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Objective:To investigate the targeted surveillance combined with cluster management on isolation protector use rate and hand hygiene qualification rate in caregivers of patients with respiratory tract multidrug-resistant bacterial infections.Methods:Second Hospital of Shanxi Medical University began to perform targeted surveillance combined with cluster management among caregivers of patients with multidrug-resistant bacterial infections in July 2019. The caregivers of 50 patients with respiratory tract multidrug-resistant bacterial infections who were admitted before targeted surveillance combined with cluster management were included in the pre-implementation group. The caregivers of 50 patients with respiratory tract multidrug-resistant bacterial infections who were admitted after targeted surveillance combined with cluster management were included in the post-implementation group. Multidrug-resistant bacterial infections in caregivers, isolation protector use rate, environmental disinfection and hand hygiene qualification rate were compared between before and after 6 months of targeted surveillance combined with cluster management. The application value of targeted surveillance combined with cluster management in the prevention of respiratory tract multidrug-resistant bacterial infections was analyzed.Results:The number of caregivers with respiratory tract multidrug-resistant bacterial infections in the post-implementation group was lower than that in the pre-implementation group (5 vs. 13, P < 0.05). The proportion of caregivers who wear a mask (94.11%), isolation clothes (80.39%) and gloves (98.03%) in the post-implementation group was significantly higher than that in the pre-implementation group (70.00%, 62.00%, 78.00%, χ2 = 10.027, 4.911, 9.683, all P < 0.05). The proportion of caregivers who were qualified in terms of hand hygiene (82.35%), object surface (76.47%), and keeping the air fresh in the post-implementation group was significantly higher than that in the pre-implementation group (64.00%, 58.00%, 64.00%, χ2 = 4.341, 3.915, 5.450, all P < 0.05). Conclusion:Targeted surveillance combined with cluster management can effectively help prevent respiratory tract multidrug-resistant bacterial infections in caregivers and increase isolation protector use rate and hand hygiene qualification rate.
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Objective To study the incidence and risk factors of infection caused by methicillinresistant staphylococcus aureus (MRSA) with a targeted surveillance at intensive care unit (ICU) acquired MRSA infection in Tianjin area.Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1,2012 through March 31,2014 was carried out.The ICUs were divided into four groups according to the type of the ICU.All of the patients were cared for with routine MRSA surveillance.A number of risk markers and prognostic factors were recorded.The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model.Comparison of survival between groups was analyzed with Kaplan-Meier method.Results A total of 1 787 patients were enrolled,and 144 cases of them were MRSA infections.The patients with MRSA infection were significantly older than those with non-MRSA infection (P =0.043),length of ICU stay,length of antimicrobial therapy,the history of repeated administration of antibiotics in recent days,history of operation in the past five years,history of MRSA infection or colonization,frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection.The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (x2 =9.23,P =0.004).The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012,because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013.Multivariate Logistic regression analysis demonstrated that advanced age (OR =1.05,95％ CI:1.009-1.086),length of ICU stay (OR =1.05,95％ CI:1.01-1.08),history of MRSA infection or colonization (OR =1.33,95％ CI:1.82 -3.27),glucocorticoid therapy (OR =2.85,95％ CI:1.18-6.91),antacid medicine (OR =4.92,95％ CI:1.18-20.58),history of recent or repeated application of antibiotics (OR =3.26,95％ CI:1.06-4.59) catheter-associated infections (OR =2.22,95％ CI:1.08-4.59) were associated with ICU acquired MRSA infections.Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections.The advanced age,length of ICU stay,history of MRSA infection or colonization,glucocorticoid therapy,antacids medicine,history of recent or repeated application of antibiotics,catheterassociated infections were independent risk factors of ICU acquired MRSA infections.
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Objective To investigate the occurrence and risk factors of vascular access infection(VAI) in hemodialysis outpatients.Methods Prospective surveillance method,monitoring methods was formulated and adopted by referring to the relevant guidelines and regulations at home and abroad,targeted surveillance was performed among all outpatients receiving hemodialysis in a hospital from June 1,2014 to May 31,2016.Results A total of 584 outpatients received hemodialysis from June 1,2014 to May 31,2016,with 64 203 times of vascular access,79 patients developed 85 cases of infection,case incidence of VAI was 1.32％.36 cases(42.35％) were infection at vascular puncture sites,49 (57.65％) were vascular access-related bloodstream infection.Among patients with different types of vascular access,incidence of VAI was the highest among patients with artificial vascular graft(19.67％),followed by those with non tunneled central venous catheter(4.91％),with tunneled central venous catheter (0.73％),and with arteriovenous fistula(0.09％).Age＞ 60 years,hemodialysis time＞ 1 year,diabetes,and hypertension were risk factors for VAI in outpatients with hemodialysis(all P＜0.05).39 strains of pathogens were isolated from 49 patients with vascular access-related bloodstream infection,including 36 (92.31％) gram positive bacteria,mainly Staphylococcus aureus (n =30,6 of which were methicillin-resistant Staphylococcus aureus);3 (7.69 ％) gram-negative bacteria.Conclusion Strengthening prospective targeted surveillance can better understand the status,characteristics,and risk factors of VAI in hemodialysis outpatients,it is conducive to taking targeted prevention and control measures,thus reduce the incidence of VAI in hemodialysis outpatients.
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Objective To analyze the effect of PDCA cycle quality management model on multi-drug resistant organism (MDROs) infec-tion control in a tertiary rehabilitation hospital. Methods From March, 2013 to December, 2015, targeted surveillance of MDROs infection control was performed with PDCA cycle quality control. The MDROs detection rate, the awareness rate of MDROs prevention and control, the rate of doctor issuing isolation orders and execution rate of medical sanitation disinfection and isolation were analyzed. Results The de-tection rates of methicillin-resistant staphylococcus aureus and Carbapenem-resistant Pseudomonas aeruginosa decreased (χ2>3.922, P399.17, P<0.001). Conclusion PDCA cycle quality management model played an impor-tant role in the prevention and control of MDROs in rehabilitation hospital.
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Objective To explore the effect of targeted surveillance on the control of nosocomial infection in neonatal intensive care unit (NICU).MethodsThe nosocomial infection rates were retrospectively analyzed after continuous improvement of targeted surveillance in NICU from January 2013 to June 2015.ResultsDuring the research period, 59 cases has nosocomial infection in 1011 case who were selected in accordance with inclusion criteria, nosocomial infection rate is 5.8% and daily infection rate is 3.5%. On semiannual basis, the daily infection rates decreased from 8% in the ifrst half of 2013 to 2.2% in the ifrst half of 2015. The ventilator associated pneumonia cases/1000 ventilator days decreased from 12.8‰ to 0‰ from the ifrst half of 2013 to the ifrst half of 2015. The central ventral indwelling catheter related bloodstream infection cases/1000 central ventral indwelling catheter days decreased from 4.5‰ to 0‰ from the ifrst half of 20133 to the ifrst half of 2015. The differences were statistically significant (P all?
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Objective To understand the occurrence of surgical site infection (SSI)following class I incision operation in a tumor hospital,explore the continuous surveillance and improve effectiveness,so as to provide reference for further inter-vention.Methods Targeted surveillance on thyroid surgery patients undergoing classⅠincision operations in a hospital in January-June 2013 were performed by medical record review,bedside observation,dressing change observation and patient follow-up,the surveillance result was compared with that of the same period of 2010.Results There was one case of SSI in January-June 2013 and January-June 2010 respectively,SSI rate was 0.20% and 0.18% respectively,there was no significant difference(P =1.000).In January-June 2013,prophylactic perioperative antimicrobial usage rate was 0.20%,which was lower than 27.21% of 2010;the coincident rate of indication for antimicrobial use was 100%, which was higher than 6.67% of 2010,the difference was statistically different(all P <0.001).Conclusion Targe-ted surveillance on SSI is helpful for the rational perioperative use of antimicrobial agents,the reducing of antimicro-bial prophylactic use doesn’t lead to the increase of class Ⅰ incision SSI.
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Objective To investigate healthcare-associated infection (HAI)in neonatal intensive care unit(NICU),and provide reference for controlling HAI in newborns.Methods Targeted surveillance on HAI in all newborns in NICU of a hospital from January 2011 to December 2013 was performed by prospective investigation method.Results A total of 5 365 newborns were monitored,128 newborns developed 133 times of HAI,HAI rate and HAI case rate was 2.39% and 2.48% respectively.The major infection sites were conjunctiva (33.08%),upper respiratory tract (23.31%)and skin soft tissue (17.29%).The daily infection rate was 3.32‰(128/38 528),vascular catheter usage rate and respirator usage rate was 1.75%(676/38 528)and 1.09%(420/38 528)respectively.The difference in vascular catheter usage rate and res-pirator usage rate in newborns with different body weight had statistical difference (χ2 =3 075.22;442.46,both P 2 500 g was 16.67%, 12.26%,4.15% and 1.06% respectively.None newborns developed catheter-related bloodstream infection(CRBSI),the incidence of ventilator-associated pneumonia (VAP )was only 4.76‰(2/420).A total of 51 specimens were sent for de-tection,27 pathogens were isolated,the major were gram-positive bacteria(55.56%).Conclusion The incidence of HAI in newborns is high,the main infection sites are eye,upper respiratory tract,and skin and soft tissue.
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Purpose: Surveillance of hospital-acquired infection (HAI), particularly device-associated infection (DAI), helps in determining the infection rates, risk factors, and in planning the preventive strategies to ensure a quality healthcare in any hospital. The present study was carried out to know the prevalence of DAI in a tertiary care teaching hospital of rural Gujarat. Materials and Methods: A prospective, site-specific surveillance of three common DAIs that is catheter-associated urinary tract infection (CA-UTI), IV-catheter-related bloodstream infection (IV-CRBSI), and ventilator-associated pneumonia (VAP) was carried out between July 2007 and April 2008, in different wards/ICUs. A surveillance plan, with guidelines and responsibilities of nurses, clinicians and microbiologist was prepared. Infection surveillance form for each patient suspected to have DAI was filled. The most representative clinical sample, depending on the type of suspected DAI, was collected using standard aseptic techniques and processed for aerobes and facultative anaerobes. All the isolates were identified and antimicrobial sensitivity testing performed as per CLSI guidelines. An accurate record of total device days for each of the indwelling devices under surveillance was also maintained. Data, collected in the prescribed formats, were analysed on monthly basis; and then, compiled at the end of the study. Descriptive analysis of the data was done and DAI rate was expressed as number of DAI per 1000 device days. Results: The overall infection rate for CA-UTI, IV-CRBSI, and VAP were found to be 0.6, 0.48, and 21.92 per 1000 device days, respectively. The organisms isolated were Staphylococcus aureus, CONS, Enterococci, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Conclusions: Duration of indwelling devices was found to be the major risk-factor for acquiring DAIs. Low DAI rate might have been due to use of antibiotics, often prophylactic. Active surveillance is quite a tedious and time-consuming process; however the outcome is useful in prevention and control of DAIs.
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OBJECTIVE To study the application of APACHE Ⅲ in ICU targeted surveillance to assess the standards for clinical illness grading and scoring.METHODS From Sep 2006 to Feb 2007,nosocomial infection was monitored among the patients in a comprehensive ICU and the APACHE Ⅲ was used in assessing the standards for clinical illness grading and scoring in comparison with the previous method.RESULTS Among 972 ICU patients over that time,264 cases were selected as the supervision targets,84 patient-times with nosocomial infection were found out with a daily incidence of 8.642%.Two clinical doctors assessed and graded patients′ conditions.There was significant difference in the results between the methods by the clinical doctors and APACHE Ⅲ(P
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0.05);rate of prophylactic antibiotics was reduced remarkably(P
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OBJECTIVE To investigate the characteristics and risk factors of nosocomial infection(NI) in patients with hematological malignancies(HM),and provide the bases for making the controlling measures of NI.METHODS Using the targeted monitoring to study NI in patients with HM,and recording 14 factors such as the time of hospitalization,chemotherapy,count of leukocyte and absolute neutrophil count(ANC) and so on.The data were analyzed with unifactorial ?2 test and multifactorial Logistic-regression analysis.RESULTS Among 242 patients with HM the prevalence of NI was 35.5%(86/242) and the prevalence of NI time-cases was 52.9%(128/242).Among 86 patients of NI there were 27 patients occurred multiple sites NI(31.4%).The main infection sites were upper respiratory tract,gastrointestinal tract,lower respiratory tract,oral cavity and blood.66.7% Of NI happened in the period of chemotherapy and 7 days after chemotherapy.The time of hospitalization and ANC were independent risk factors of NI in patients with HM.CONCLUSIONS The patients with HM are susceptible population of NI,and NI often occurs in the period of chemotherapy and 7 days after chemotherapy.So medical staff should strengthen monitoring,and shorten the time of patient hospitalization and of recovery of ANC to reduce the prevalence of NI efficiently.
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Objective To explore the effects of the application of targeted surveillance in the Deparment of Neurosurgery. Methods Someone was specially assignedd to work out both process and outcome goals by means of perspective investigation, clinical groups were formed and information feedback, evaluation of effects and correction of deviation were regularly conducted. Results The process goals were obtained: from July 1996 to June 1997, the rate of hospital infection in the Department of Neurosurgery droppoed from 26.07% to 21.32% (x2 = 4.3465,P ＜0.05). The outcome goals were also obtained: from July 1997 to June 1998, the rate of infection dropped from 21. 32% to 13.40% (x2 = 16.1193,P＜0.01). Conclusion Targeted surveillance is a really effective form of surveillance and information feedback and evaluation of effects are indispensable. Application of targeted surveillance in the Department of Neurosurgery has won initial success.