Xiujuan Meng

Background: Perioperative antibiotic prophylaxis plays a key role in preventing surgical site infections (SSIs). However, inappropriate use may increase the risk of antimicrobial resistance and SSIs. This study aims to evaluate the use of perioperative prophylactic antibiotics in Class I incisions after implementing administrative multidisciplinary team (MDT) interventions and assess the effectiveness of these interventions in improving management practices. Methods: Retrospective collection of perioperative data from 2017 served as baseline data. The administrative intervention was divided into three phases: Phase I: The administrative Multi-departmental team (MDT) was composed of Medical Affairs Department, Hospital Infection Management Department, and Pharmacy Department (January 2018–December 2019). During this phase, the three departments will collaboratively conduct surveillance, evaluation, and public reporting on perioperative antimicrobial prophylaxis for Class I (clean) incisions and organize targeted training initiatives based on the findings. Phase II: The “administrative MDT” model will now be comprehensively expanded and integrated into key areas of our healthcare system, encompassing the Nursing department, Operating room, Anesthesiology department, and various clinical units. This strategic development will span a multi-department joint intervention phase, commencing from January 2020 and concluding in December 2022; Simultaneously, targeted improvement measures were implemented to address issues identified in Phase I. Phase III: Continuous follow-up (January 2023–December 2024), To evaluate the improvement effectiveness of each intervention phase compared to the baseline monitoring results. Results: After administrative interventions, all monitoring indicators for prophylactic antibiotic use in Class I incisions showed significant improvement: The prophylactic antibiotic use rate for Class I incisions decreased from 33.72% (7,168/21259) at baseline to 29.01% (24,314/83804) in Phase II and further to 25.91% (19,757/76259) in Phase III, which were statistically significant different ( p = 0.000 < 0.05). The average score rate of surgical staff on antibiotic-related knowledge assessments increased from 70.83% at baseline to 96.33% in Phase II, and high at 95.41% in Phase III. The incidence of Class I incision infections decreased slightly from 0.11% at baseline to 0.09% in Phase II, and to 0.10% in Phase III (No statistically significant difference). The results demonstrate that MDT intervention was associated with a decrease in antimicrobial use, and no significant increase in surgical site infection (SSI) rates was observed. Conclusion: This study applied the “Administrative MDT Model” to the management of prophylactic antibiotic use in Class I incisions, As a result, the utilization rate of prophylactic antibiotics for these procedures was significantly reduced. The “Administrative MDT Model,” effectively reduced unnecessary antibiotic use while maintaining low infection rates.

Antimicrobial resistance (AR) is an increasingly significant public health challenge worldwide owing to its negative impact on morbidity, mortality, and he

Background: Surgical site infections (SSIs) are the most frequent type of healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). Effective surgical hand antisepsis is a critical step in the prevention of SSIs. Limited research on clinician interventions regarding accuracy in waterless surgical hand antisepsis (WSHA) is available. This study evaluated the effect of a tailored, multifaceted improvement strategy on WSHA in a tertiary hospital in East China. We also performed a process evaluation to explore the mechanisms through which our strategy brought about change.Methods: A prospective, pre-post intervention study was performed from January 2024 through December in 28 departments. Data from the pre-post intervention studies were collected using a specially designed score checklist and video surveillance (≥4 per department). In addition to the score collection, the mid-term assessment also used a questionnaire that included demographic characteristics and cultural climate surveys. A number of customized interventions were conducted before and after the mid-term assessment.Results: The scores of pre-intervention, mid-term assessment, and post-intervention were 71.4 ± 16.8, 92.7 ± 9.2, and 78.7 ± 19.4, respectively. There were statistical differences between the scores of pre-intervention and mid-term assessment (p < 0.001), mid-term assessment and post-intervention (p < 0.001), and pre-intervention and post-intervention (p = 0.002). There were statistical differences among different genders, ages, positions, years of working experience, and departments (p < 0.05). Lower scores appeared in males, orthopedics, and internal medicine. The psychological comfort score was more than 4 points when being reminded to standard WSHA. The number of times the score was less than 2 points was reduced.Conclusion: Our interventions have been successful in improving WSHA accuracy. In the future, it will be necessary to closely monitor and supervise WSHA practices to determine the long-term effectiveness of current intervention strategies.

Background: The pandemic of Coronavirus Disease 2019 (COVID-19) significantly impacted healthcare systems worldwide, especially improving awareness of infection prevention and control in medical institutions. However, it remains unclear to what extent COVID-19 influenced the occurrence of bloodstream infection (BSI). This study aimed to analyze the distribution and antibiotic resistance patterns of pathogens responsible for BSI before and after the COVID-19 pandemic in a tertiary hospital.Methods: Pathogens from patients with BSI were collected from January 2018 to December 2022. Pathogen identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility testing was conducted using broth microdilution, the Kirby-Bauer (K-B) disk diffusion method, and Etest. Data were analyzed using WHONET and SPSS software. This study was approved by the Medical Ethics Research Committee of the hospital (2023-11-C026).Results: Following the COVID-19 pandemic, the blood culture submission rate decreased from 12.82 to 11.07%, while the standardized blood culture positivity rate increased from 0.53 to 0.62%. Among the identified pathogens, Gram-negative bacteria accounted for 67.90%, Gram-positive bacteria for 28.82%, and fungi for 3.28%. The most frequently isolated pathogens were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. The resistance rate of E.coli to ciprofloxacin increased from 60.10 to 66.84% post-pandemic, whereas K. pneumoniae showed a reduction in cefepime resistance, decreasing from 25.42 to 15.54%. Additionally, the proportion of extended-spectrum beta-lactamase (ESBL)-producing E. coli increased from 35.93 to 50.63%. In contrast, S. aureus exhibited no significant changes in resistance to commonly used antibiotics post-pandemic.Conclusion: The COVID-19 pandemic impacted the distribution and antibiotic resistance of pathogens in patients with BSI. Notably, the prevalence of ESBL-producing E. coli were increased, while the isolation rates of other multidrug-resistant organisms remained relatively stable.

Introduction: Blood-borne occupational exposure (OBE) is one of the major public health problem for healthcare workers globally. Effective education and training on post-exposure management and standard precautions for healthcare trainees, are important measures for reducing OBE and infection rates. The aim of this study was to evaluate the effectiveness of standard precaution training on OBE disposition for healthcare trainees, comparing the differences of “theoretical teaching” and “situational simulation” training methods. Methods: A pre-post intervention study was conducted among 1347 healthcare trainees at a university teaching hospital located in Jining, Shandong Province from July 2023 to September 2023. Healthcare trainees who were undergoing training at the hospital from July 2020 to July 2023 were selected as the research subjects. They voluntarily participated in theoretical teaching group or situational simulation group. The two groups taught the same knowledge using different methods. Both groups were tested the same content before and after the training. Results: The accuracy rates before and after training in different groups were 71.71% and 78.08%, respectively (P< 0.001). The accuracy rate after training in the scenario simulation group (79.08%) was higher than that in the theoretical teaching group (76.60%), with a statistically significant difference (P< 0.05). The accuracy rate for trainees who experienced OBE was 69.87% before training and 77.11% after training. For trainees who had not experienced OBE, the accuracy rates were 71.38% before training and 77.25% after training. The accuracy rates were higher after training compared to before training, with statistically significant differences (P< 0.001). Conclusion: Scenario simulation training exhibits significant advantages in improving accuracy due to its strong practicality, high level of participation, and timely feedback. The self-protection awareness, knowledge on OBE management, and standard precaution among healthcare trainees were enhanced through the training, and operational content can achieve better results through scenario simulation training.

Introduction: Hand hygiene is a cost-effective measure to reduce healthcare-associated infections (HAIs) in healthcare facilities. The impact of the coronavirus disease 2019 (COVID-19) pandemic on hand hygiene performance (HHP) provided evidence for targeted hand hygiene intervention measures.Methods: This study evaluated the HHP rate in a tertiary hospital before and after the COVID-19 outbreak. HHP was checked by infection control doctors or nurses every day, and they inputted the HHP rate to the full-time infection control staff every week. A random examination of HHP was conducted by a confidential worker every month. The HHP of healthcare workers (HCWs) was monitored in the outpatient department, inpatient ward, and operating room from January 2017 to October 2022. The influence of COVID-19 prevention and control strategies on HHP was elucidated by analyzing the results of HHP during the study period.Results: The average HHP rate of HCWs was 86.11% from January 2017 to October 2022. The HHP rate of HCWs after the COVID-19 pandemic was statistically significantly higher than that before the pandemic (P < 0.001). The HHP rate was the highest (93.01%) in September 2022 when the local epidemic occurred. Among the different occupation categories, medical technicians showed the highest HHP rate (89.10%). The HHP rate was the highest after contact with body fluids or blood of patients (94.47%).Conclusion: The HHP rate of HCWs in our hospital showed an increasing trend in the recent 6 years, especially during the COVID-19 pandemic, and the increase was most obvious during the local epidemic.

Background: Gut microbiota composition of intensive care unit (ICU) patients suffering from Clostridium difficile -positive diarrhea (CDpD) is still poorly understood. This study aims to use 16S rDNA (and metagenome) sequencing to compare the microbiota composition of 58 (and 5) ICU patients with CDpD (CDpD group), 33 (and 4) ICU patients with C. difficile negative diarrhea (CDnD group), and 21 (and 5) healthy control subjects (control group), as well as CDpD patients in A ⁺ B ⁺ (N=34; A/B: C. difficile TcdA/B ), A ^- B ⁺ (N=7), and A ^- B ^- (N=17) subgroups. For 16S rDNA data, OTU clustering (tool: UPARSE), taxonomic assignment (tool: RDP classifier), α-diversity and β-diversity analyses (tool: QIIME) were conducted. For metagenome data, metagenome assembly (tool: SOAP), gene calling (tools: MetaGeneMark, CD-HIT, and SoapAligner), unigene alignment (tool: DIAMOND), taxon difference analysis (tool: Metastats), and gene annotation (tool: DIAMOND) were performed. Results: The microbial diversity of CDpD group was lower than that of CDnD and control groups. The abundances of 10 taxa (e.g. Deferribacteres, Cryptomycota, Acetothermia) in CDpD group were significantly higher than that in CDnD group. The abundances of Saccharomycetes and Clostridia were significantly lower in CDpD in comparison with control. A ⁺ B ⁺ , A ^- B ⁺ and A ^- B ^- subgroups couldn’t be separated in principal component analysis, while some taxa are significantly different between A ⁺ B ⁺ and A ^- B ^- subgroups. Conclusion: CDpD might relate to the decrease of beneficial taxa (i.e. Saccharomycetes and Clostridia) and the increase of harmful taxa (e.g. Deferribacteres, Cryptomycota, Acetothermia) in gut microbiota in ICU patients. C. difficile type might be slightly associated with gut microbiota composition.

The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital. We conducted a retrospective, matched case–control–control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection. Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26–12.42), tracheostomy (OR:2.24; 95%CI: 1.14–4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31–28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52–95.4), urinary system disease (OR: 16.69; 95%CI: 3.01–89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46–5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89–26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01). Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.