After more than 30 years of localized development of infection prevention and control in China, a prevention and control system in line with China’s conditions has been established. Since the coronavirus disease 2019 pandemic began, with the unprecedented attention paid to healthcare associated infection by health administrative departments at all levels, the awareness of infection prevention and control of various personnel has been continuously strengthened, which has promoted the cross-integration and development of infection prevention and control-related disciplines. However, under the normalized pandemic prevention and control, infection prevention and control work also faces enormous pressure and challenges. This paper summarizes the opportunities for infection prevention and control in the new era, analyzes the current challenges in the field of infection prevention and control, and aims to provide some ideas for the future development of infection prevention and control.
In October 2022, thirteen government departments including the National Health Commission jointly issued the National Action Plan to Combat Antimicrobial Resistance (2022-2025) to proactively address challenges of antimicrobial resistance. In support of the implementation of the National Action Plan in healthcare institutions, the authors put forward following suggestions for prevention and control measures: strengthen construction of supporting systems and disciplines, enhance prevention and control of hospital-acquired infections caused by drug-resistant bacteria, promote precision diagnosis and treatment through diagnostic stewardship, advance rational drug use by performing prescription review, carry out universal and targeted training, establish clinical decision support systems using information technology, improve monitoring and evaluation systems, and enhance multi-source data fusion and application.
There is a worldwide consensus that urgent action is needed to prevent and control multi-drug resistant organisms in health care settings, especially carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPsA). In 2017, to focus on this topic, World Health Organization organized experts worldwide to develop guidelines for the prevention and control of CRE, CRPsA and CRAB. In this paper, we introduced the background, development process, main measures, advantages and disadvantages of the guidelines to help infection prevention and control practitioners take actions properly based on the guidelines.
ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo investigate the management of hospital infection control of 23 hospitals in Sichuan province, China for making the questionnaires and providing basic data of the China-U.S. cooperative program on emerging and re-emerging infectious diseases "The Nosocomial Infection Surveillance Project in China". MethodsWe selected 23 representative hospitals from different regions of Sichuan in the survey for the management of hospital infection control. The survey included basic situation of the hospital such as the hospital level, ownership, number of beds, employees and discharged patients, the situation of hospital infection management such as the organization of management, the previous surveillance for prevalence of nosocomial infection, the composition of the staff, and the distribution pattern of important pathogens. ResultsThere were 18 Triple A hospitals, 1 Double A hospital, 4 Triple B hospitals were investigated, of which there were21 general hospitals and 2 specialty hospitals. The total number of patient beds were 26 801. The total numbers of staff were 32 757 including 8 571 doctors, 13 611 nurses, 1 391 technicians and 1 014 pharmacists. In 2010, the total numbers of out-patients, operations, and discharged patients were 16 127 038, 334 057, and 776 806, and the length of mean hospital stays were 11.30 days. All hospitals established the hospital infection control department with 105 infection control professionals. Most of the staffs of infection control department had medical or nursing background with college, or undergraduate level. Nineteen hospitals (82.61%) did the surveillance for the prevalence of nosocomial infection. The last surveillance showed the mean rate of hospital infection was 2.58%. Lower respiratory tract, upper respiratory tract and surgical site infection were top three infections. The annual number of culture specimens totalled 267 061; the average positive rate was 33.06%. Escherichia coli, klebsiella pneumoniae, pseudomonasaeruginosa, staphylococcus aureus and acinetobacter baumannii were top five infectious bacteria. ConclusionThe survey on the hospital infection control management could help us understand the overall situation of the hospital infection control. Also it could found the weaknesses and targeted interventions for the future project, and ensure the authenticity and reliability of the data for this research project eventually.
Objective To survey and analyze the drug resistance of clinical isolated strains of bloodborne infectious staphylococci, in order to provide references for clinical diagnosis of aureus septicemia and rational use of antimicrobial agents. Methods We retrospectively studied the clinical data of 496 patients with staphylococcal septicemia confirmed by blood culture between June 2008 and May 2015 in West China Hospital of Sichuan University. The microbiological characteristics of the disease were analyzed. Results In the included 496 cases, there were 216 (43.55%) cases of coagulase-positive Staphylococcus (CPS) septicemia and 280 (56.45%) of coagulase-negative Staphylococcus (CNS) septicemia; 85 (17.14%) cases were caused by community infection, while the other 411 (82.86%) resulted from hospital infection. The drug resistance rate of CPS and CNS toward oxacillin was respectively 27.78% (60/216) and 87.50% (245/280), with a significant difference (P < 0.05). In al l the clinical isolated strains of CPS, the drug resistance rate of community infected strains and hospital infected strains toward oxacillin was respectively 9.67% (6/62) and 35.06% (54/154), with a significant difference (P < 0.05). For the clinical isolated strains of CNS, the drug resistance rate of community infected strains and hospital infected strains toward oxacillin was respectively 69.57% (16/23) and 89.11% (229/257), also with a significant difference (P < 0.05). Conclusions The drug resistance of hospital infected staphylococcal strains is stronger than community infected strains. The CNS strains are more drug-resistant than CPS strains.
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.