| Section 1 Surveinence of Informative Media Transmitted Nosocomia InfectionsObjectiveNosocomial infection(NI) is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. NI poses a heavy burden on the national budegt due to its high incidence. For instance, each year, more than 2 million patients get NI and the cost of its health care reached $ 4.5 billion in the United States. Meanwhile, NI is also one of the most serious and difficult public health problems in China. The prevention and control of NI are not only a tough problem, but affect the quality of health care as well. Cutting off the transmission chain of NI is an important measure to prevent nosocomial infection.In view of the surface shape, nature and other characteristics of the healthcare environment, we monitored contaminations on various surface, studied characteristics of modern NIs and combined with the national conditions to develop practical management strategies for prevention and control of hospital infections, which are crucial for decreasing multi-drug resistant bacterial infections.Application of hospital information system has already enhanced the level and efficiency of diagnosis and treatment, but infections caused by the hardware devices have not been reported yet. Through a cross-sectional survey on the surface contaminations of the modern devices in the hospital, we clarified the features of NI media and provided a theoretical basis for the disinfection strategies in the modern hospital and medical environment.MethodDuring March and October of 2014, we conducted a cross-sectional study on 10 departments at a tertiary hospital in Chongqing. The enrolled medical research departments consisted of Emergency Unit ICU, Burn Unit ICU, Cardiothoracic Surgery ICU, Neurology ICU, Respiratory ICU, Hepatobiliary Division ICU, Center ICU, Pediatrics and Infectious Diseases.By means of stratified random sampling method, we collected 814 samples from seven objects, such as the surface of keyboards, mouses, telephones, monitors, infusion pumps, incubators, bed rails in wards; and then made analysis on the types and distribution of bacterial colonies and multi-drug resistant bacteria; afterwards, we compared qualified rate of bacteria colonies on the surface of different objects and the positive rate of multidrug-resistant bacteria in different hospital departments.Analysis of the structure of media chain of nosocomial infection laid a solid foundation for the evaluation of the effectiveness of disinfection approaches for hospital information devices. We made a series of statistical analysis by SPSS 13.0 statistical software, and acquared qualified rates of bacteria colonies and positive rates of multi-drug resistant bacteria by means of chi-square test for those independent samples; moreover, we adopted Fisherr exact probability method when theoretical frequency is greater than 1 but less than 5.Results1. Hospital infection pathogenic bacteria including Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, Enterobacter cloacae.2. Composition ratio on the surface of multi-drug resistant is listed as below: Acinetobacter baumannii 85.33%, methicillin-resistant Staphylococcus aureus 8.00%, Klebsiella pneumonia 4.00%, Enterobacter 2.67%.3. Qualified rate of bacteria colonies in all hospital departments averaged 72.60 percent, the difference of which had statistical significance(c2= 45.50, P = 0.00). The center ICU had the lowest qualified rate(49.00%), whereas the Burns section had the highest qualified rate(85.00%) on colonies. The positive rate of multidrug resistant bacteria in different departments was 9.21% in average, which had statistical significance(c2=63.97, P = 0.000), center ICU got the highest detection rate(29.00%), but infection section had not any multidrug-resistant bacteria.4. Qualified rate of bacteria colonies on the surface of different objects was 72.60% on average, which showed statistical significance(c2=31.84, P = 0.00). Among them, infusion pump colonies got the lowest qualified rate(52.78%), while incubator got the highest qualified rate(90.63%). Positive rate of multidrug-resistant bacteria on the surface was 9.21% on average, of which the detection rate of multi-drug resistance had statistical significance(c2= 85.63, P = 0.00), infusion pumps got the highest positive rate(38.89%), while telephones got the lowest positive rate(2.38%).ConclusionsIn wards, there is no denying that different degrees of pollution consistently exists on the surface of keyboards, mouses, telephones, monitors, infusion pumps, incubators and bed rails, which could be regarded as bacteria carriers as well. When conditions are suitable for spreading diseases, it will definitely give rise to NIs. For instance, Acinetobacter baumannii, multidrug-resistant Klebsiella pneumoniae are widely planted on the surface of objects in ICU. If sterilization is not strictly implemented, a massive outbreak of infectious diseases would occur in the hospital. Because of the above mentioned, great attention should be paid on the prevention of NIs. In addition, accordance with the media features, scientific measures should be taken to reduce or avoid the NIs.Section 2 Research on the Disinfection Strategies for Nosocomia Infection MediaObjectiveWith the rapid development of the modern social information technology, hospitals are speeding up the overall construction of the information platform and HIS system for the sake of improving the level of hospital service and core competitiveness. Nearly all of the hospital clinical departments, logistics and administrative departments are in the use of a computer system. During working hours, the medical staff have to contact with communication device in hospital, such as keyboards, mouses, pagers, etc. In that case, if hand hygiene system is not conducted seriously and strictly, the keyboard may well become a shelter for pathogenic microorganisms, which would eventually spread diseases in wards and cause the occurance of NI.In this paper, by means of two different tests, we compared several disinfection methods to evaluate the disinfection effect on the surface of the keyboards and to figure out the most effective hygiene approaches for keyboards in wards. By establishing effective disinfection measures on the surface of the whole electric equipments, we hope they are capable of cutting off the route of diseases transmissions, and providing the basis for effective prevention and control of NIs.MethodsThe first intervention trial took the 132 keyboards as the research objects, which are used in emergency department ICU, center ICU, hepatology ICU, infectious wards of a tertiary hospital. Through the method of stratified random sampling, 132 keyboards were averagely divided into four groups, each group was exposed to disposable sterilized wet wipes, water dishcloth, 0.05% chlorine cloth and 75% alcohol gauze as disinfection, respectively. And then, we compared bacterial colonies and detection rates of coagulase negative bacteria, gram positive bacillus, micrococcus, mold, multi-resistant bacteria before and after disinfection. The second intervention trial took 89 keyboards from four nursing units as the research objects. According to the method of stratified random sampling, 89 keyboards were randomly divided into the sticking group of 55 and the control group of 34.The sticking group adopted membranes and disposable sterilized wet towel as daily disinfection, while the control group only used disposable sterilized wet towel as disinfection. A week later, we compared bacterial colonies and detection rates of coagulase negative bacteria on the surface of the keyboard, gram-positive bacilli, micrococcus, mold and multi-resistant bacteria.Results1. Before disinfection, the mean bacterial colonies of the 132 keyboards was 23.21±16.98 cfu/cm2; after disinfection, mean colonies were 5.07 ±2.63 cfu/cm2, colony number decreased significantly after disinfection. The difference of them was statistically significant(t = 12.21, P < 0.05). After disinfection, the detection rate of coagulase negative bacteria, gram positive bacillus, micrococcus, mold and multi-resistant evidently reduced, and the difference was statistically significant(P < 0.05).2. After disinfection, disinfection of four colonies in each group were significantly less than before wiping(p<0.01).Differences among colony counts of the four disinfection methods were statistically significant(F = 10.99, p<0.001). Among which, colony count of the disposable medical towel got the lowest rate, while the detection rates of disinfectant wipes on coagulase negative bacteria and gram positive bacillus were the lowest. The difference had statistical significance. Whereas the detection rate of the multi-resistant bacteria of the four groups had no significant difference.3. The colony count of the sticking group decreased after membranes, the difference of which was statistically significant(t = 22.69, P = 22.69). The colony count difference had no statistical significance(t = 0.07, P = 0.07) after the intervention. Before membrane treatment, the detection rate of micrococcus in the sticking group is lower than before(?2 = 16.84, P = 16.84); the detection rate of gram positive bacillus, multi-resistant bacteria had no statistical significance.ConclusionsThe disposable sterilized wet wipes can effectively kill or reduce pathogenic microorganisms on the surface of the keyboards in the wards. The gaps between the keys on the keyboards may be a breeding place of pathogenic microorganisms, but the keyboard membranes can effectively reduce the amount of microbials on the surface. Therefore, it is feasible, effective, and convenient to use keyboard membranes and disposable medical wet towels for daily disinfection. |
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