Risk factors of peripherally inserted central catheter-related bloodstream infection in patients with hematological malignancy / 中国感染与化疗杂志

Objective To investigate the morbidity and risk factors of peripherally inserted central catheter (PICC) related bloodstream infection and the distribution and antimicrobial susceptibility of pathogens in patients with hematological malignancy for better prevention and management of such infections. Methods The relevant data were collected from the patients with hematologic malignancy and PICC in hematology department from July 2013 to November 2016. The risk factors of PICC related bloodstream infection were analyzed. Blood samples and catheter-related blood samples were taken for culture of pathogens. The pathogens were identified on VITEK-32. Antimicrobial susceptibility was tested by using Kirby-Bauer method. Results A total of 10 213 patients with PICC were included in this study. PICC related bloodstream infection was identified in 280 (2.74％) patients, about 0.55 per 1 000 PICC days. The main risk factors of PICC related bloodstream infection were type of hematological malignancy (P＜0.001) and days of indwelling PICC (P＜0.001). A total of 322 strains of pathogenic bacteria were isolated, including gam-negative bacteria (73.91％), gam positive bacteria (22.05％) and fungus (4.04％). The gram-negative species isolated from bloodstream were mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. E. coli and K. pneumoniae isolates were relatively sensitive to piperacillin-tazobactam, cefepime, cefoperazone-sulbactam, imipenem, gentamicin and amikacin. S. maltophilia isolates were relatively sensitive to piperacillin-tazobactam, ceftazidime, cefoperazone sulbactam and ciprofloxacin, while P. aeruginosa strains were relatively sensitive to the commonly used anti-Pseudomonas antibiotics. The gram-positive isolates including Staphylococcus epidermidis, Staphylococcus hominis and Staphylococcus haemolyticus were all susceptible to vancomycin, linezolid, and teicoplanin. The most frequently identified fungal species was Candida tropicalis. Conclusions Prolonged duration of PICC may increase the risk of central line-associated bloodstream infection (CLABSI). The incidence of CLABSI is associated with the type of hematological malignancy. CLABSI pathogens are mainly gram-negative microorganisms with various levels of antibiotic resistance. Clinicians should adhere to standard operating procedures, strengthen surveillance of patients with PICC, evaluate the risk dynamically, and remove PICC as early as possible.

Current status of cleaning and disinfection of digestive endoscopes in medi-cal institutions in Suzhou City / 中国感染控制杂志

cleaning and disinfection.Results All 28 surveyed medical institutions had separate endoscope disinfection rooms, 89.29% of which had integrated endoscopic cleaning station,17.86% had automatic endoscope washer/disinfector;100% used multi-enzymatic detergent,chose the right disinfectant,monitored disinfectant concentration every day, and implemented standard disinfection time.But only 39.29% changed multi-enzymatic detergent for each endo-scope,cleaning and disinfection personnel in 78.57% of medical institutions wore personal protective equipment correctly.77 digestive endoscopes were detected,the qualified rate was 88.31%.Conclusion Cleaning and disin-fection management of digestive endoscope in secondary and above medical institutions in Suzhou City is generally standardized,there are still some problems in the manipulation procedures,relevant national regulations should be strictly complied with,efficacy of cleaning and disinfection of digestive endoscope should be further improved.

Cross-sectional survey and analysis of cleaning quality of dental handpieces in Suzhou City / 中国感染控制杂志

Objective To explore the cleaning status and cleaning quality of dental handpieces in various types of medical institutions in Suzhou City.Methods On October 26-31, 2015, dental clinics in the whole city were sampled according to cross-sectional survey and proportional sampling method, the cleaning quality of dental handpieces in each clinic was detected by ATP bioluminescence assay.Results 72 medical institutions, 201 handpieces, 402 samples in 10 administrative regions of the city were sampled, 42 samples was unqualified, unqualified rate was 10.45％, unqualified rate of cleaning of dental handpiece surface was higher than waterline of dental handpiece(17.91％ vs 2.99％, P<0.05).Cleaning quality of dental handpieces in different grades of medical institutions was different(P<0.05), tertiary medical institutions were all ualified, medical institutions without grade was 14.45％.According to the classification based on name of different medical institutions, cleaning quality of handpieces was statistically significant(P<0.05), cleaning efficacy of dental handpieces in department of stomatology of public hospitals was best(unqualified rate was 4.31％), while private dental clinics had the worst cleaning efficacy(unqualified rate was 13.81％).Conclusion Education and training of dental handpieces cleaning in the whole city should be strengthened, especially the management of cleaning of dental handpieces in low grade and private dental clinics.

Three methods for microbiological monitoring on dialysate and dialysis water for hemodialysis / 中国感染控制杂志

Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis.Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions,specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours,Tryptic soy agar(TSA)plate incubated at 35℃ for 72 hours,and Reasoner's 2A agar(R2A agar)plate incubated at 23℃ for 168 hours,colony counts,isolation of colony,and detection rate of colony exceeding action level(≥50 CFU/mL)were compared among three methods.Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate,TSA plate and R2A plate were 40.28%,63.89%,and 69.44%respectively,difference was significant(x2=14.16,P<0.05);pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate.There was significant difference in isolated colony count between blood agar plate and R2A agar plate,TSA plate and R2A agar plate respectively(Z=-4.515,-6.970 respectively,both P<0.05).The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate,TSA plate,and R2A agar plate were 1.39%,4.17%,and 20.83%respectively,difference was significant(x2=19.83,P<0.05),detection rate of R2A agar plate was higher than the other two methods.Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate,detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate,R2A agar plate for microbial monitoring(23℃,168 h)on dialysate and dialysis water is superior to the other two methods.

Relevant influential factors for cleaning quality of dental handpieces / 中国感染控制杂志

Objective To understand the cleaning quality of dental handpieces in Suzhou City, analyze the relevant factors that influencing cleaning effect.Methods A cross-sectional study was performed with the proportional system sampling method, questionnaires were adopted to investigate the cleaning location, cleaning method and process of dental handpieces, the ATP fluorescence detection method was conducted to detect cleaning quality.Results In 10 administrative regions of this city, a total of 72 medical institutions were selected, 25 were public medical oral diagnosis and treatment institutions, 47 were private clinics.Cleaning effect of automatic handpiece cleaning machine was better than traditional manual cleaning (unqualified rate :3.95% vs 11.96%, P0.05).The quality of cleaning of handpieces could be improved if waiting time of cleaning ≤30 minutes, enzymes were used during cleaning, and purified water was used at the end rinse(all P<0.05);whether there was drying process and used lubricant, difference were both not significant.Conclusion Using automatic handpiece cleaning machine, cleaning personnel with adequate knowledge, cleaning waiting time ≤30 minutes, enzyme use during the cleaning process, and purified water use at the end rinse can improve the quality of cleaning of dental handpieces.

The relationship between obesity phenotypes and the changes of bone mineral density and vitamin D receptor in type 2 diabetes mellitus patients / 中国基层医药

Objective To investigate the correlation between vitamin D receptor gene and bone mass and obesity phenotypes in patients with type 2 diabetes mellitus.Methods 318 patients with type 2 diabetes were chosen as diabetes group,and 50 healthy people were selected as healthy control group.Vitamin D receptor gene Apa Ⅰ type was detected in the two groups.Height,weight and body mass index(BMI)biochemical index,fat content(FM),lean tissue content(LM)and bone mineral density were detected in patients with type 2 diabetes mellitus.The relationship between vitamin D receptor gene(Apa Ⅰ)polymorphism and BMD and obesity phenotypes in type 2 diabetes was analyzed.Results The VDR gene distribution between the diabetes group and healthy control group showed no signif-icant difference(Z =0.561,P >0.05).The vitamin D receptor genotype in the diabetes group included AA 31 cases (9.7%),Aa type 108 cases(34.0%),aa type 179 cases(56.3%),while the vitamin D receptor genotype in the healthy control group comprised AA 7 cases(9.3%),Aa type 29 cases(38.7%),aa type 39 cases(52.0%).The percentage of AA in both groups was significantly less than that of Aa and aa(χ2 diabetic group =4.127,3.976,all P <0.05;χ2 healthy control group =5.129,4.213,all P <0.05).Proportion of normal bone mass and average bone density in AA,Aa,aa type decreased(χ2 =15.552,P <0.05;F =5.127,P <0.05),the genotype AA was not detec-ted in osteoporosis group.BMI and FM were the highest in AA,which were significantly higher than those of Aa,aa (F =4.319,4.263,all P <0.05).Conclusion Vitamin D receptor gene Apa Ⅰ type polymorphism is related with BMD and obesity in type 2 diabetes mellitus,and it has predictive value on bone mass changes.The increase of BMI and FMmay be beneficial to bone mineral density.

Analysis on influence factors of medication compliance in elderly patients with hypertension / 中华老年医学杂志

Objective To know the medication compliance in elderly patients with hypertension,to analyze the influence factors of medication compliance,and to propose forward intervention countermeasures.Methods The treatment of hypertension in elderly patients was investigated by questionnaire survey.Medication compliance and influence factors were analyzed.Results 166 cases with poor medication compliance,and the rate was 45.0％; 203 cases with good medication compliance,and the rate was 55.0％.It's showed significantly difference on degree of education between the observation group and control group (x2 =12.071,P=0.002).The proportion of peasant and worker was higher in the observation group than control group (78.9％ vs.62.1％,x2 =12.817,P=0.002).The smoker (48.8％) and drinker (59.0％) in observation group more than smoker (27.1％) and drinker (31.0％) in control group(x2=18.481,P＜0.001; x2=29.115,P＜ 0.001).The ratio of payout of-pocket for healthcare was higher in the observation group (21.1％) than control group (9.9％) (x2=9.084,P=0.003).The duration of hypertension was longer in the observation group (8.8±4.6) than control group (6.0±4.1) (t=1.806,P=0.036).The income per month was less in the observation group (1850±150) than control group (2150±200) (t=5.799,P＜ 0.001).There were regression relationship between medication compliance and degree of education,medical security and duration of hypertension.Conclusions According to the influence factors of medication compliance in elderly hypertensive patients,it's useful to improve medication compliance by enhancing health education and designing a personal treatment.

Nursing of patients undergoing chemotherapy with capecitabine / 中国实用护理杂志

Objective To discuss the adverse effect caused by capecitabine chemotherapy and its nuning measures.Methods A retrospective analysis was carried out for the adverse effect,occurrence regularity and nursing measures in 58 patients undergoing chemotherapy with capecitabine from June 2004 to December 2007.Results Handfoot syndrome happened in 30 cases,nausea and vomiting 23 cases,diarrhea 20 cases and stomatitis 15 cases in 58 patients.After positive prevention and effective nursing 57 patients successfully accomplished capecitabine chemotherapy.Only one patient withdrew due to grade 3 handfoot syndrome.Conclusions Positive prevention and eady detection and treatment can alleviate the adverse effect of capecitabine chemotherapy,so the psychological burden of patients can be relieved.

Strengthening Links of Quality Control Safety in Use of Medical Consumptive Materials / 中华医院感染学杂志

OBJECTIVE To probe into and summarize the method and route of quality control of each link for safety in use of the medical consumptive materials.METHODS The combining method of integrated management and decentralized management was adopted to manage the medical consumptive materials.RESULTS Prevent and block the hospital incurred because of using the medical consumptive material to infect.CONCLUSIONS Through the implementation of work system,standardized operation and strengthened supervision to guarantee the safety in use of the medical consumptive materials.

Quality Control of Medical Equipment / 医疗卫生装备

Methods for strengthening quality management of medical equipment is discussed. Facing so many management methods, medical engineering department should strengthen the support and management by setting standard management rules for medical equipment with the total cost control as the core. The concept of green service is proposed and discussed.

Management of nosocomial consumables in supermarket style based on PowerBuilder / 医疗卫生装备

Objective To realize management of nosocomial consumables in supermarket style by developing bar code input and output modules.Methods Based on No.1 Military Medical Project and Consumables Management System,source codes were extracted and bar code input and output modules were added into original system.Results With the bar code modules,the actual work flow of this system was simplified to be three steps: consumables input by scanning bar codes;scan statistics;consumables output by scanning bar codes.Conclusion A lot of disadvantages in original workflow are removed such as overmuch procedures in workflow,frequent occurrence of errors,high labor repetition,low work efficiency,etc.work efficiency and accuracy are greatly improved and supermarket style management of nosocomial consumables is realized.

Informatized Management of Medical Consumptive Material / 医疗卫生装备

Objective To strengthen and improve the information-based management of medical consumables.Methods Supported by No.1 Military Medical Project and based on computer technology and LAN,the self-developed Medical Consumables Supermarket-style Management System was utilized.Results The Medical Material Management System of No.1 Military Medical Project was improved and the working procedures were simplified with higher working efficiency.Conclusion Mistakes are reduced,the management of warehouse is improved and the accuracy of the data accuracy is ensured.

New Attempt of the Management of Combat Readiness / 医疗卫生装备

The significance, development and advantage of barcode are introduced. The wsing of barcode module turns the management of medical consumables into supermarket, which promotes the management of medical consumables to a new step. In daily works, it can save manpower, material resources and cost, also improve the efficiency of work.

Protective effects of resveratrol on oxidized low-density lipoprotein-induced injury on endothelial cells / 解放军医学杂志

Objective To study the protective effect of resveratrol on endothelial cells injury induced by oxidized low-density lipoprotein (oxLDL) and its protective mechanism. Methods The injured model was established by endothelial cell treated with oxLDL. In the experiment, endothelial cell were cultured in vitro and divided into seven groups which were: control group; solvent (DMSO) group, oxLDL group, quercetin plus oxLDL group, Reseveratrol-L (0.5 mol/L), M(5 mol/L), H(50 mol/L) plus oxLDL group respectively. Endothelial cells were incubated with 200?g/ml oxLDL for 18 hours in the absence or presence of various concentrations of resveratrol and quercetin. The apoptotic index was detected by flow cytometric. Meanwhile, the content of Malondialdehyde (MDA), and the activity of SOD, GSHPX in the culture medium and homogenate of endothelial cells were measured. Results Incubation of endothelial cells with oxLDL for 18 h elicited a significant increase in the percent of apoptotic endothelial cells, in control group, the percent of apoptotic cells is 7.6?0.6, however in oxLDL group, it increased to 41.4?2.3, furthermore, oxLDL induced the increase of the contents of MDA, and accompanied by the decrease in the activity of SOD, GSHPX in the endothelial cells, the difference of was significant as compared with control group. Pretreatment of resveratrol with 0.5～50 mol/L decreased these oxLDL-induced changes, in Reseveratrol with 50 mol/L group, the percent of apoptotic cells decreased to 13.0?1.5, the difference of was significant as compared with oxLDL group (P