Objective To investigate and analyze the difficulties of nosocomial infection management in different-level medical institutions in Shanghai, and to provide scientific basis for improving the level of nosocomial infection management. Methods A questionnaire was designed to include 10 difficulties in nosocomial infection management such as professional title promotion, salary, and personnel allocation. In October 2023, the Shanghai Nosocomial Infection Quality Control Center, in collaboration with the Shanghai Hospital Association, conducted a questionnaire survey among the heads of nosocomial infection management departments in medical institutions in Shanghai. The scores of difficulties were analyzed by stratification according to hospital level, allocation and changes of full-time personnel. Results A total of 548 questionnaires were distributed, and 530 valid questionnaires were retrieved, with a recovery rate of 96.72%. There were 55 public tertiary, 93 public secondary, 169 public primary and 213 social medical institutions. The rates of full-time personnel allocation meeting standards were 76.36% (42/55), 72.04% (67/93), 31.95% (54/169), and 21.60% (46/213), respectively. There was a statistically significant difference in the rates of full-time personnel allocation meeting standards among different levels of medical institutions (χ2=105.149, P<0.001). There was no statistical difference in the total scores of nosocomial infection management difficulties among different-level medical institutions (F=1.657, P=0.176). There were statistically significant differences in the scores of difficulties in professional title promotion, cumbersome daily norms and requirements, insufficient allocation of full-time personnel, and high personnel turnover (P<0.05). Conclusions The main difficulties in nosocomial management of medical institutions at all levels in Shanghai include the difficulty in career promotion, cumbersome daily norms and requirements, insufficient allocation of full-time personnel and lack of experience. In the future, medical institutions should strengthen the allocation of full-time personnel and enhance their capabilities, provide smooth promotion channels, to promote the high-quality development of nosocomial infection management ultimately.
ObjectiveTo study the current situation and influencing factors of biofilm formation of digestive endoscopy in Zhongshan Hospital, Fudan University.MethodsFrom September 1st to 13th, 2020, ATP fluorescence assay and membrane filtration method were carried out on 130 endoscopes from the Endoscopy Center of Zhongshan Hospital, Fudan University. The type, number, source, duration of use and disinfection times in the past week were collected. Positive culture samples were identified by matrix-assisted laser desorption / ionization time of flight mass spectrometry. Logistic regression analysis was used to explore the factors affecting the formation of biofilms.ResultsThe total qualified rate of ATP assay and bacterial culture was 94.62% and 92.31% respectively. The 10 positive culuture samples were mainly composed of Pseudomonas aeruginosa, Moraxella osloensis, Stenotrophomonas maltophilia, Pseudomonas putida and Micrococcus luteus. Multivariate logistic regression analysis showed that the frequency of disinfection in the past week was associated with positive biofilm culture (P=0.001). The odds ratio of disinfection frequency more than 30 times in past week compared with disinfection frequency less than 15 times was 0.040, and 95% confidence interval was (0.005, 0.295).ConclusionsThe biofilm of digestive endoscopy in the Endoscopy Center of Zhongshan Hospital, Fudan University is mainly formed by aquatic bacteria. The formation biofilm can decrease by increasing disinfection frequency, and attention should be paid to the monitoring of endoscopic biofilm in the future.
Objective To describe the current state of hospital infection prevention and control for flexible endoscope in Shanghai, and analyze the trend of infection prevention and control quality from 2018 to 2022. Methods According to Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS 507－2016), the quality of infection prevention and control for flexible endoscope was divided into seven parts: organizational management, layout, cleaning and disinfection (sterilization) process, environmental disinfection and sterilization, final rinse water, recording and monitoring, and occupational protection. Each quality control item was judged according to the on-site score and the correction opinion, and the item with correction opinion was judged as “unqualified”, otherwise it was “qualified”. The results of the infection prevention and control quality supervision for flexible endoscope from 2018 to 2022 were reviewed and analyzed, and the qualification rates of quality control items for hospitals at different levels and in different years were calculated. Results From 2018 to 2022, the total qualification rates of organization management, final rinse water, environmental disinfection and sterilization, and occupational protection were over 90%, and the total qualification rates of cleaning and disinfection (sterilization) process, and records and monitoring were over 80%. There was no statistically significant difference in the annual qualification rate (P>0.05). The total qualification rate of the layout was 78.19%, which was significantly higher before the outbreak of COVID-19 (2018-2019) than after the outbreak of COVID-19 (2020-2022) (P<0.001). There was no significant difference in the qualification rate of different levels of hospitals in terms of organizational management, layout, cleaning and disinfection (sterilization) process, records and monitoring, or occupational protection item (P>0.05). There were statistical differences in the qualification rates of different levels of hospitals in terms of final rinse water and environmental disinfection and sterilization (P<0.05). Conclusions The infection prevention and control qualification rate of flexible endoscope in Shanghai is high. However, the layout qualification rate after the COVID-19 pandemic is lower than before. There has been no significant trend in the quality of other items in the past five years. Weaknesses in the cleaning and disinfection (sterilization) process, as well as in recording and monitoring, are identified as key areas in management. Targeted training and supervision are recommended to address these weaknesses.
Objective To investigate the current status of occupational environment support, occupational satisfaction, and job competence of hospital infection prevention and control personnel, and to explore the mediating effect of occupational satisfaction on the relationship between occupational environment support and job competence, in order to provide reference and guidance for effectively improving the job competence of hospital infection prevention and control personnel. Methods A survey questionnaire was distributed to various levels and types of medical institutions in Shanghai through the platform of the Shanghai Hospital Infection Quality Control Center. The questionnaire included the Occupational Environment Support Scale, Occupational Satisfaction Scale, and Job Competency Assessment Scale. The mediating effect of occupational satisfaction on the relationship between occupational environment support and job competency of hospital infection prevention and control personnel was analyzed. Results A total of 1027 hospital infection prevention and control personnel from 728 medical institutions participated in this survey, with 989 valid questionnaires and an effective response rate of 96.3%. There were statistically significant differences in the job competency scores of hospital infection prevention and control personnel based on gender, years of experience in infection control work, professional background, highest education level, professional title, job nature, type of medical institution, and annual income (P<0.05). The total score of job competence for hospital infection prevention and control personnel was 301.0 (267.5, 326.0), the total score of occupational environment support was 21.44±3.66, and the total score of occupational satisfaction was 19.25±2.78. The occupational environment support of hospital infection prevention and control personnel was positively correlated with occupational satisfaction and job competence (r=0.373, 0.339; P<0.001), and occupational satisfaction was positively correlated with occupational environment support (r=0.547, P<0.001). The mediating effect of job satisfaction on the occupational environment support and job competence was 0.085, accounting for 22.8% of the total effect. Conclusion Occupational satisfaction partially mediates the relationship between occupational environment support and job competence, and the mediating effect is significant.
Objective To analyze the drug resistance genes, virulence genes and homologies of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonized and infected patients in surgical intensive care unit based on whole genome sequencing. Methods Whole genome sequencing analysis was performed on CRKP infected strains isolated from the Department of General Surgery Intensive Care Unit and the Department of Liver Surgery Intensive Care Unit of Zhongshan Hospital, Fudan University in March 2021 and CRKP colonized strains isolated from the above departments between January and March 2021. The drug resistance genes, virulence genes and homologies of the strains were analyzed. ResultsA total of 16 CRKP strains were included, including 10 colonized strains and 6 infected strains. Except for the β-lactamase drug resistance gene CTX (16.7% vs. 100.0%, P<0.05), there was no significant difference in the detection rate of other drug resistance genes between CRKP infected strains and colonized strains (P>0.05). The cluster analysis of drug resistance genes of some strains was relatively close. Whole genome sequencing analysis showed that CRKP strains carried a variety of virulence genes, and the detection rates of entB, irp2, iroN, and rmpA genes were 100.0%, 87.5%, 37.5%, and 62.5%, respectively. There was no significant difference in the detection rate of virulence genes between CRKP infected strains and colonized strains (P>0.05). Homology analysis showed that some strains had close homologous relationships, and there was the possibility of cross transmission. Conclusions Some of CRKP infection strains and colonization strains in surgical intensive care unit patients have the risk of cross transmission. In the future, we should strengthen the prevention and control of nosocomial infection to reduce the incidence of infection.
Objective To investigate the impact of different final rinsing parameters of automated endoscopic reprocessors on peracetic acid (PAA) residuals in gastrointestinal endoscope channels, and to provide scientific evidence for optimizing endoscope cleaning and disinfection processes in clinical settings and reducing patient exposure risks. Methods From January to March 2025, 86 gastroscopes and 6 automated endoscopic reprocessors regularly used in the Endoscopy Center, Zhongshan Hospital, Fudan University were selected as the research subjects. They were divided into 3 groups based on the duration and frequency of final rinsing (group A: final rinsing for 2 times, with each rinsing lasting for 2.5 minutes, and a total rinsing time of 5 minutes; group B: final rinsing for 3 times, with each rinsing lasting for 2 minutes, and a total rinsing time of 6 minutes; group C: final rinsing for 3 times, with each rinsing lasting for 2.5 minutes, and a total rinsing time of 7.5 minutes). The PAA residuals in the endoscope channels of each group before and after drying were detected, and the compliance rates of PAA residues with standards were calculated. Results During the study period, groups A, B, and C underwent 40, 52, and 43 endoscopic disinfection procedures, respectively. Before drying, there was a significant difference in the residual PAA levels among the three groups (median PAA residual levels in groups A, B, and C were 5.34, 2.51, and 0.94 mg/L, respectively; P<0.05). Further pairwise comparisons also showed statistically significant differences (P<0.05). After drying, there was a significant difference in the residual PAA levels among the three groups (median PAA residual levels in groups A, B, and C were 3.37, 0.90, and 0.75 mg/L, respectively; P<0.05). However, further pairwise comparisons revealed no significant difference in PAA residual levels between group B and group C (P>0.05), while the remaining pairwise comparisons showed statistically significant differences (P<0.05). Within-group comparisons of PAA residual levels before and after drying showed significant differences in PAA residual levels in groups A and B before and after drying (P<0.05), while there was no significant difference in PAA residual levels in group C before and after drying (P>0.05). The PAA residual compliance rates in groups A and B after drying were significantly higher than those before drying (group A: 5.00% before drying and 27.50% after drying; group B: 1.92% before drying and 57.69% after drying; P<0.05), while there was no significant difference in the PAA residual compliance rates in group C before and after drying (P>0.05). Conclusions Increasing the number of final rinsing, extending the rinsing duration, and intensifying the drying process can effectively reduce PAA residues. Clinically, it is recommended to optimize the final rinsing parameters of the automated endoscopic reprocessor, combined with intensified drying, to reduce PAA residues and ensure patient safety.
Objective To investigate the current status of healthcare-associated infection (HAI) management in medical institutions in Shanghai, analyze the implementation of HAI surveillance indicators, and provide evidence to support the improvement of refined and scientific HAI management. Methods Using the Shanghai Three-Network Linkage Platform, a survey was conducted from April to May 2025 covering HAI management practices in the preceding year at medical institutions in Shanghai. Investigation and analysis were conducted on the HAI information systems, staffing of infection prevention and control (IPC) professionals, and implementation of HAI surveillance indicators. Results A total of 56 medical institutions in 16 administrative districts of Shanghai were surveyed. Among them, there were 45 tertiary medical institutions and 11 secondary medical institutions. There were 48 comprehensive medical institutions and 8 specialized medical institutions. All 56 medical institutions had established fully functional HAI information systems (100.0%). The structure and training compliance of IPC personnel were generally satisfactory; however, 4 institutions (7.1%) had insufficient IPC staffing levels. No statistically significant differences were observed between tertiary and secondary hospitals in the scores for implementation of HAI surveillance indicators (P>0.05). In contrast, significant differences were found between general and specialty hospitals in scores for rates of three types of device-associated infections (P=0.005) and hand hygiene compliance (P=0.041). After standardization of indicator implementation scores, the five lowest-scoring indicators requiring priority attention were, in descending order: blood culture submission rate for patients with pneumonia and fever ≥38.5°C; blood culture submission rate for patients with central venous catheters retained for ≥5 days; timing of perioperative prophylactic antimicrobial use for Class Ⅰ surgical incisions; catheter-related urinary tract infection incidence; and consumption of liquid soap and alcohol-based hand rub in wards. Conclusions Overall, HAI information system construction and management frameworks in Shanghai medical institutions are well established and functioning effectively. Nevertheless, gaps remain in IPC staffing allocation and in the clinical implementation of certain core HAI surveillance indicators. Continued efforts are required to advance the standardization and refinement of HAI management.
