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Application of targeted high-throughput sequencing technology in the investigation of pseudo-outbreak of Mycobacterium chelonae hospital infection caused by flexible bronchoscope

Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.

综合ICU医院感染监测的效果分析

目的 对综合ICU开展目标性监测，控制医院感染。 方法 2008年1月-12月开始对综合ICU进行目标性监测；将感染率、呼吸机相关性肺炎（VAP）、动静脉置管、泌尿道插管的感染率及抗菌药物使用及病原菌情况与2006年进行对比。 结果 2008年患者618例，感染率7.6%，例次感染率7.9%；2006年患者509例，感染率14.7%，例次感染率15.5%，2008年呼吸机相关性肺炎为51.1%，动静脉置管感染率为0.17%，泌尿道插管感染率为016%；2006年呼吸机相关性肺炎感染率为100%，动静脉置管感染率为1.0%，泌尿道插管感染率为1.0%；VAP感染率两者比较有差异，动静脉置管与泌尿道插管感染率无差异。 结论 ICU患者存在诸多医院感染的易感因素，目标性监测能有效控制医院感染。

Hot topics in the prevention and control of healthcare-associated infections

Healthcare-associated infection management has advanced rapidly in recent years. With the development of more standards and guidelines, infection control measures become more standardized and evidence-based. Evidence-based measures are increasingly applied in infection control, which promote more studies on the prevention and control of healthcare-associated infections. Furthermore, more new ideas of infection control have emerged, with old ones being challenged. The hand hygiene reform, multidrug-resistant organisms, and surgical site infections become the hot topics in recent years. In addition, whole-genome sequencing also provides more bases for understanding pathogen transmission in hospitals. Based on the high-quality studies published in recent years, this opinion review discusses these hot topics in the prevention and control of healthcare-associated infections.

肿瘤医院护理人员手卫生认知及执行状况调查

目的了解肿瘤医院护理人员手卫生认知及执行状况，为控制医院感染、制订预防措施提供有效依据。 方法2011年5月-7月，采用横断面调查法，对肿瘤医院的23个科室中528名护理人员进行问卷调查，调查护理人员手卫生认知及执行情况。 结果绝大多数护理人员对手卫生指征具有正确的认识，问卷的正确回答率（正答率）较高。护理人员手卫生知识认知情况正答率不足90%的项目有8项。47.85%的护理人员日消毒或洗手次数为10～20次。“工作太忙”为手卫生执行效果不佳的主要原因。 结论肿瘤医院护理工作人员手卫生知识认知和手卫生执行率还有待加强。

医院感染非发酵革兰阴性杆菌的耐药研究

摘要:目的: 监测综合性医院医院感染非发酵革兰阴性杆菌的分布和耐药状况。为临床用药和控制医院感染提供参考。 方法 : 收集我院2006年7月1日至2009年6月30日548株非重复的医院感染非发酵革兰阴性杆菌,复核后采用琼脂稀释法进行体外敏感试验,按照美国临床和实验室标准协会(CLSI)2007年的标准测定MIC,以MIC50 和MIC50 表示抗菌药物的抗菌活性,并计算出耐药率(R%),中介率(I%)和敏感率(S%)。 结果 : 14种抗菌药物对铜绿假单胞菌的抗菌活性敏感率从大到小依次为:美罗培南(81.5%),哌拉西林∕三唑巴坦(77.8%),亚胺培南(73.6%),阿米卡星(72.7%)。鲍曼不动杆菌对亚胺培南,美罗培南,左氧沙星,头孢吡肟敏感性最高,敏感率分别为:78.5%,72.4%,69.5%,62.8%。 结论 : 2种非发酵菌是一组多重耐药且耐药率较高的细菌,临床应根据药敏结果选用抗菌药物。

Risk Factors for Multiple Nosocomial Infection in Adults: A Case-control Study

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.

A cross-sectional study of hospital infection management system in maternal and child health care institutions in Sichuan Province

ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.

A Puzzle in the Therapy of Nosocomial Infection：Colonization or Infection

医院感染是指住院患者在医院内获得的感染,包括在住院期间发生的感染和在医院内获得出院后发生的感染。重症加强治疗病房( ICU) 是医院感染的高发科室, 其中又以肺部感染最为常见, 导致患者死亡率增加及治疗成本上升。随着医疗技术的发展, 器官移植、有创检查及治疗手段的不断推广, 以及广谱抗生素、糖皮质激素和免疫抑制剂在临床治疗中的广泛应用, 下呼吸道感染病原菌的种类不断发生变迁, 由多重耐药菌( MDR) 及真菌引起的感染不断增多, 成为下呼吸道感染的主要病原菌之一。在大多数情况下, 这类条件致病菌在合适的部位定植而不引起感染, 当机体因各种因素造成的抵抗力下降、菌群失调或天然屏障结构破坏时可引起感染发生。 由于定植菌的致病性是相对的, 临床上无法通过患者的临床表现经验诊断至属或种, 实验室亦无法单纯依赖培养鉴定技术确定其是感染病原菌还是定植菌。在呼吸机相关性肺炎( VAP) 患者中, 下呼吸道的真菌定植率较高, 但真正出现真菌性肺炎的患者比例并不高, 以致对患者的结局无显著影响。如果仅仅根据真菌定植结果制定治疗方案就容易造成抗真菌药物的过度使用。因此, 判断肺部感染的病原学是定植还是感染成为目前医院感染治疗中的难点问题之一。

开展科学研究，提升国内感染控制核心价值

The Prevalence Survey and Cross-sectional Analysis of Nosocomial Infection in Sichuan Provincial People’s Hospital

目的　了解四川省人民医院2011年的医院感染情况及其高危因素、抗菌药物使用情况。 方法　2011年9月采用横断面调查、床旁调查和病历调查相结合的方法，调查该院在调查日的医院感染、高危因素和抗菌药物使用等信息。 结果　调查住院患者1 898例，医院感染现患率4.53%，医院感染例次率4.64%；动静脉插管、呼吸机使用、泌尿道插管、气管切开、激素使用、化学疗法和免疫抑制剂的使用、血液透析等为医院感染的高危因素；调查当日抗菌药物使用率为32.93%。 结论　通过医院感染横断面调查可方便、快捷地获得全院医院感染方面的信息，为医院感染防控工作的开展提供依据。