usage of antibiotics and the isolation of pathogen from nosocomial infection cases.(RESULTS) The proportion of the patients with prophylactic and remedial indications was increased remarkably((P