In recent years, the prevalence of carbapenem-resistant Enterobacterales (CRE) has been remarkably increasing. Infections caused by CRE have significantly increased the burden on patients both medically and economically, and the CRE often leads to outbreaks of healthcare-associated infections. It has now become a global public health concern. Consequently, international organizations and academic societies/associations, including the World Health Organization, have developed corresponding prevention and control guidelines. This article provides a detailed introduction to the background, principles, key understandings, and implementation recommendations of China’s Standard for Prevention and Control of Carbapenem-resistant Enterobacterales (WS/T 826－2023). The aim is to enhance the recognition of healthcare workers and medical administrators to prevent and control CRE and to provide detailed technical guidance for healthcare facilities in responding to the spread of CRE, thus ensuring medical quality and patient safety.
Objective To construct a multi-dimensional risk assessment system and scale for the prevention and control risk of respiratory infectious diseases in general hospitals, and make evaluation and early warning. Methods Through the collection of relevant literature on the prevention and control of respiratory infectious diseases during the period from January 1st, 2020 to December 31st, 2022, the articles related to the risk assessment of respiratory infectious diseases such as severe acute respiratory syndrome, COVID-19 and influenza A (H1N1) were screened, and the Delphi method was used to evaluate the articles and establish an indicator system. The normalized weight and combined weight of each item were calculated by analytic hierarchy process. The technique for order preference by similarity to the ideal solution method was used to calculate the risk composite index of 38 clinical departments in a tertiary general hospital in Jiangxi Province in December 2022. Results A total of 16 experts were included, including 4 with senior titles, 8 with associate senior titles, and 4 with intermediate titles. After two rounds of Delphi consult, a total of 4 first-level indicators, 11 second-level indicators, and 38 third-level indicators of risk assessment for the prevention and control of respiratory infectious diseases were determined. The reliability and validity of the scale were good. The top three items with the largest combined weights in the scale were spread by aerosol, spread by respiratory droplet, and commonly used instruments (inspection instruments and monitoring equipment). After a comprehensive analysis on the 38 departments, the top 10 departments in the risk index were the departments of medical imaging, pediatrics, ultrasound, cardiac and vascular surgery, infection, emergency, respiratory and critical care, general medicine, otolaryngology and neck surgery, stomatology, and obstetrics. Conclusions This study constructed the risk assessment scale of respiratory infectious diseases in general hospitals, and the scale has good reliability and validity. The use of this scale for risk assessment of general hospitals can provide a theoretical basis for the risk characteristics of prevention and control of respiratory infectious diseases in general hospitals.
When a clustered coronavirus disease 2019 epidemic occurs, how to prevent and control hospital infection is a challenge faced by each medical institution. Under the normalization situation, building an effective prevention and control system is the premise and foundation for medical institutions to effectively prevent and control infection when dealing with clustered epidemics. According to the principles of control theory, medical institutions should quickly switch to an emergency state, and effectively deal with the external and internal infection risks brought by clustered epidemics by strengthening source control measures, engineering control measures, management control measures and personal protection measures. This article summarizes the experience of handling clustered outbreaks in medical institutions in the prevention and control of coronavirus disease 2019, and aims to provide a reference for medical institutions to take effective prevention and control measures when dealing with clustered outbreaks.
Healthcare-associated infections pose a significant challenge to healthcare institutions, severely threatening healthcare quality and patient safety. To enhance the quality of infection prevention and control across healthcare facilities at all levels, promote standardization, and drive continuous quality improvement, quality control centers for infection prevention and control have been established nationwide and have played a crucial role. This article conducts an in-depth analysis of the functions, current development status, and key challenges faced by these quality control centers throughout their evolution, aiming to provide insights for future advancements in quality control systems.
ObjectiveTo study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of patients with craniovertebral junction disorders who were treated with transoral approach operations. And to provide a theoretical basis for the prevention of postoperative complications such as infection.MethodsThe clinical data of 20 cases with craniovertebral junction disorders and treated with transoral approach operations between October 2009 and May 2010 were analyzed. There were 8 males and 12 females, aged 2-66 years (median, 34.5 years). According to the classification of American Spinal Injury Association (ASIA), there were 4 cases of grade B, 8 of grade C, 6 of grade D, and 2 of grade E. The Japanese Orthopedic Association (JOA) score was 10.3±3.0. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points including 3 days before operation/before gargling (T1), 3 days after continuous gargling by chlorhexidine acetate/after anesthesia intubation on the day of operation (T2), after intraoperative cleaning and washing of the mouth (T3), and after intraoperative iodophor immersion for 5-10 minutes (T4). The microflora was stained by means of smear and further counted after an investigation by microscope. The ASIA classification and the JOA scores were applied to evaluate the postoperative nerve function of the patients. A regular reexamination of cervical vertebra with X-ray film, CT, and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesion, and tumor resection in the craniovertebral junction.ResultsAfter a series of oral disinfection, the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state, which was considered as type Ⅰ incision. All these 20 patients were treated with successful operations, without any intraoperative injury in vertebral artery and spinal cord, or any postoperative complications such as plate loosening, incision infection, or intracranial infection. All the patients were followed up 3-23 months, with an average of 5.15 months. The symptoms such as neck pain, limb numbness and weakness, neural symptoms, etc. were improved to different degrees after operation. The JOA score was improved to 13.4±1.9 at 3 months after operation, showing significant difference when compared with preoperative score (t=8.677, P=0.000); and the atlantoaxial joints had been fused. At last follow-up, the ASIA grades were improved when compared with those before operation. ConclusionIt is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach in the treatment of craniovertebral junction disorders.
Ventilator-associated pneumonia (VAP) is a kind of pneumonia that occurs when artificial airway (tracheal intubation or tracheotomy) is established and mechanical ventilation is accepted. The occurrence of VAP will significantly prolong the ventilation time and hospitalization time of patients, increase the mortality rate and the medical burden. In order to effectively prevent and reduce the occurrence of VAP, the Society for Healthcare Epidemiology of America released the Strategies to Prevent Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute-Care Hospitals: 2022 Update, which is an update of the 2014 version. In order to facilitate the reading and understanding of the medical workers, this article will interpret the infection prevention and control strategies of adult VAP and ventilator-related events.
Currently, there is a lack of guidelines and consensuses on hospital infection prevention and control for continuous renal replacement therapy (CRRT) at home and aboard. Given that in-hospital infection control for CRRT differs from that for intermittent hemodialysis, the Nephrology Brunch of Sichuan International Medical Exchange & Promotion Association, in collaboration with West China Hospital of Sichuan University, has established an expert consensus group for CRRT hospital infection prevention and control. The group conducted systematic retrieval, data analysis, and expert consultation on the thematic content, and developed five topics: occupational protection for CRRT healthcare personnel, CRRT catheter-related infections, collection of CRRT blood/waste specimens, disinfection of CRRT machines, and utilization and disposal of CRRT consumables and waste. The aim is to standardize clinical practices, prevent nosocomial infections, and enhance awareness among healthcare personnel regarding infection prevention and control in CRRT settings.
Running an infection control regular meeting is an effective way to develop and improve the communication between the infection control team and clinical units. This paper introduces the infection control regular monthly meeting which is held in the last week of each month in a newly-opened branch hospital of a university teaching hospital in China. Through collecting the issues for discussion beforehand, feeding back the surveillance data of last month including nosocomial infection, hand hygiene, multidrug-resistant organisms, occupational exposure, and medical waste, discussing the current infection control issues from each ward and trying to solve them together, and delivering and sharing new knowledge, skills, and information in terms of infection control, the monthly meeting achieves remarkable successes in the aspects of promoting the hospital infection control-related cultural construction, enhancing the supervision and implementation of infection control measures, and running new projects on hospital infection management, etc. Infection control regular monthly meeting builds up a study and work platform, promotes the multidisciplinary and multi-department communication and collaboration, and improves the quality of infection control eventually.
Objective To evaluate the current status of human resources in healthcare-associated infection prevention and control (infection control) in Jiangxi Province, and explore the impact of emergency public health events on the human resources of infection control professionals in various levels and types of medical institutions. Methods From October 1st to 31st, 2023, questionnaire and on-site interviews were conducted to investigate the human resources situation of infection control professionals in various levels and types of medical institutions in Jiangxi Province. Three stages were selected for the investigation: before the outbreak of COVID-19 (before the event, December 2019), during the event (June 2022), and after the transition of COVID-19 (after the event, June 2023), focusing on the characteristics of human resources between before the event and after the event by the comparative analysis. Results Finally, 289 medical institutions were included. There was a statistically significant difference in the number of infection control professionals in medical institutions among 2019, 2022, and 2023 (χ2=189.677, P<0.001). The number of infection control professionals in 2019 was lower than that in 2022 (P<0.001) and 2023 (P<0.001), but there was no statistically significant difference between 2022 and 2023 (P=0.242). The number of infection control professionals per thousand beds in 2019, 2022, and 2023 was 4.40, 6.16, and 5.76, respectively. There was no statistically significant difference between 2019 and 2023 in terms of professional titles, gender, educational level, or professional background (P>0.05). Conclusion Emergency public health events have promoted the increase in the number of infection control professionals, but there is no statistical significance in the professional titles, educational level, or professional background of infection control professionals.
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.
