Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor / 中华流行病学杂志

Objective To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor.Methods The tumor patients treated in neurosurgery ward from July 1,2015 to June 30,2017 were included in the study.The patients with and without postoperative infections were divided into a case group and a control group,respectively (1:1 ratio),matched by admission time (± 3 months),age (± 5 years) and surgical site.Average hospitalization days and medical costs between the two groups were analyzed.Results The incidence of postoperative infection was 5.66％,the surgical site infection and lower respiratory tract infection accounted for 54.72％ and 31.32％ of the total,respectively.The median of hospitalization days in the case group was 20.5,8.5 days longer than that in the control group (Z=-10.618,P＜0.001).The median of total medical costs in the case group was 91 573.42 yuan,higher than that of the control group by 30 518.17 yuan (Z=-9.988,P＜0.001).The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan,respectively.Among them,surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627,P＜0.001) and 43 631.36 yuan (Z=-4.954,P＜0.001),respectively.Conclusions Postoperative infection greatly increased the patient's financial burden,prolonged the hospitalization duration and resulted in unnecessary use of health resources.It is necessary to pay close attention to postoperative infection.

Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor / 中华流行病学杂志

Objective To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor.Methods The tumor patients treated in neurosurgery ward from July 1,2015 to June 30,2017 were included in the study.The patients with and without postoperative infections were divided into a case group and a control group,respectively (1:1 ratio),matched by admission time (± 3 months),age (± 5 years) and surgical site.Average hospitalization days and medical costs between the two groups were analyzed.Results The incidence of postoperative infection was 5.66％,the surgical site infection and lower respiratory tract infection accounted for 54.72％ and 31.32％ of the total,respectively.The median of hospitalization days in the case group was 20.5,8.5 days longer than that in the control group (Z=-10.618,P＜0.001).The median of total medical costs in the case group was 91 573.42 yuan,higher than that of the control group by 30 518.17 yuan (Z=-9.988,P＜0.001).The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan,respectively.Among them,surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627,P＜0.001) and 43 631.36 yuan (Z=-4.954,P＜0.001),respectively.Conclusions Postoperative infection greatly increased the patient's financial burden,prolonged the hospitalization duration and resulted in unnecessary use of health resources.It is necessary to pay close attention to postoperative infection.

Targeted monitoring on ventilator-associated events / 中国感染控制杂志

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.

Multidrug-resistant organisms causing healthcare-associated infection and comprehensive intervention in a neurological intensive care unit / 中国感染控制杂志

Objective To understand the infection caused by multidrug-resistant organisms(MDROs)in a neurological in-tensive care unit (Neuro-ICU),and evaluate the effect of comprehensive intervention measures.Methods Targeted monito-ring on MDROs among patients who hospitalized in a Neuro-ICU for >48 hours between March and December 2011 was implemented,comprehensive intervention measures were taken,MDRO infection before and after intervention was com-pared.Results A total of 932 patients were monitored,72 (7.73%)developed MDRO healthcare-associated infection (HAI);the top five MDROs were Acinetobacter baumannii ,Klebsiella pneumoniae ,Pseudomonas aeruginosa ,Staphylo-coccus aureus ,and Escherichia coli .The main infection site of MDRO infection was lower respiratory tract,followed by urinary tract and bloodstream.Detection rates of MDROs before and after intervention were 11.70%(n=55)and 3.68%(n=17)respectively(χ2 =16.675,P <0.001).Conclusion Patients in Neuro-ICU are prone to develop MDRO infection, comprehensive intervention measures can reduce the incidence of HAI.

Targeted monitoring on healthcare-associated infection in a respiratory in-tensive care unit of a teaching hospital / 中国感染控制杂志

Objective To investigate the incidence of healthcare-associated infection (HAI)in patients in a respiratory in-tensive care unit (RICU)of a teaching hospital,and provide reference for HAI prevention and control.Methods All pa-tients admitted to this RICU from January to December 2014 were surveyed with prospective targeted monitoring method, surveyed data were analyzed statistically.Results A total of 561 patients were surveyed,43 patients developed 44 times HAI,HAI rate and HAI case rate were 7.66% and 7.84% respectively,incidence of HAI and adjusted incidence of HAI per 1 000 patient-days were 6.26‰ and 1.79‰ respectively.The main infection site was urinary tract (45.46%,n=20). Incidence of ventilator-associated pneumonia (VAP ),catheter-related bloodstream infection (CRBSI),and catheter-associat-ed urinary tract infection (CAUTI)per 1 000 catheter-days were 2.73‰(n=13),1.57‰(n=2),and 3.78‰(n=18)re-spectively.Incidence of HAI per 1 000 patient-days between the first and second half year of 2014 was significantly differ-ent(4.59‰ vs 7.89‰;u=-1.75,P =0.04).A total of 47 pathogenic strains were isolated,the main pathogens were gram-negative bacteria(n=26,55.32%).Conclusion The major HAI in RICU is device-associated infection,it is necessary to strengthen the management of invasive procedures;targeted monitoring can find the weak links of infection control prac-tice and helpful for taking effective prevention and control measures to reduce the incidence of HAI in ICU.

Risk factors and prognosis of patients with bloodstream infection due to carbapenem-resistant Acinetobacter baumannii / 中国感染控制杂志

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.

Study on improvement of hand hygiene compliance and correctness of health care workers in a large hospital / 中国感染控制杂志

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.

Nasal Colonization by Opportunistic Pathogens among Health Care Workers:A Survey / 中华医院感染学杂志

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