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Objective To investigate the causes of a healthcare-associated lower respiratory tract infection(HA-LRTI) outbreak due to Enterobacter cloacae(E.cloacae), and provide basis for clinical prevention and control of HAI.Methods Epidemiological data of patients with E.cloacae HA-LRTI following bronchoalveolar lavage(BAL) in the departments of respiratory disease and thoracic surgery of a hospital were collected, antimicrobial resistance analysis on isolated pathogens from patients and environment was performed, pulsed-field gel electrophoresis (PFGE) was used for genotyping.Results On March 8-16, 2013, a total of 15 patients underwent BAL in the fiberobronchoscopy room in the departments of respiratory disease and thoracic surgery of a hospital, 13 of whom developed E.cloacae LRTI, 4 cases were community-associated infection (the initial case was included), the other 9 cases were HAI;8 environmental specimens were detected 2 strains of E.cloacae, the strains were from vacuum suction joint of fiberbronchoscope and scissors used for trimming disposable controllable sputum suction pipeline.15 strains of E.cloacae from environment and patients were screened by antimicrobial susceptibility testing, 11 strains were with similar antimicrobial susceptibility testing result, 2 of which were environmental strains, 6 were from inpatients, and 3 were from patients in community.PFGE typing of 11 strains revealed that there were 8 strains with the same genotype, 6 of which were from patients in department of thoracic surgery, 2 were from vacuum suction joint of fiberbronchoscope and scissors used for disposable controllable sputum suction pipeline;the other 3 strains were of the same genotype, and from departments of respiratory disease and thoracic surgery.Conclusion This outbreak is due to contamination of bronchofibroscope by the same E.cloacae strain, the strain is susceptible to the clinic commonly used antimicrobial agents, such events should be paid attention in clinic, the key to control infection is to take necessary measures for cutting off the spread of the epidemic.
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Objective To ensure the quality of disinfection and sterilization of the fiberbronchoscope in the sterilesupply center through the implementation of whole life cycle management.Methods Using the historical comparative method,the fiberbronchoscopes managed by the departments were enrolled into a control group from February 2013 to March 2014,and the ones undergoing life-cycle management in the sterile supply center were involved in an observation group from April 2014 to May 2015.The two groups were divided according to the management subject and mode,and compared from the aspects of treatment flow,process quality control and record tracing validity.All the data were input with Excel sheet,andanalyzed statistically with SPSS 17.0.Results The observation group and the control group had the numbers of positive results in internal cavities,positive results in external surface,damaged or irrationally-placed package,invalid data tracing and non-standardized storage being(0,1.11±0.15),(0,1.09±0.20),(1.07±0.13,2.75±0.22),(0.57±0.03,1.53±0.31) and (0.13±0.07,0.95±0.21) respectively,and the differences between the two groups were significant (P＜0.05).The turnover of the fiberbronchoscope was enhanced significantly in the observation group when compared with that in the control group.Conclusion Life cycle management contributes to strengthening quality control of the treatment of polluted fiberbronchoscope,and decreases the incidences for hospital infection.
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Objective To investigate the causes of an outbreak of healthcare-associated infection with methicillin-resist-ant Staphylococcus aureus (MRSA)in a neurosurgical intensive care unit(NSICU).Methods Epidemiological investigation on 8 patients with lower respiratory tract infection (LRTI)in a NSICU between June 15 and June 28,2104 were performed by combination methods of prospective and retrospective survey.Results The attack rate of MRSA LRTI in NSICU patients was 22.86%,a total of 16 MRSA isolates were detected from patients’clinical specimens,nasal vestibule,as well as hospital surroundings during the period,pulsed-field gel electrophoresis (PFGE)result revealed that infection outbreak was caused by two subtypes of MRSA;risk factors analysis showed that long length of stay in ICU and aspiration of spu-tum through bronchoscopy were risk factors for MRSA LRTI.Conclusion Contamination of bronchoscope was the key factor for this epidemic spread of healthcare-associated MRSA infection.
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Objective To explore the diagnosis rate.pathology types and positive rate of cancer cell in spu-tum of early central pulmonary carcinoma in three obstructive signs on chest X ray screened by fiberbromchoscope.Methods 326 cases of three obstructive signs with high risk of lung cancer were screened for central pulmonarycarcinoma by spiral CT.biopsy by fiberbronchoscope and cytological examination of sputum.Results 32 patients were diagnosed with central pulmonary carcinoma,with morbidity of 9.8%.In these patients,21 were confirmed with obstructive pneumonia(65.6%),7 with obstructive atelectasis(21.9%),4 with obstructive emphysema(12.5%);In terms of pathology type,16 cases were defined as squamous cell carcinoma(50.0%),9 as small cell carcinoma(28.1%).3 were as large cell carcinoma(9.4%).2 were as adenocarcinoma(6.3%),1 as admosquamous carci-noma(3.1%),1 as bronchial gland carcinoma(3.1%);cancer cell could be found in sputum of 5 patients of 32 cases,among them,it was found in 3 of 21 patients with obstructive pneumonia(14.3%),1 in 7 patients with ob-structive atelectasis(14.3%),1 in 4 patients with obstructive emphysema(25.0%).Conclusion The prevelance of early central pulmonary carcinoma in three obstructive signs on chest X-ray is 9.815%,in which squamous carci-noma and small-cell carcinoma are common in pathology type.Screening can increase the detection rate of early pul-monary carcinoma.
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Objective To evaluate the value of CT guided branchofiberoscopic biopsy of carcinoma originating from small bronchiole. Methods The fiberbronchoscopic biopsy results of 33 cases under CT guidance were compared to the results of surgical pathology, including fiberbronchoscopic blind examination and CT guided percutaneous lung biopsy. Results The lesions occurred in 1 - 3 grade bronchus could be approached with fiberbronchoscopic biopsy under direct vision. CT guided fiberbronchoscopic biopsy had the benefit of getting more reliable, accurate samples simultaneously with less complications in the diagnosis of bron-chiolar lesions. It was more easy and having higher positive rate to diagnose the lesion of terminal bronchiole and alveoli by CT guided percutaneous lung biopsy. Conclusions CT guided fiberbronchoscopic biopsy can collect more wholesome pathologic specimen than other examinations for small lesions of bronchus. The comprehensive utilization of microscopy, brush biopsy and multiple sites biopsy can improve the accuracy.