Contamination of personal protective equipment and environmental surfaces in Fangcang shelter hospitals.

BACKGROUND: Fangcang shelter hospitals emerged as a new public health concept after COVID-19. Data regarding contamination of Fangcang shelter environments remains scarce. This study aims to investigate the extent of SARS-CoV-2 contamination on personal protective equipment and surfaces in Fangcang hospitals. METHODS: Between March and May 2022, during wave of omicron variant, a prospective study was conducted in 2 Fangcang hospitals in Shanghai, China. Swabs of personal protective equipment worn and environmental surfaces of contaminated areas, doffing rooms, and potentially contaminated areas were collected. SARS-CoV-2 RNA was detected by reverse transcription quantitative polymerase chain reaction. If viral RNA was detected, sampling was repeated after cleaning and disinfection. RESULTS: A total of 602 samples were collected. 13.3% of the personal protective equipment were contaminated. Positive rate was higher in the contaminated areas (48.4%) than in the doffing rooms (11.7%) and the potentially contaminated areas (0; P<.05). Contamination was highest in patient occupied areas (67.5%). After cleaning, samples taken at previously contaminated surfaces are all negative. CONCLUSIONS: SARS-CoV-2 RNA contamination is prevalent in Fangcang hospitals and healthcare workers are under risk of infection. Potentially contaminated areas and surfaces after cleaning and disinfection are negative, underlying the importance of infection control policy.

Increased multidrug resistant isolates: new clinical burdens for 66 hospitals in Shanghai, 2015 to 2017.

BACKGROUND: To investigate the etiology of urinary tract and respiratory infections and the rate of drug resistant bacteria in Shanghai from 2015 to 2017, provide the support to the promotion of the correct clinical etiological specimens detection. METHODS: The retrospective questionnaire survey was conducted to obtain the antibiotic prescription rate, pathogen detection rate, and isolation rate of drug-resistant bacteria of the inpatients in 66 hospitals of Shanghai in 2015 and 2017. RESULTS: Although the detection rate of multidrug-resistant bacteria in sputum specimens has decreased, the clinical pathogen detection still relied mainly on sputum specimens in 2017. Among the sputum specis, the detection rates of extended-spectrum ß-lactamase-producing Escherichia (ESBL-ESC), extended-spectrum ß-lactamase Klebsiella pneumoniae (ESBL-KP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and methicillin-resistant Staphylococcus aureus (MRSA) in 2017 were 66.67%, 32.46%, 61.74%, 32.01% and 58.55% respectively. The detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA in 2017 were increased while the MRSA was decreased than 2015 (P<0.001). Among the blood samples, the detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA, MRSA and vancomycin-resistant Enterococcus sp (VRE) in 2017 were 53.71%, 31.43%, 50.80%, 19.43%, 43.87% and 0.55% respectively. The detection rates of ESBL-KP, CRAB, CRPA and MRSA increased while the rates of ESBL-ESC and VRE decreased compared with 2015 (P<0.005). The pathogens of multi-drug resistant bacteria were mainly detected from sputum specimens in 2017, which were all higher than detected from the blood specimens (P<0.001). CONCLUSIONS: Most of the multi-drug resistant bacteria in Shanghai, especially in Acinetobacter baumannii or Pseudomonas aeruginosa are mainly detected from sputum specimens, indicating that the actual drug resistance may be overestimated.

Colonization of Toxigenic Clostridium difficile Among Intensive Care Unit Patients: A Multi-Centre Cross-Sectional Study.

Background:Clostridium difficile (CD) is a major cause of healthcare-associated infections and antibiotic-associated diarrhea in hospitalized patients worldwide. Carriers of toxigenic CD (tCD) have a higher risk of developing CD infections and can transmit CD to the environment and susceptible patients. However, little is known regarding the carriers and transmission of tCD in China. Methods: A multi-center cross-sectional study of tCD colonization (tCDC) was conducted from October 24 to 31, 2014, at 33 hospitals in Shanghai, China. Rectal swabs or stool samples were collected and tested, and the clinical and demographic status, epidemiological data, and blood parameters of 531 participants were recorded. The status of tCDC was defined by a positive result on the nucleic acid amplification test for the tcdA (toxin A), tcdB (toxin B), and cdtAB (toxin CDT) genes after positive bacterial culture. Results: The overall prevalence of CD colonization (CDC) was 19.02%, tCDC accounted for 92.08%, and A+B+CDT- was the dominant genotype (87.13%). The CD infection (CDI) prevalence was 1.51%. Potential tCDC-associated factors were admission to secondary grade hospitals, a body mass index <18.5, hospitalization during the previous 30 days, underlying diseases (including hypertension, diabetes mellitus, coronary heart disease, and respiratory failure), diarrhea during the previous 7 days, and exposure to fluoroquinolones or lansoprazole. Conclusions: This study reveals the prevalence of CDC and tCDC in Shanghai, elucidates several associated factors, contributes to the awareness of the current epidemiology in parts of eastern China and provides new insights for further study and infection control practices.

A survey of sharps injuries and occupational infections among healthcare workers in Shanghai.

BACKGROUND: Healthcare workers (HCWs) are at greater risk of occupational exposure to sharp injuries in their daily routine work, which is extremely worrying due to the potential risk of transmitting bloodborne pathogens. This study aims to assess what procedures and factors present the greatest risk of sharp injuries to HCWs in Shanghai and to provide an evidence base for improving measures to reduce sharps injuries. METHODS: A cross-sectional study was administered to all HCW who might be exposed to sharp instruments in 81 hospitals in Shanghai. According to the voluntary, investigate as many HCWs as possible and get feedbacks N=61,309. The survey addressed the sharp injury (SI) incidents, SIs of common instruments, SIs of common locations, SIs of operating procedures, SIs of common instruments and common sources of SI occurrences. Statistical analysis was performed using the SPSS program. RESULTS: A total of 61,309 HCWs were surveyed for this study, and 935 (1.53%) HCWs experienced the various types of sharp injuries in one month. Of the 1,140 sharp injuries, 292 (25.61%) sharp injuries were reported, and 815 (71.49%) sharp injuries were traced to their sources. Interns experienced the highest proportion of sharps injuries (4.12%). General wards were the most common location where sharp injuries occurred to HCWs (36.05%), while disposable syringes were the most common medical devices that caused sharp injuries (32.11%). Nurses, doctors and logistical workers who did not receive relevant training had a higher incidence of SI (4.40%, 4.95% and 4.03%, respectively) than those who received training (1.58%, 1.03% and 0.67%, respectively, P<0.001). HBV infection was the main source of exposure to sharp injuries, with scalpel cuts being the most common related occurrence. CONCLUSIONS: Sharp injuries occur among HCWs in Shanghai dented optimism. There are multiple high-risk factors for SI and exposure to blood-borne pathogens in their work such as interns, general wards, disposable syringes, and lack of relevant training. HBV infection was the main source of exposure to sharp injuries. As such, medical institutions shall pay closer attention to this topic.

[Perioperative antibiotic prophylaxis in colorectal surgery: an investigation of 2 465 cases].

OBJECTIVE: To investigate the influence of changes in perioperative antibiotic prophylaxis (PAP) duration in colorectal surgery on surgical site infection (SSI). METHODS: The data on PAP in April and October between 2011 and 2013 was collected from tertiary and secondary hospitals in Shanghai. Prevalence of SSI rates over the same period was compared. RESULTS: A total of 2 465 cases of colorectal surgeries were studied over the three-year period, including 1 784 cases in tertiary hospitals and 681 cases in secondary hospitals. In 940 surgical operations, PAP duration were within 72 hours, accounting for 38.1% of all cases. 48.0% of the operations in 2013 had a PAP within 72 hours, which is significantly higher than that of 20.8% seen in 2011 (χ(2) = 129.986, P = 0.000). In 2013, 53.5% of the all procedures in tertiary hospitals had PAP ≤ 72 hours, compared with 35.5% in secondary hospitals over the same period (χ(2) = 22.714, P = 0.000). Combined uses of nitroimidazoles, with an effect of anti-anaerobic, were used much more commonly in tertiary (76.0%) than in secondary hospitals (41.4%) (χ(2) = 267.820, P = 0.000). The usage of cephamycin were higher in secondary (20.6%) than in tertiary hospitals (4.7%) (χ(2) = 149.865, P = 0.000). According to the investigations by SICC on prevalence of healthcare-associated infections between 2011 and 2013, colorectal surgeries have an average SSI rate of 2.0%. Stratified data showed that the rate of PAP ≤ 72 hours increase from 23.6% in 2011 to 45.8% in 2013 over the same period. However, the SSI rate did not show a significant change (1.9% in 2011, 1.7% in 2013). There was no linearly dependent between the two rates (r = 0.015, P = 0.990). CONCLUSIONS: The proportion of rational PAP of colorectal surgeries in Shanghai has increased. Perioperative antibiotic prophylaxis duration decreased, while SSI rates over the same period did not increase.