ObjectiveTo explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.MethodsThe children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.ResultsA total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.ConclusionsLong-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.
Objective
To compare the epidemic status of nosocomial infections (NIs) among medical institutions at different levels.
Methods
The cross-sectional surveys on prevalence rates of NIs, distribution of NIs, and antimicrobial use were conducted through combination of bedside investigation and medical record reviewing among all in-patients of 20 medical institutions in Baoshan District, Shanghai from 00:01 to 24:00 on November 12th 2014, December 9th 2015, and November 30th 2016, respectively.
Results
A total of 18 762 patients were investigated, the prevalence rate of NIs in the first, second, and third class hospitals were 5.36%, 2.37%, 1.68%, respectively (χ2=88.497, P<0.05). The main NIs sites were lower respiratory tract, urinary tract, and upper respiratory tract in the first and second grade hospitals; while were other unclassified sites, respiratory tract, and upper respiratory tract in the third grade hospitals. The utilization rates for antimicrobial in the first, second, and third grade hospitals were 5.88%, 31.64%, and 42.11%, respectively (χ2=928.148, P<0.05); submission rates for specimen were 9.82%, 48.89%, and 82.39%, respectively (χ2=601.347, P<0.05). Four cases of pathogen were reported in the first grade hospitals, 94 in the second grade hospitals, and 96 in the third grade hospitals. The in-patients in different hospitals with different genders, ages, and departments had a statistical difference in prevalence rate of NIs (P<0.05) .
Conclusion
The first grade hospitals need to enhance the etiological examination; the third grade hospitals should severely restrict the antimicrobial utilization, and refine the prevention and control work for NIs.
Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection( CLABSI) in intensive care unit( ICU) .Methods A retrospective study was made to investigate the CLABSI epidemic data in ICU from June 2006 to June 2009. Clinical and physiological parameters were summarized and compared between these patients, which were divided into two groups based on the clinical outcome. Meanwhile, events including blood transfusion,mechanical ventilation, as well as cost of hospitalization were also reviewed. Logistic regression method was introduced to investigate the potential prognostic risk factors. Results There were 49 patients were diagnosed as nosocomial CLABSI, in which 19 cases( 38. 8% ) died in the hospital and 30( 61. 2% ) weresurvival. In univariate analysis, differences in body temperature, central venous pressure, acute physiology and chronic health evaluation( APACHEⅡ ) score, blood transfusion amount, pH value, D-dimer, blood serum alanine transarninase, blood urea nitrogen level, serumcreatinine, serumpotassiumbetween the survivors andthe non-survivors were significant( P lt;0. 05) . However, no significant differences were observed between the two groups in in-hospital days, ICU days and hospitalization cost ( all P gt; 0. 05) . With multiple logistic regressions, higher APACHEⅡ score( OR 0. 78; 95% confidence interval: 0. 66-0. 94; P = 0. 007) , APTTlevel( OR 0. 87; 95% confidence interval: 0. 77-0. 98; P = 0. 026) and serum potassium( OR 0. 09; 95% confidence interval: 0. 01-0. 80; P = 0. 031) were independent predictors of worse outcome. Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLABSI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLABSI patients with different prognosis.
ObjectiveTo study the effect of PDCA cycle model on the standardization of the application of common disinfectants, in order to promote the management level of hospital disinfection.
MethodsBy questionnaire and observation, the study was to learn the knowledge and its application in medical workers on common disinfectants. Based on the results, we tried to regulate effective preventive measures and carry out continuous improvements.
ResultAfter the implementation of PDCA cycle model, the awareness rate of the medical staff on disinfection and the application accuracy of disinfectants were significantly increased (P<0.05).
ConclusionThe implementation of PDCA cycle model can improve nosocomial infection management level effectively, ensure medical quality management and patients' safety, which is an effective way of management to reduce the rate of nosocomial infection.
During the medical rescue after the Wenchuan earthquake, in order to prevent hospital environmental pollution and cross infection, the nosocomial infection control committee of West China Hospital of Sichuan University immediately initiated the emergency response plan, improved the triage system, and organized multi-disciplinary infection control groups to improve the triage of the wounded and the infection control of the emergency department. At the same time, we regulated the individual behavior of healthcare professionals and took appropriate measures for personnel protection so as to ensure the safety of both the wounded and healthcare professionals.
ObjectiveTo compare the point prevalence of nosocomial infection in a comprehensive hospital between 2014 and 2015, and to put forward prevention and control measures so as to reduce the incidence of nosocomial infection.
MethodsBy means of reviewing electronical medical records and beside investigation, the prevalence rates of nosocomial infection in patients hospitalized on June 4, 2014 and June 16, 2015 were investigated. Data were collected by a uniform questionnaire and analyzed by Excel 2007 and SPSS 18.0.
ResultsThe nosocomial infection rates in those two time points were respectively 4.51% and 3.21% without a significant difference (χ2=2.246, P=0.134). Intensive Care Unit, Department of Neurosurgery and Department of Orthopedics were listed in the top five in terms of nosocomial infection rate for two consecutive years. The nosocomial infection sites were mainly lower respiratory tract, and a total of 64 strains were detected including mainly G? bacteria accounting for 76.6%. Antimicrobial agent usage covered 34.05% and 33.33% at those two time points. The purpose was mainly for therapy, and the pathogenic bacteria specimen detection rate was 68.06% and 59.73%, without statistically significant difference (χ2=0.114, 3.311; P>0.05).
ConclusionThe prevalence of nosocomial infection in this hospital is at average national level but higher than the average level in Sichuan Province. Infection surveillance, prevention and control measures should be strengthened in key departments and key infection sites, and antimicrobial agent should be rationally used so as to reduce the incidence of nosocomial infection.
Objective To investigate on the epidemiologic characteristics of nosocomial infection in surgery departments of general hospitals by analyzing the data collected from documents which were published in recent years, so as to provide references for the construction of precautionary system model. Methods Applying comprehensive search strategies, we searched various electronic databases as CBM (1978 to 2008), CNKI (1912 to 2008), VIP (2001 to 2009) and WanFang Data (2001 to 2009). MeSH terms and/or text words included: nosocomial infections, cross infection, hospital infection, prevent and control. Data from top and second grade hospital were included in this analysis. Results Sixty four articles and a total of 1 990 929 inpatients were included. Results showed: average nosocomial infection rate was 4.46%; the total rates of medicine department and surgery department were 23.28% and 17.33% respectively and no significant difference was found between the two departments; the infection rates of G– and G+ germ were 47.71% and 21.31% respectively; the rates of average antibiotics use was 60.59% and the rate of missing report was 12.42%. Noscomial infection was related to season change and the wave peak was from February to May. Conclusion Most of the included studies were retrospective studies and cross-sectional studies. The type of data was inconsistency and incomplete, causing weak strength of evidence. High missing rate of reports makes the precautionary model hard to build in future.
ObjectiveTo understand the current status of nosocomial infections in a municipal medical unit, to find problems in daily monitoring, and to provide the evidence for the prevention and control of nosocomial infection in high-risk groups and procedures.
MethodsAccording to the 2013 survey requirements made by the nosocomial infection control center of Chengdu, we made a cross-sectional survey about nosocomial infection among all the inpatients on July 25th, 2013 and statistically analyzed the results.
ResultsTotally, 1 301 cases were actually investigated within 1 307 inpatients of the time (the actual investigation rate was 99.54%). The prevalence rate of nosocomial infection was 3.38% (44 cases). The top five departments of infection rate were Respiratory Intensive Care Unit (RICU), Center of Intensive Care Unit (CICU), Department of Neurosurgery, Department of Thoracic Surgery and Department of General Surgery. The main site of infection was respiratory tract, which took possession of 62.25%. In univariate analyses, age≥60, length of hospital stay >2 weeks, invasive operation, history of diabetes, operation, radiotherapy/chemotherapy, utilization of antibiotics were found to be risk factors for infections. Multivariate analysis showed that length of hospital stay (OR=3.115, P=0.001), invasive operation (OR=14.930, P<0.001), diabetes mellitus (OR=2.157, P=0.046), radiotherapy/chemotherapy (OR=7.497, P<0.001) were independent risk factors for nosocomial infections. The utilization rate of antibiotics was 45.73%. Among them, there was 85.21% using single antibiotics, and 82.18% of them were used therapeutically.
ConclusionUnderstanding the current status of nosocomial infection in municipal hospitals helps us grasp the key and difficulty of infection control, make out prevention-control measures for high-risk groups and high-risk departments, and guide and supervise its implementation in clinical departments, which points out the direction to further reduce the incidence of nosocomial infection.
ObjectiveTo establish the model of nosocomial infection risk assessment, and evaluate its accuracy of prediction.
MethodsThe model of nosocomial infection risk assessment was established by expert grading, and cross-section survey of nosocomial infection was used to evaluate the predictive effect from December 2013 to February 2014.
ResultsThe infection risk score of the model had statistically significant influence on nosocomial infection [OR=1.35, 95%CI (1.26, 1.44), P<0.001]. The area under curve of the receiver operating characteristic curve was 0.754. The diagnostic test's sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 56.30%, 84.50%, 17.80%, 97.00% and 82.95% respectively, and the cutoff was 4.
ConclusionThe model of nosocomial infection risk assessment has certain significance in the prediction of nosocomial infection, and can be regarded as a reference for establishing precaution system of nosocomial infection.
ObjectiveTo investigate the educational background of practitioners from the hospital infection control departments located in the mainland of China and reveal the necessity and employment prospects of setting up a major of hospital infection control for a bachelor degree in universities.MethodsA self-designed questionnaire was used to conduct an online survey on the Shanghai International Forum for Infection Control and Prevention and the WeChat group of nosocomial infection control from March 12th to March 25th, 2018. The convenient sampling method was used to investigate the leader of infection prevention and control department in each hospital. The survey included the regional distribution, attention on nosocomial infection control, existing staff structure, future staff needs and employment prospects of hospitals in 2018, and the attention on nosocomial infection control in the same period in 2014.ResultsA total of 1 654 questionnaires were obtained, from 30 provincial-level regions, including 103 maternal and child health hospitals, 143 other special hospitals, 258 hospitals of traditional Chinese medicine, and 1 150 general hospitals. Hospitals upgraded more attention on nosocomial infection control in 2018 than in 2014 [(3.76±0.98) vs. (2.94±1.14) points; t=-36.112, P<0.001]. Currently, there were 5 068.5 labors engaged in nosocomial infection control. The educational background of the current practitioners was mainly nursing [60.52% (3 067.5)]. In the next 5 years, 83.50% (820/982) of the hospitals that had recruitment plans planed to recruit graduates specialized in the hospital infection control, and respectively, 44.86% (742/1 654) and 17.35% (287/1 654) of the respondents believed that the employment prospects of graduates with bachelor degree specialized in the hospital infection control were good or very good.ConclusionThere is a tremendous demand for the graduates specialized in the hospital infection control, and it is imperative to set up this undergraduate major.
