The article summarized the national and international history and current situation of healthcare-associated infection control, and analyzed the tendency of new technique and progress in healthcare-associated infection control according to the experience in research and practice.
ObjectiveTo explore the continuous changing trend of healthcare-associated infection prevalence rate in a children’s hospital.MethodsFrom July 2012 to November 2018, a cross-sectional survey was conducted to investigate the prevalence of healthcare-associated infections in hospitalized children for seven consecutive years by combining case-checking and bedside survey.ResultsA total of 10 310 hospitalized children were investigated in the past seven years. The incidence of healthcare-associated infections from 2012 to 2018 was 2.08%, 4.84%, 1.59%, 3.76%, 1.63%, 1.74%, and 2.08%, respectively, showing a statistically significant downward trend (LLA=7.631, P=0.006). The departments with higher proportion of healthcare-associated infections were pediatric surgery (50.0%), pediatric medicine (44.8%), neonatal medicine (2.8%), and intensive care units (2.4%) . Viruses (38.8%) were the most common pathogens of healthcare-associated infections, followed by Gram-negative bacteria (34.3%) .ConclusionsThe prevalence of healthcare-associated infections in the children’s hospital showed a downward trend year by year. Pediatric surgery is the most common occurrence department, and viruses are the most common pathogens. It can provide evidence for prevention and control of healthcare-associated infection in children’s hospitals.
Medical institutions of China still face two challenges in hospital infections currently: one challenge is from infection, including infectious diseases, multidrug-resistant bacteria healthcare-associated infection (HAI), and classic HAI; the another challenge comes from the management of HAI in medical institutions, such as lack of full-time staff and insufficient capacity, inadequate infection control organizations, insufficient awareness of infection control among medical staff, and unbalanced development. To cope with these severe challenges, we must do the following three aspects: establishing the discipline of HAI, and improving people’s infection control ability through human-orienting; improving the management organization and system of HAI; improving the awareness of infection control among all medical staff, carrying out scientific and orderly infection prevention and control work in accordance with the law, and adhering to evidence-based infection control.
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.
Healthcare-associated infection outbreaks are a serious threat to patient safety and often cause serious consequences. The use of genotyping methods to identify the source of infection and the route of transmission in outbreaks is a critical point in controlling outbreaks. Recently, the use of whole-genome sequencing (WGS) makes it faster and much more accurate. Compared with traditional methods, WGS can distinguish highly correlated pathogen lineages, track infection source accurately and help researchers understanding the propagation dynamics model, and even provide more target intervention information. The application of WGS technology in healthcare-associated infection outbreak investigation and control is reviewed in this paper, and its advantages and challenges are also evaluated.
ObjectiveTo investigate the incidence and trendency of healthcare-associated infections (HAIs) in a pediatric intensive care unit (ICU) of a hospital, identify the main objectives of infection control, and formulate corresponding preventive and control measures.MethodsA prospective targeted monitoring method was adopted to investigate HAIs in the pediatric ICU of a hospital from January 2013 to December 2018.ResultsFrom January 2013 to December 2018, the number of target ICU patients was 11 898, the number of patient-days was 55 159; 226 HAIs occurred, the HAI case rate was 1.90%, the incidence of HAI per 1 000 patient-days was 4.10‰, and the adjusted incidence of HAI per 1 000 patient-days was 1.21‰. The main infection site was respiratory tract [83 cases (36.7%)], with ventilator-associated pneumonia in 73 cases (32.3%); secondly, 69 patients (30.5%) had bloodstream infection, among which 48 (21.2%) had non-catheter-related bloodstream infection.ConclusionHospital targeted monitoring is helpful to grasp the situation and trend of HAIs, define the main target of infection control, and formulate corresponding preventive and control measures, which can effectively reduce the incidence of HAIs.
This paper expounds the classification and characteristics of healthcare-associated infections (HAI) surveillance systems from the perspective of the informatization needs of HAI monitoring, explains the determination requirements of numerator and denominator in the surveillance statistical data, and introduces the regular verification for auditing the quality of HAI surveillance. The basic knowledge of machine learning and its achievements are introduced in processing surveillance data as well. Machine learning may become the mainstream algorithm of HAI automatic monitoring system in the future. Infection control professionals should learn relevant knowledge, cooperate with computer engineers and data analysts to establish more effective, reasonable and accurate monitoring systems, and improve the outcomes of HAI prevention and control in medical institutions.
ObjectiveTo measure and evaluate the economic burden of hospital infection in Sichuan, and provide a basis for targeted economic evaluation of healthcare-associated infection (HAI).MethodsIn hospitals participating in the 2016 Sichuan provincial prevalence survey of HAI, matched cases were used to extract cases and controls, and then a multi-center nested case-control study was conducted.ResultsA total of 225 pairs/450 patients were selected in 51 hospitals, and 175 pairs/350 patients were successfully matched. The median of the difference of hospitalization costs between matched-pairs were RMB 3 362.0, and the difference was statistically significant (Z=3.275, P<0.001).ConclusionsThe hospitalization costs caused by HAI should be given special attention in the current medical insurance reform. Efforts need to be taken to reduce the hospitalization costs caused by HAI.
Objective To construct a quality evaluation index system for healthcare-associated infection (HAI) management, and conduct an empirical evaluation on the quality of HAI management in clinical departments. Methods The literature research method and panel discussion method were adopted to initially form the framework of HAI management quality evaluation index system, and the Delphi method and the analytic hierarchy process were used to establish the index system and determine the weights from January to December 2018. Eight comprehensive evaluation methods, such as osculating value method and technique for order preference by similarity to an ideal solution method, were used to evaluate the quality of HAI management in clinical departments of West China Hospital, Sichuan University in 2018. Kendall’s coefficient of concordance (W) was used to assess the consistency of the results. The clinical departments were ranked by the standardized total scores, which were the means of the normalized scores of the eight methods. Results A quality evaluation index system for HAI management with 3 first-level indicators and 15 second-level indicators was established finally. The results of the eight comprehensive evaluation methods for the quality evaluation of HAI management in 39 clinical departments of West China Hospital, Sichuan University were consistent (W=0.952, χ2=259.800, P<0.001). The standardized total score of Department 18 was 100, which ranked the first place. Conclusion The HAI management quality evaluation index system constructed in this study could be used in clinical departments to evaluate the quality of HAI management in combination with comprehensive evaluation methods.
Objective To understand the current situation of healthcare-associated infection (HAI) in comprehensive hospitals with a number of beds≥900, and provide a reference for the next step in formulating HAI prevention and control measures. Methods The data on the prevalence rate of HAI in comprehensive hospitals with a number of beds≥900 of Yunnan Province between 2020 and 2022 were retrospective collected. The HAI situation and trend in each year were analyzed. Results A total of 119 comprehensive hospitals were included, with 166 745 patients surveyed and 3 237 cases of HAI. Lower respiratory tract infection and urinary tract infection were the most common sites. The department with the highest incidence of hospital infections was the intensive care unit, followed by neurosurgery and hematology. The prevalence rates of HAI showed a downward trend from 2020 to 2022 (2.08% vs. 1.99% vs. 1.79%, χ2=14.301, P<0.001). A total of 1 315 strains of hospital-acquired pathogens were detected, all of which were mainly Gram-negative bacteria, with Escherichia coli and Klebsiella pneumoniae being more common. The rate of antibiotics use and the rate of pathogen testing showed an upward trend from 2020 to 2022 (χ2=79.233, 23.866, P<0.001), the infection rate of incision site and the prophylactic use rate of antimicrobial drugs in patients with class Ⅰ surgery both showed a decreasing trend (χ2=15.551, 6.311, P<0.05). Conclusions The prevalence of infection in comprehensive hospitals of Yunnan Province is decreasing. But the supervision of key departments, the implementation of pathogen prevention and control measures, and the rational use of antibiotics in inpatients are still the focus of future work.