Abstract:Patients with major infectious diseases are at high risk of secondary hospital-acquired infections due to compromised immune function and the high burden of environmental contamination with hospital-acquired infection pathogens in the admitting departments. These infections are predominantly endogenous or environmentally acquired exogenous infections, are difficult to recognize early, and represent a weak point in hospital-acquired infection prevention and control. Building upon standard hospital-acquired infection prevention and control strategies, this prevention and control pathway proposes systematic enhanced measures targeting the above-mentioned specific risks. This pathway includes protecting patients' own microbiota, safeguarding open body cavities, active screening and decolonization, built environment control, and environmental cleaning and disinfection. It also recommends a closed-loop management system through infection surveillance and review, post-discharge follow-up, and environmental sampling. This pathway aims to provide healthcare facilities with a reference framework for targeted prevention and control to reduce the incidence of secondary hospital-acquired infections in patients with major infectious diseases and to ensure patient safety.

Abstract:Since its implementation in 2014, GB 50333-2013 Architectural Technical Code for Hospital Clean Operating Department has long served as the sole national-level technical basis for the planning, construction, operation & maintenance management of clean operating departments in China. Over the past decade, as surgical procedures have become increasingly minimally invasive and complex, and the pressure of infection prevention and control has continued to increase, the original standard has gradually revealed inadequacies in framework integrity, parameter unification, instrument management, and dynamic process infection control. The 2026 partial revision represents a systematic upgrade built upon the existing framework. It explicitly proposes the core concept that "cleaning technology is not equivalent to a safeguard for infection control." Through framework restructuring, parameter unification, instrument management (aligned with the WS 310 series, National Health Commission. Document Guo Wei Yi Fa〔2018〕No.11, and YY/T 0506.1-2023), and reinforcement of safety safeguards, the revision establishes a whole-process infection control system covering the environment, personnel, instruments, procedures, and emergency response. This article, based on the revision announcement, drafting notes, and relevant supporting standards, provides a systematic interpretation of the key provisions, core differences, technical rationale, and implementation challenges of the partial revision, offering technical references for hospital infrastructure renovation, hospital-acquired infection prevention and control, clinical application, and acceptance supervision.

Abstract:Objective To investigate the species composition, antifungal resistance characteristics, and genotyping of Candida isolates from invasive candidiasis at a hospital, thereby providing evidence for the rational clinical use of antifungal agents and source tracing of cases. Methods Candida isolates from invasive candidiasis collected at Hebei Yanda Hospital between June 2019 and December 2025 were analyzed for species distribution and antifungal resistance. Species identification was confirmed using the VITEK MS mass spectrometry system. In vitro antifungal susceptibility testing against nine antifungal agents was performed with fungal susceptibility testing panels. Microsatellite markers were used for genotyping of the isolates. Results A total of 132 Candida isolates from invasive candidiasis were recovered. Candida albicans was the most common species, with 53 isolates (40.15%), followed by Candida parapsilosis species complex with 33 (25.00%), Candida tropicalis with 22 (16.67%), Candida glabrata with 18 (13.64%), Candida auris with 2 (1.51%), and other Candida species with 4 (3.03%). The correct identification rate after confirmatory identification was 85.61% (113/132). C. albicans showed low resistance rates (<8%) to all nine antifungal agents, whereas the resistance rates of C. tropicalis to both fluconazole and voriconazole were 54.5%. Microsatellite genotyping revealed that Candida isolates recovered from different body sites of the same patient shared identical genotypes. Conclusion C. albicans remained the predominant species among Candida isolates from invasive candidiasis and showed high susceptibility to most antifungal agents. C. tropicalis showed cross-resistance to azoles. Microsatellite genotyping indicated genotypic polymorphism among C. albicans, C. parapsilosis, and C. tropicalis isolates, and the genotypes of isolates causing invasive infections were associated with those of colonizing isolates.

Abstract:Objective To investigate the current status of hand hygiene compliance and correct performance among healthcare workers in China, thereby providing comprehensive evidence for the continuous improvement of hand hygiene in medical institutions nationwide and a basis for relevant policy-making. Methods A direct observational survey was conducted at each participating institution. Uniformly trained observers performed on-site observations of antiseptic handrubbing and handwashing practices among healthcare workers in general intensive care unit (ICU), respiratory departments (groups), orthopedics departments, infectious diseases departments (groups), pediatric outpatient and emergency departments, hemodialysis units (centers) and operating departments (rooms). Data on the actual number of open beds in participating medical institutions, workload of each department, and consumption of hand-hygiene supplies were collected. Differences in hand hygiene compliance rate, correct performance rate, and hand hygiene supply consumption among groups were compared. Results A total of 1 248 medical institutions completed the survey according to the protocol. For antiseptic handrubbing and handwashing, 711 094 hand hygiene opportunities were observed; hand hygiene was performed on 619 483 occasions, yielding a compliance rate of 87.12%, and was performed correctly on 552 896 occasions, yielding a correct performance rate of 89.25%. For surgical hand antisepsis, 107 872 opportunities were observed; 107 489 actions were performed, yielding a compliance rate of 99.64%, and 91 775 were performed correctly, yielding a correct performance rate of 85.38%. Among medical institutions of different sizes, those with ≥900 open beds had the lowest compliance rate (84.82%) and correct performance rate (88.51%) for antiseptic handrubbing and handwashing. Across departments, general ICUs had the highest compliance rate (88.87%), whereas orthopedics departments had the lowest (85.84%); hemodialysis units (centers) had the highest correct performance rate (90.20%), whereas respiratory departments (groups) had the lowest (88.52%). Among hand hygiene moments, both compliance (78.55%) and correct performance (87.92%) were lowest after touching patient surroundings. Among indications for surgical hand antisepsis, compliance was lowest after glove damage or hand contamination (99.38%), whereas correct performance was lowest before surgical procedures (84.04%). The consumption of hand hygiene supplies in general ICUs, respiratory departments (groups), orthopedics departments, and infectious diseases departments (groups) was 79.64, 12.06, 10.96, and 19.98 mL/bed-day, respectively. The consumption was 2.87 mL/patient visit in the pediatric outpatient and emergency departments, 11.12 mL/session in hemodialysis units (centers), and 63.02 mL/surgical procedure in operating departments (rooms). Significant differences in hand hygiene supply consumption were observed across medical institutions of different sizes for the surveyed departments. Overall, most departments in large medical institutions with ≥900 open beds consumed more hand hygiene supplies than their counterparts in institutions of other sizes. Conclusion The overall hand hygiene performance was good in this survey. Compliance rate with surgical hand antisepsis was higher than that with antiseptic handrubbing and handwashing, whereas its correct performance rate was slightly lower. Hand hygiene compliance varied significantly across medical institutions of different sizes, departments, and hand hygiene moments. Large medical institutions, orthopedics departments, the moment after touching patient surroundings, and surgical hand antisepsis before surgery should be prioritized for strengthened supervision. Hand hygiene supply consumption varied considerably among departments, with the highest consumption reported in general ICUs and operating departments (rooms). Large medical institutions generally consumed more supplies than institutions of other sizes. Marked imbalances remained in hand hygiene management, and targeted corrective measures should be prioritized to improve management effectiveness.

Abstract:Objective To investigate the high-risk molecular characteristics of Klebsiella pneumoniae (KP) isolates from hospital environments, and to identify high-risk antimicrobial resistance genes (ARGs) with potential transmission risks along with their associated genetic structures. Methods A total of 20 environmental KP isolates and 112 clinical KP isolates were collected from two hospitals in Shanghai between 2023 and 2025. Whole genome sequencing (WGS), multilocus sequence typing (MLST), phylogenetic analysis, and analyses of antimicrobial resistance and virulence genes were performed. High-risk ARGs were screened based on evidence of their associations with mobile genetic elements (MGEs), and their local genetic structures were further analyzed. Results The 132 KP isolates were classified into 18 sequence types (STs), with ST11 being predominant, accounting for 53.79% (71 isolates). The environmental isolates did not form an independent phylogenetic clade, but were scattered across clades predominantly composing clinical isolates. The positivity rate of core hypervirulence-associated genes among environmental isolates was 40.00%, and the co-occurrence rate of antimicrobial resistance and hypervirulence-associated characteristics was 25.00%. Four major high-risk ARGs groups were identified: bla _KPC, bla _CTX-M, rmtB, and bla _NDM. These ARGs showed varying degrees of association with MGEs, and bla _KPC and rmtB exhibited relatively recurrent local genetic structural patterns in some environmental isolates. Conclusion KP isolates from the hospital environment exhibited certain high-risk molecular characteristics. Some high-risk ARGs were associated with MGEs, suggesting the potential for horizontal transfer and further dissemination of these resistance genes.

Abstract:Objective To analyze the serotype distribution, molecular typing characteristics, antimicrobial resistance phenotypes, and antimicrobial resistance-virulence gene profiles of foodborne Salmonella strains isolated in Wenzhou from 2023 to 2024, and to provide a scientific basis for rational drug use in clinical practice and for the prevention, control, and source tracing of foodborne diseases. Methods Salmonella strains isolated from 12 designated surveillance hospitals in Wenzhou were collected. The strains were re-identified using a microbial mass spectrometer and serotyped by slide agglutination. Representative strains of different serotypes and from different isolation periods were selected for antimicrobial susceptibility testing by the broth microdilution method and high-throughput whole-genome sequencing. Based on the sequencing data, housekeeping-gene multilocus sequence typing (MLST) and core-genome multilocus sequence typing (cgMLST) were performed, and the antimicrobial resistance genes and virulence genes carried by the strains were screened and analyzed. Results A total of 421 Salmonella strains belonging to 43 serotypes were obtained. The predominant serotypes, in descending order, were Salmonella Typhimurium (153 strains, 36.34%), Salmonella Enteritidis (77 strains, 18.29%), and Salmonella London ( 50 strains, 11.88%). Antimicrobial susceptibility testing was performed on 275 representative strains, with a multidrug resistance rate of 68.36%. Among them, 72 strains were resistant to seven or more classes of antimicrobial agents, accounting for 26.18%. The highest resistance rates were observed for ampicillin and tetracycline, at 68.73% and 55.64%, respectively. A phylogenetic tree was constructed based on the core genomes of the 275 strains. The results showed that Salmonella Typhimurium had high genetic diversity and formed an evolutionary cluster separate from its monophasic variant; Salmonella Enteritidis strains were generally closely related, whereas Salmonella London showed relatively large genetic distances. The 275 strains collectively carried 10 major categories of virulence genes and were classified into five virulence profiles. A total of 95 antimicrobial resistance genes were detected in 185 strains of the three predominant serotypes. All strains carried aminoglycoside resistance genes, and 139 strains (75.14%) carried β-lactam resistance genes, among which the bla _TEM-1 was the predominant subtype (48.65%). Conclusion The predominant serotypes of foodborne Salmonella in Wenzhou were Salmonella Typhimurium, Salmonella Enteritidis, and Salmonella London. Multidrug resistance was prominent, and the carriage rate of antimicrobial resistance genes and virulence genes were high. Prevention and control efforts should focus on the antimicrobial resistance and virulence characteristics of the predominant serotypes.

Abstract:Objective To explore, based on the capability-opportunity-motivation-behavior (COM-B) model, the characteristics of the capability, opportunity, and motivation dimensions and their pathway relationships in perioperative prophylactic antimicrobial use across the preoperative, intraoperative, and postoperative stages of gynecologic surgery. Methods A total of 116 healthcare workers involved in gynecologic perioperative diagnosis and treatment at a tertiary Grade A hospital were recruited using convenience sampling in February 2026. A questionnaire covering three perioperative stages—preoperative timing of administration, intraoperative redosing, and postoperative discontinuation—was developed based on the COM-B framework. Confirmatory factor analysis (CFA) was used to assess construct validity, and structural equation modeling was employed to analyze path relationships among the dimensions. Results Cronbach's α coefficients for the three stage-specific subscales were 0.863, 0.889, and 0.887, respectively. In the preoperative and postoperative stages, scores for capability and motivation were relatively high [preoperative: 4.34±0.74 and 4.33±0.81, respectively; postoperative: 4.48±0.63 and 4.57±0.55, respectively], whereas opportunity scores were relatively low [preoperative: 4.04±0.90; postoperative: 4.14±0.80]. In the intraoperative stage, scores for the three dimensions were relatively similar [capability: 4.26±0.88; opportunity: 4.31±0.95; motivation: 4.31±0.84]. The preoperative structural equation model showed an acceptable fit, with significant positive pathway relationships among capability,opportunity, and motivation (all P<0.05). The intraoperative and postoperative models showed poor fit, and their path coefficients were not used as a basis for inference. Conclusion Perioperative prophylactic antimicrobial use showed a pattern of "high motivation and low opportunity". Capability and opportunity positively influenced motivation in the preoperative stage. The poor fit of intraoperative and postoperative models suggests that measuring COM-B-related factors solely through individual self-assessment may not adequately explain the complex decision-making behavior involving collaboration among multiple stakeholders and patient-related factors. Future interventions may be implemented by stage, with particular emphasis on optimizing the opportunity dimension.

Abstract:Objective To investigate the associations between virological characteristics of hepatitis B virus (HBV) infection and antiviral therapy with adverse pregnancy outcomes. Methods A total of 3 355 hepatitis B surface antigen (HBsAg)-positive pregnant women who were hospitalized for delivery at Hunan Provincial Maternal and Child Health Hospital from January 2020 to June 2024 were included in the exposed group, and 3 600 HBsAg-negative pregnant women were included in the unexposed group in this unmatched retrospective cohort study. Univariate analyses, multivariable logistic regression, and stratified analysis were performed. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated to analyze the associations of HBsAg status, hepatitis B e antigen (HBeAg) status, HBV DNA load, and antiviral therapy with adverse pregnancy outcomes. Results Multivariable analysis showed that HBsAg-positivity was an independent risk factor for intrahepatic cholestasis of pregnancy, preterm birth, threatened miscarriage, fetal distress and neonatal respiratory distress syndrome, with adjusted odds ratios (aORs) (95%CIs) of 2.46(1.67-3.61), 1.45(1.19-1.78), 7.68(3.95-14.93), 1.65(1.40-1.98), and 5.71(2.54-12.81), respectively. Stratified analysis showed that the risks of preeclampsia and fetal growth restriction were higher in the HBeAg-positive group than in the HBeAg-negative group, with aORs of 2.53 and 3.11, respectively. An HBV DNA load >2.0×10⁵ IU/mL was an independent risk factor for fetal growth restriction (aOR=4.07). Among women with high viral loads, antiviral therapy was a protective factor against gestational diabetes mellitus, preterm birth, and fetal growth restriction, with aORs of 0.44, 0.28, and 0.35, respectively (all adjusted P<0.05). Conclusion HBsAg positivity was an independent risk factor for multiple adverse pregnancy outcomes. HBeAg positivity and a high HBV DNA load can further increase the risk of adverse pregnancy outcomes. Antiviral therapy in pregnant women with high viral loads can reduce the risk of some adverse pregnancy outcomes. Enhanced screening and management during pregnancy are recommended for HBsAg-positive pregnant women, and timely intervention for high-risk populations.

Abstract:Objective To investigate the effect of pre-consultation antigen testing on visit efficiency in a fever clinic during infectious disease epidemics. Methods A total of 20 050 patients who visited the fever clinic of China-Japan Friendship Hospital from November 7 to December 18, 2023 were enrolled. Taking the implementation of pre- consultation antigen testing on November 28, 2023 as the cutoff point, patients were divided into a control group (n=9 278) and an experimental group (n=10 772). Data including age, gender, influenza and COVID-19 antigen test results, waiting time, and consultation time were extracted from the hospital information system, and visit efficiency indicators were compared between the two groups. Results The experimental group had shorter consultation time [16(5, 45) min vs 53(35, 75) min] and total visit time [61(33, 95) min vs 94.5(57, 150) min] than the control group (both P<0.001). The median waiting time decreased from 36 min to 26 min (P=0.122), and the proportion of patients with a waiting time >30 min decreased from 54.05% to 42.92% (P<0.001). The average number of patients seen per hour increased from 18.41 to 21.37 (P=0.008). Analysis by time showed that the improvement in visit efficiency associated with pre-consultation antigen testing was more significant during peak visiting hours. Conclusion Implementation of pre-consultation antigen testing during infectious disease epidemics can significantly improve visit efficiency in fever clinics and alleviate the pressure on fever clinic services.

Abstract:Objective To evaluate the effects of active screening combined with preemptive isolation on healthcare-associated infections and the detection of multidrug-resistant organisms (MDROs) among patients transferred from other hospitals to the intensive care unit (ICU), and to explore its clinical effectiveness in interrupting the transmission of imported MDROs. Methods A prospective quasi-experimental design was adopted to conduct a before-and-after study in the neurology ICU of a hospital. During the baseline period (April to September 2025), routine infection control measures were implemented. During the intervention period (October 2025 to March 2026), in addition to routine measures, active screening was performed for all patients admitted to the ICU (specimens were collected from multiple sites within 48 h of admission), and preemptive contact precautions were initiated for patients at high risk of infection. MDRO detection, healthcare-associated infections, MDRO infections, and mean length of stay were compared between the two groups. Results A total of 600 patients were included in the control group and 733 in the intervention group. 126 patients in the intervention group underwent both active screening and preemptive isolation, accounting for 17.19% of the intervention group. The MDRO detection rate was 21.17% (127/600) in the control group and 11.05% (81/733) in the intervention group, with a statistically significant difference (χ²=23.86, P<0.001). Among the 127 patients with MDROs detected in the control group, 85 ( 66.93%) had MDROs newly detected during their ICU stay; among the 81 patients with MDROs detected in the intervention group, 26 (32.10%) had MDROs newly detected during their ICU stay. The proportion was lower in the intervention group than in the control group, with a statistically significant difference (χ²=24.28, P<0.001). The incidence density of healthcare-associated infection episodes was 9.50 per 1 000 patient-days in the control group and 5.07 per 1 000 patient-days in the intervention group, with a statistically significant difference (P< 0.05). The incidence density of MDRO healthcare-associated infection episodes was 3.79 per 1 000 patient-days in the control group and 1.27 per 1 000 patient-days in the intervention group. The mean length of stay was 0.92 d shorter in the intervention group than in the control group (P<0.05). Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) were predominantly imported (i.e., detected on admission), whereas carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Klebsiella pneumoniae (CRKP) were predominantly hospital-acquired. Conclusion Active screening combined with preemptive isolation can effectively interrupt the transmission of imported MDROs within the ICU, reduce the incidence of healthcare-associated infections, and shorten the length of stay.

Abstract:Objective To compare the performance of ventilator-associated events (VAE) and traditional ventilator-associated pneumonia (VAP) surveillance in mechanically ventilated patients in the intensive care unit (ICU), and to provide evidence for optimizing surveillance strategies. Methods Patients who received invasive mechanical ventilation for ≥4 days in a general ICU of a tertiary hospital from August 1st, 2023 to March 31st, 2026 were included. Prospective surveillance was conducted using the 2023 criteria for VAE and VAP of the U.S. Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN), respectively. The incidence rates, pathogen characteristics, agreement, diagnostic performance, and time to first identification of the two surveillance methods were compared. Results A total of 1 609 patients were included. The incidence rate of VAE was 11.19% and that of traditional VAP was 12.93%, with no statistically significant difference (P>0.05). A total of 232 pathogenic bacterial isolates were detected, predominantly Gram-negative bacteria (194 isolates, 83.62%). The three most common pathogens were Klebsiella pneumoniae (72 isolates, 31.04%), Pseudomonas aeruginosa (40 isolates, 17.24%), and Acinetobacter baumannii (31 isolates, 13.36%). Using traditional VAP surveillance as the gold standard, VAE surveillance had a sensitivity of 33.82%, and a specificity of 92.23%, with a Kappa value of 0.276, indicating fair agreement. Among the 70 cases identified by both methods, the median difference in identification time was 3 days; the agreement rates within 1 day and within 7 days were 37.14% and 74.29%, respectively, and VAE identified 47.14% of the cases earlier. Conclusion VAE surveillance and traditional VAP surveillance had similar incidence rates but only fair agreement. VAE surveillance showed higher specificity and provided earlier warning, making it suitable for early screening, whereas traditional VAP surveillance had higher sensitivity and provided clearer information on the causative pathogens. A combined surveillance model using VAE for early screening and traditional VAP for confirmation is recommended to improve the timeliness and accuracy of surveillance for ventilator-associated complications in the ICU.

Abstract:Objective To investigate the distribution characteristics, environmental transmission patterns, and performance of different detection methods for Candida auris-positive patients in the intensive care units (ICUs), and to provide evidence for developing targeted prevention and control strategies. Methods From January 2025 to March 2026, clinical follow-up was conducted for 6 Candida auris-positive patients (P1-P6) identified in the ICU and the neurosurgical ICU of a hospital. Expanded screening was also performed on environmental surfaces around the patients and healthcare workers who had contact with them. All collected samples underwent fungal culture, of which 39 were additionally tested using real-time quantitative polymerase chain reaction (qPCR). The results of the two methods were compared. Results All six patients were male, with a median age of 72.5 years (range, 56-95 years). Five cases were from the ICU and one was from the neurosurgical ICU. Three patients died, one improved, and two were discharged against medical advice. Epidemiological investigation showed marked temporal and spatial clustering and exposure association among the five patients in the ICU from January 2025 to February 2026. Notably, patients P4 and P5 had sequentially occupied the same bed (Bed 5), suggesting that persistent contamination of the bed environment may have served as a primary vehicle for transmission. Environmental and personnel screening showed that medical equipment and facilities had the highest positivity rate (19.6%), followed by bed-unit facilities (19.4%). Among the 39 samples tested using both methods, the positive rate of qPCR (33.3%) was higher than that of conventional culture (12.8%), with a statistically significant difference (P=0.039). Conclusion Candida auris in the ICU posed a risk of environmental cross-transmission, and qPCR showed an advantage in detecting occult contamination. An integrated comprehensive prevention and control system encompassing three aspects— testing and screening, environmental disinfection, and personnel protection—is recommended.

Abstract:Objective To assess the current level of knowledge regarding healthcare-associated infection (HAI) prevention and control among healthcare workers in traditional Chinese medicine (TCM) institutions at different levels in Fujian Province and to analyze associated factors. Methods A cross-sectional survey was conducted in 2025 via an online questionnaire platform among 2 209 healthcare workers from 38 TCM institutions in Fujian Province. The Kruskal-Wallis rank-sum test was used for univariate analysis. Linear mixed-effects model (LMM) and generalized linear mixed model (GLMM), with hospital as a random intercept, were constructed for multivariable analysis, and intraclass correlation coefficient (ICC) were used to assess clustering effects at the medical institution level. Results The overall mean score for HAI knowledge was 78.59±13.61 points, with a passing rate (≥60 points) of 93.25% and an excellence-performance rate (≥90 points) of 26.75%. Univariate analysis showed statistically significant differences in the distribution of total scores according to medical institution level, region, and job category (all P<0.05). The multivariable LMM showed that healthcare workers in grade I and below TCM institutions scored an average of 7.63 points lower than those in grade III institutions (95%CI: -10.98 to -4.28, P<0.001), while personnel in "other" job categories scored an average of 6.08 points lower than physicians (95%CI: -10.08 to -2.09, P=0.003). In the GLMM for the passing rate outcome, compared with grade III medical institutions, the OR for passing among healthcare workers in grade I and below institutions was 0.25 (P=0.004), and compared with physicians, the OR for passing among personnel in "other" job categories was 0.37 (P= 0.017). The ICC of the total-score model was 3.51%, suggesting that the regional differences identified in the univariate analysis may have mainly resulted from differences in the composition of medical institution levels within individual regions. Conclusion The overall level of HAI knowledge among healthcare workers in TCM institutions in Fujian Province was above moderate, but obvious knowledge gaps were observed among healthcare workers in primary-level medical institutions and those in non-clinical job categories.

Abstract:Objective To investigate the current status of reusable medical instrument cleaning management in central sterile supply departments (CSSDs) of medical institutions across the nine prefecture-level cities and autonomous prefectures of Guizhou Province, analyze regional differences, and provide a scientific basis for promoting homogeneous management of instrument cleaning in CSSDs across the province. Methods From June 19th to 30th, 2025, a questionnaire survey was conducted to investigate reusable medical instrument cleaning management in CSSDs of 169 medical institutions across the nine prefecture-level cities and autonomous prefectures of Guizhou Province. The survey covered key aspects including staffing structure, cleaning management systems, cleaning methods, cleaning quality monitoring, and traceability management. Results Significant differences were observed in the composition of professional titles among CSSD head nurses across the nine regions (P<0.001). The median continuing education rate across the province was 30.00%, and the median staff turnover/separation rate was 0, with no significant regional differences in either indicator (P>0.05). Among CSSDs in the province, 64.50% provided training for cleaning staff once per month, and no statistical regional differences were found in training frequency, training content, or the development of individualized training programs (all P>0.05). A combined manual and mechanical cleaning mode was adopted in 71.01% of CSSDs. The rate of standardized post-use processing of cleaning tools was 98.82%, and the qualified rate of final-rinse water conductivity was 92.31%. No significant regional differences were observed in medical instrument cleaning methods or cleaning-tool management (all P> 0.05). A total of 88.17% of CSSDs had developed standard operating procedures (SOPs) for medical instrument cleaning, 81.07% had established cleaning quality evaluation methods, and 84.02% had established cleaning quality traceability systems, with no significant regional differences in these three indicators (all P>0.05). Manual traceability was the predominant form of traceability management (51.48%), with a significant regional difference (χ²=38.335, P=0.032). Visual inspection was the predominant method for cleaning quality monitoring (69.82%), whereas adenosine triphosphate (ATP) bioluminescence testing (15.39%) and residual protein testing (14.20%) were less frequently used. Relevant quality control forms and monitoring requirements were available in 85.21% of CSSDs; however, only 47.34% had established explicit cleaning quality control indicators and had implemented continuous quality improvement, with no significant regional differences (all P>0.05). Conclusion Basic management systems for instrument cleaning in CSSDs of medical institutions across the nine prefecture-level cities and autonomous prefectures of Guizhou Province have been preliminarily established; however, unbalanced regional development remains predominant. Major shortcomings include delayed talent development, a relatively low level of digital traceability, and insufficient application of objective monitoring methods. Targeted measures are needed to address management loopholes and improve the homogeneous level of instrument cleaning management across CSSDs in the province.

Abstract:Objective To investigate the epidemiological characteristics and disease burden of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), central line-associated bloodstream infections (CLABSI), and secondary bloodstream infections (SBSI) in patients undergoing hematopoietic stem cell transplantation (HSCT), thereby providing data to support clinical prevention and control. Methods A retrospective study was conducted using the clinical and laboratory data of HSCT patients with bloodstream infections from January 2022 to December 2025. The incidence of infection, the distribution of pathogens, and clinical outcomes were analyzed. Results Among 1 895 hospitalized HSCT patients, the BSI incidence was 10.50% (199 episodes). MBI-LCBI, SBSI, and CLABSI accounted for 69.85%, 17.59%, and 12.56% of BSI episodes, respectively. The incidence rates of all three types of infection were relatively high in patients aged 50-60 years. MBI-LCBI occurred relatively frequently in patients with myelodysplastic syndrome, chronic myeloid leukemia, aplastic anemia, and acute myeloid leukemia. The lower respiratory tract was the predominant primary infection site of SBSI (74.28%). The main pathogens detected in MBI-LCBI were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, and Enterobacter cloacae. The main pathogens detected in CLABSI were Pseudomonas aeruginosa, Staphylococcus hominis, Bacillus cereus, and Stenotrophomonas maltophilia, whereas those detected in SBSI mainly included Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae. Multidrug-resistant organisms were detected less frequently in CLABSI. Carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Escherichia coli (CREC) were detected more frequently in MBI-LCBI, while the proportions of carbapenem- resistant Acinetobacter baumannii (CRAB), CRKP, and carbapenem-resistant Pseudomonas aeruginosa (CRPA) in SBSI ranged from 25.00% to 37.50%. There were no statistically significant differences among the three BSI types in 30-day mortality, proportion of patients admitted to the intensive care unit (ICU), incidence of septic shock, length of hospital stay, duration of central venous catheterization, or hospitalization costs (all P>0.05). Among patients with MBI-LCBI, there were no statistically significant differences in disease burden indicators between carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-sensitive Enterobacteriaceae (CSE) (all P>0.05). Conclusion Among HSCT patients, bloodstream infections were primarily caused by MBI-LCBI. Pathogen profiles differed considerably among the different infection types, whereas differences in disease burden were not statistically significant. Infection management should be refined according to differences in mechanisms of infection.

Abstract:Objective To explore the effect of preoperative dedicated role for intravenous infusion and temperature management (hereinafter referred to as dedicated-role management) on the prevention and control of surgical site infection (SSI) based on healthcare failure mode and effect analysis (HFMEA). Methods The risk priority number (RPN) and action priority (AP) were combined to identify high-risk failure modes for SSI in perioperative patients based on HFMEA. A historical control design was adopted. Patients who underwent elective surgery and received routine perioperative management at the First Affiliated Hospital of Nanjing Medical University from January 1 to December 31, 2023 were included in the control group, while patients who underwent elective surgery from January 1 to December 31, 2024 were included in the intervention group. The intervention group received a structured new process centered on dedicated-role management. The SSI incidence, perioperative hypothermia incidence, correct rate of prophylactic antimicrobial administration 0.5 h-1 h before surgery, and interval between consecutive surgeries were compared between the two groups. After the intervention, the high-risk failure modes were reassessed to evaluate the effectiveness of this management model. Results A total of 6 high-risk failure modes with RPN≥125 were identified, of which 3 were classified as high priority and 3 as medium priority according to AP. After the implementation of dedicated-role management, all indicators in the intervention group improved compared with those in the control group: the incidence of SSI decreased from 0.72% to 0.48% (P=0.006), the incidence of perioperative hypothermia decreased from 3.61% to 1.19% (P<0.001), and the correct rate of prophylactic antibiotic administration increased from 35.88% to 94.52% (P<0.001). The interval between consecutive surgeries decreased from (50.04±25.48) min to (45.64±16.57) min (P<0.001). Reassessment showed that the RPN values of all 6 failure modes were <125 and their AP classifications were all reduced to low priority. Conclusion HFMEA can effectively identify high-risk failure modes for SSI in perioperative patients. On this basis, establishing preoperative dedicated-role management, through centralized and precise administration of antimicrobial agents combined with active temperature management, can significantly reduce the risk of SSI and perioperative hypothermia.

Abstract:Objective To develop evaluation indicators and a scale for assessing the implementation of the infection control link nurse (ICLN) program based on the RE-AIM framework, and to explore strategies for improving implementation by evaluating the implementation of the ICLN program in a tertiary grade A hospital. Methods Based on the RE-AIM framework, evaluation indicators and a scale for evaluating implementation strategies of the ICLN program were developed. The evaluation scale was used to conduct a cross-sectional survey of all ICLNs in a tertiary grade A hospital where the ICLN program had been implemented for 10 years. Results The evaluation indicators and scale covered 10 items across five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance. The survey results showed that: in terms of Reach, the proportion of nursing units with an ICLN was 100%, while the standardized ICLN establishment rate was 44.14%. Regarding Effectiveness, among the core work contents of the ICLN program, except for revising policies and procedures, the scores for the other three items were above 4 points. Regarding Adoption, among the adoption scores of different personnel groups for ICLN training, physicians had the lowest score, at 4.32±0.73 points. Regarding Implementation, self-audit and feedback had the highest implementation rates (both 100%), while the implementation rate for reviewing policies and procedures was the lowest (37.24%). Regarding Maintenance, the mean score for willingness to serve as an ICLN was 4.40±0.82 points. Conclusion The RE-AIM-based ICLN evaluation indicators and scale can be used to comprehensively evaluate the implementation of the ICLN program and provide a basis for further research on ICLN implementation strategies.

Abstract:Vibrio cholerae is the pathogen of cholera, a severe intestinal infectious disease, and ocular infections caused by this bacterium are rare in clinical practice. This article reports a case of traumatic endophthalmitis in a pediatric patient caused by non-O1/non-O139 Vibrio cholerae (NOVC). The pediatric patient presented after the left eye was injured by a syringe needle. Two morphologically distinct colonies, rough and smooth, were isolated from an intraoperative vitreous cavity fluid culture, and both were identified as NOVC using the VITEK 2 Compact and mass spectrometry systems. Serological testing excluded the O1 and O139 serogroups. Antimicrobial susceptibility testing showed that both isolates were resistant to ampicillin and susceptible to ceftazidime, cefepime, imipenem, amikacin, levofloxacin, and trimethoprim-sulfamethoxazole. After multiple surgical procedures, including vitrectomy combined with intraocular drug injection, silicone oil removal, and intraocular lens suspension and fixation, the corrected visual acuity of the left eye eventually recovered to 0.4. This case suggests that ophthalmologists should be aware of the possibility of NOVC as a rare pathogen after ocular trauma and that timely etiological examination and antimicrobial susceptibility testing should be performed in pediatric patients with a history of water exposure to guide treatment.

Abstract:Although antiretroviral therapy has transformed human immunodeficiency virus (HIV) infection into a manageable chronic disease, clinical practice continues to face substantial challenges in early diagnosis, treatment adherence, long-term drug toxicity, and management of complications. In this context, the development of efficient risk prediction models has become a key breakthrough for achieving precision prevention and treatment of HIV infection. With advances in big data and machine learning technologies, HIV-related prediction models have made significant progress in risk screening, diagnostic optimization, treatment efficacy evaluation, and prognostic management. This article systematically reviews the applications and research advances of prediction models at different stages of the full-cycle management of HIV infection, aiming to identify current research bottlenecks, explore future directions for model optimization in the context of integrating traditional Chinese and Western medicine, and provide theoretical guidance and practical insights for improving the precision prevention and treatment system for HIV infection.

Abstract:To date, tuberculosis (TB) remains one of the leading causes of death worldwide. Immunomodulatory strategies have become a key approach to addressing drug resistance and the limitations of current vaccines. As important mediators of intercellular signal transduction, natural killer (NK) cell-derived exosomes can deliver diverse functional molecules to recipient cells. By dynamically regulating key cells and signaling pathways in both innate and adaptive immune responses, they participate throughout the host immune response against Mycobacterium tuberculosis (Mtb) infection. This paper systematically summarizes the mechanisms and latest research advances of NK cell-derived exosomes in regulating anti-tuberculosis immunity during Mtb infection, and further discusses their application potential as a novel strategy for anti-tuberculosis vaccine development and as therapeutic delivery systems, with the aim of providing a theoretical basis for the development of novel immunomodulatory strategies for tuberculosis.