| [Objective] The hospitalized patient medical records of a tertiary hospital in Jiangsu Province from 2013 to 2015 were retrospectively analyzed to grasp the rate of nosocomial fungal infection, the composition ratio of different pathogens in fungi and the common infection sites.8 hospitals in different regions of Jiangsu province were selected to investigate the fungal infection and the fungal contamination in the Department of Hematology. To study the environmental factors of nosocomial fungal infection in patients with key areas in the Department of hematology ward, to analysis the relationship among the air disinfection measures, air purification facilities, ultraviolet lamps and other hospital wards’disinfection measures with the total number of fungal colonies in the environment, and to study the resistance of the clinically isolated Candida albicans to commonly used disinfectants. To provide a scientific basis for the prevention of nosocomial fungal infection.[Methods] The retrospective survey method were used to analyze the data which were collected from the infection monitoring system of hospital infection management department from June 2013 to December 2015 by different years, different pathogens in fungi, and different infection sites.The surveillance data of nosocomial Candida albicans infection were collected from 8 prefecture-level city of the province from November 2014, to records and summary the basic situation of hospitalized patients for more than 48h with nosocomial Candida albicans infection and the hematology ward. By the Center for Disease Control and Prevention, according to full-time staff in accordance with the hospital routine environmental health test results to fill out the monitoring table, including the total number of fungal colonies, temperature, humidity, ventilation status, the protection of patients with blood diseases, and the disinfection measures of environment, etc..At the same time, a total of 15 strains Candida albicans isolated from patients in hospital were collected, the resistance gene (qacEA1-sulI、qacA/B) was detected by PCR. The broth dilution method was used for the determination of the resistance to the commonly used disinfectant (chlorhexidine acetate and benzalkonium bromide) in the hospital. Resistance measurement indicators with a minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), and compared with standard strains. Statistical analysis of data was performed by SPSS22.0, quantitative data were used the rank sum test (the sample was highly skewed), qualitative data were used chi square test and rank data were used Wilcoxon signed rank sum test, with a= 0.05 as the criteria for significant differences.[Results] From 2013 to 2015, the hospital fungal infection rate were 0.33%,0.27% and 0.27%, three years of nosocomial fungal infection rate had no statistical significance (χ2=2.54, P>0.05). On the whole, fungal infection accounted for 17.29% of hospital infection, of the infection pathogens in fungi, Candida albicans in composition was the highest, reaching 50.04%. The respiratory infection constitute ratio was the highest, accounted for 53%.Compared with the fungal infections rate of 1.15% in 2014, the rate of fungal infection was increased to 2.43% in 2015. Of all the air disinfection measures, the composition ratio of air purification disinfection facilities and air utilization was 62.5%, the proportion reached 87.5% of natural ventilation, the use of ultraviolet lamp was 75%. Environmental monitoring results show that the amount of air sampling was 463 copies, of which the number of positive fungi collection was 394, with a total collection rate of 85.28%. The collection rate of air fungi were different in different hospitals (χ2=175.73, P<0.05); There were 1316 copies of surface sampling, of which the number of positive fungi collection was 1056, with a total collection rate of 80.24%. The object surface of fungi collection rate were different in different hospitals (x2=382.78, P<0.05); There were 52 samples of water sampling, the fungal positive number was 0, the average acquisition rate was 0%. The statistical analysis results showed that the air purification facilities can reduce the total number of fungal colonies of air and object surface, the difference was statistically significant (P<0.05), the ultraviolet light can reduce the total number of air fungal colonies, the difference was statistically significant (P<0.05), while the UV light can not reduce the total number of object surface fungal colonies, the difference was not statistically significant (P>0.05).A total of 15 Candida albicans isolated from clinical, which the resistance gene qacEA1-SulI, qacA/B test were all negative. To the chlorhexidine acetate, the MIC value of 6 strains were lower than that of the standard strain, which were 7.5 mg/1. And the rest were the same as the standard strain, which were 15 mg/1. The MIC value of Candida albicans isolated from the clinical were different from that of the standard strain (Z=-2.45, P<0.05). Among them, the MBC of 1 strains of Candida was higher than the standard strain, which was 30 mg/1. The MBC value of 4 strains was lower than the standard strain, which was 7.5 mg/1. And the rest were the same as the standard strain, which were 15 mg/1. The MBC value of Candida albicans isolated from the clinical had no significant difference with the standard strain (Z=-0.71, P>0.05).To the benzalkonium bromide, the MIC value of 3 clinical isolates were higher than that of the standard strain, of which, one was 156 mg/l, the other two were 78 mg/l, and the remaining 12 strains were the same as the standard strain, which were 39 mg/l. The MIC value of Candida albicans isolated from the clinical had no significant difference with the standard strain (Z=-1.63, P>0.05). The MBC value of 1 strains was higher than the standard strains, which was 156 mg/l, but there were 2 strains lower than the standard strain, which were 39 mg/l. and the remaining 12 MBC values were the same as the standard strain, which were 39 mg/l. The MBC value of Candida albicans isolated from the clinical had no significant difference with the standard strain (Z=-0.74, P>0.05).[Conclusion] The study showed that the levels of fungal infection was similar with the Gram-positive bacteria level,which close behind the Gram-negative bacterial infections. Candida albicans infection risk was larger, the significant opportunities for fungal infection occurred in the respiratory tract. At the same time, hematology department has greater risk of fungal infection, in which airborne spreaded fungal infection’s risk is greater than object surface’s, and the fungal infection transmission risk of the water treatment is smaller. Air purification facilities and UV lights can reduce the total number of fungal colonies in the air, and the effect of UV lights on the amount of fungi on the surface of the object needs to be further explored. The results showed that individual Candida albicans strains had higher resistance to the chlorhexidine acetate than the standard strains, but in general it was equivalent to the standard strains. The Candida albicans which isolated from the clinical had similar resistance to the benzalkonium bromide with the standard strains. |
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