Since the outbreak of coronavirus disease 2019 (COVID-19), health authorities at all levels have issued many prevention and control schemes, guidelines, and notices, and medical institutions have also formulated hospital-level COVID-19 prevention and control measures accordingly. However, the epidemic prevention and control work can only be done well when the prevention and control measures are effectively implemented. West China Hospital of Sichuan University has adopted the two-level (hospital-level and department-level) supervision. By clarifying the content and frequency of two-level supervision and adopting multiple forms of supervision, a complete supervision system covering the whole hospital has been formed. Through supervision, risk points in prevention and control were identified and continuous improvement was carried out to promote the implementation of prevention and control measures. This paper introduces the application of two-level supervision in COVID-19 prevention and control in West China Hospital of Sichuan University, providing a reference for peers.
目的 了解医院感染情况，对医院感染控制工作进行评价，为医院感染控制措施提供依据，提高医务人员的感染控制意识。 方法 采用横断面调查的方法，于2012年8月21日进行医院感染现患率调查，将调查结果进行分类、统计、分析。 结果 应查住院患者1 383例，实查1 378例，实查率99.64%，现患率3.41%。医院感染下呼吸道感染占53.19%，泌尿道感染占25.53%，手术部位感染占4.26%，调查当日抗菌药物使用率20.90%。 结论 通过医院感染现患率调查，可快捷地获得全院医院感染的情况，为医院感染防控工作提供依据。
Objective To understand the current rate of nosocomial infection and its changing trend in a grade A comprehensive hospital in 10 years, and to provide scientific basis for the monitoring, control and management of nosocomial infection. Methods Using the method of cross-sectional survey, the inpatients in Mianyang Central Hospital from 2011 to 2020 were selected for bedside survey, and the questionnaire was filled in after review of medical records. The data of cross-sectional survey of nosocomial infection were collected, and the infection-related data of nosocomial and community-acquired infection of patients in each department were statistically analyzed. Results A total of 19 595 cases were investigated. The prevalence rate of nosocomial infection was 3.79%, and the the case prevalence rate of nosocomial infection was 4.04%. The prevalence of community-acquired infection was 33.44%, and the case prevalence rate of community-acquired infection was 35.30%. The departments with higher prevalence rate in nosocomial infection were intensive care unit, neurosurgery, cardiothoracic surgery and hematology. The departments with high prevalence rate in the community-acquired infection were burn department, pediatrics department, neonatology department, respiratory medicine department and pediatric intensive care unit. The most common site of nosocomial infection was lower respiratory tract infection, followed by upper respiratory tract sensation, urinary tract, abdominal tissue and blood. The main pathogens of nosocomial infections were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. The utilization rate of antibacterial drugs was 42.93%. There was a downward trend in prophylactic drug use, mainly one drug combination, and the proportion of combination drug decreased.Conclusion Through the investigation, it can be seen that the key points of nosocomial infection management and prevention and control should be lower respiratory tract infection, postoperative surgical infection, multi-drug resistant bacteria management and rational use of antibiotics.
In recent years, along with more importance having been given by health care facilities and health administrative departments nationally, the work force of infection prevention and control is constantly increasing. In the new era, to help infection prevention and control practitioners and all health care workers make the right direction in infection prevention and control professional business and make sure the infection prevention and control measures are implemented, what we need is to define the target of infection prevention and control scientifically, identify obligation subjects, and improve the infection prevention and control system and working mechanism from the top-level.
目的 调查四川省妇幼保健院医院感染发生情况及影响因素，以改进医院感染发病率监测方法与医院感染预防和控制措施。 方法 对2011年9月19日0：00～24：00所有住院患者进行调查，包括当日出院、转院、死亡的患者，但不包括新入院患者，使用全国医院感染监控网统一设计的调查表，采用床旁调查和查阅病历相结合，对调查结果进行统计分析。 结果 应调查住院患者112例，实际调查109例，实查率为97.3%；发生医院感染4例，现患率为3.7%。医院感染部位以呼吸道为主，抗菌药物使用率为64.2%。 结论 通过医院感染现患率调查，可以在短期内全面了解医院感染的现状，针对性的制定医院感染监控措施，预防和控制医院感染的发生。
ObjectiveTo explore the risk factors for multiple nosocomial infection in adult hospitalized patients, so as to provide references for the control of nosocomial infection. MethodsThe clinical data of adults hospitalized patients with nosocomial infection in the Second Affiliated Hospital of Fujian Medical University during Jan. 2015 to Dec. 2015 were collected, and the susceptible factors of multiple nosocomial infections referencing to the single nosocomial infection were analyzed. Results1226 cases (1368 case-times) of nosocomial infection were found and the infection rate and the case-time infection rate were 2.24% and 2.49%, respectively. Single factor analysis results showed that the top four risk factors of multiple nosocomial infection included hospital stay ≥30 days (25.5%), first infection time ≥30 days (23.2%), incision type Ⅲ (16.7%), and surgery (13.4%). Logistic regression analysis result showed, after adjusting the influence of age and gender, longer hospital stay was the independent risk factor of multiple nosocomial infection referencing to single nosocomial infection (OR=3.475, 95%CI 2.545 to 4.745). ConclusionLonger hospital stay is the independent risk factor of multiple nosocomial infection of adult hospitalized patients. Measures should be taken to shorten the length of stay in hospital and reduce the exposure to the high-risk environment, so as to reduce the incidence of multiple nosocomial infection.
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.
Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.