Investigation of multiple nosocomial infections using a semi-Markov multi-state model.

BACKGROUND: The prevalence of multiple nosocomial infections (MNIs) is on the rise, however, there remains a limited comprehension regarding the associated risk factors, cumulative risk, probability of occurrence, and impact on length of stay (LOS). METHOD: This multicenter study includes all hospitalized patients from 2020 to July 2023 in two sub-hospitals of a tertiary hospital in Guangming District, Shenzhen. The semi-Markov multi-state model (MSM) was utilized to analyze risk factors and cumulative risk of MNI, predict its occurrence probability, and calculate the extra LOS of nosocomial infection (NI). RESULTS: The risk factors for MNI include age, community infection at admission, surgery, and combined use of antibiotics. However, the cumulative risk of MNI is lower than that of single nosocomial infection (SNI). MNI is most likely to occur within 14 days after admission. Additionally, SNI prolongs LOS by an average of 7.48 days (95% Confidence Interval, CI: 6.06-8.68 days), while MNI prolongs LOS by an average of 15.94 days (95% CI: 14.03-18.17 days). Furthermore, the more sites of infection there are, the longer the extra LOS will be. CONCLUSION: The longer LOS and increased treatment difficulty of MNI result in a heavier disease burden for patients, necessitating targeted prevention and control measures.

ABO blood groups and nosocomial infection.

The timely identification of the high-risk groups for nosocomial infections (NIs) plays a vital role in its prevention and control. Therefore, it is crucial to investigate whether the ABO blood group is a risk factor for NI. In this study, patients with NI and non-infection were matched by the propensity score matching method and a logistic regression model was used to analyse the matched datasets. The study found that patients with the B&AB blood group were susceptible to Escherichia coli (OR = 1.783, p = 0.039); the A blood group were susceptible to Staphylococcus aureus (OR = 2.539, p = 0.019) and Pseudomonas aeruginosa (OR = 5.724, p = 0.003); the A&AB blood group were susceptible to Pseudomonas aeruginosa (OR = 4.061, p = 0.008); the AB blood group were vulnerable to urinary tract infection (OR = 13.672, p = 0.019); the B blood group were susceptible to skin and soft tissue infection (OR = 2.418, p = 0.016); and the B&AB blood group were vulnerable to deep incision infection (OR = 4.243, p = 0.043). Summarily, the patient's blood group is vital for identifying high-risk groups for NIs and developing targeted prevention and control measures for NIs.

Evaluation of the quality of COVID-19 prevention and control by a novel comprehensive evaluation model in a tertiary general hospital: a prospective observational study.

BACKGROUND: Prevention and control (P&C) of Corona Virus Disease 2019 (COVID-19) is still a critical task in most countries and regions. However, there are many single evaluation indexes to assess the quality of COVID-19 P&C. It is necessary to synthesize the single evaluation indexes reasonably to obtain the overall evaluation results. METHODS: This study was divided into three steps. Step 1: In February 2020, the improved Delphi method was used to establish the quality evaluation indexes system for COVID-19 P&C. Step 2: in March 2020, the CRITIC method was used to adjust the Order Relation Analysis (G1) method to obtain the subjective and objective (S&O) combination weights. The comprehensive evaluation value was obtained using the weighted Efficacy Coefficient (EC) method, weighted TOPSIS method, weighted rank-sum ratio (RSR) method, and weighted Grey Relationship Analysis (GRA) method. Finally, the linear normalization method was used to synthesize the evaluation values of different evaluation methods. Step 3: From April 2020 to May 2021, this evaluation method was used to monitor and assess COVID-19 P&C quality in critical departments prospectively. The results were reported to the departments monthly. RESULT: A quality evaluation indexes system for COVID-19 P&C was established. Kendall's consistency test shows that the four evaluation method had good consistency (χ2 = 43.429, P<0.001, Kendall's consistency coefficient = 0.835). The Spearman correlation test showed that the correlation between the combined evaluation results and the original method was statistically significant(P < 0.001). According to the Mann-Kendall test, from March 2020 to May 2021, the mean value of COVID-19 P&C quality in all critical departments showed an upward trend (P < 0.01). CONCLUSIONS: The combined comprehensive evaluation method based on the S&O combined weight was more scientific and comprehensive than the single weighting and evaluation methods. In addition, monitoring and feedback of COVID-19 P&C quality were helpful for the improvement of P&C quality.

Comparison of two electronic hand hygiene monitoring systems in promoting hand hygiene of healthcare workers in the intensive care unit.

BACKGROUND: Hand hygiene (HH) is the cornerstone of infection control, and the promotion of HH is the focus of the world. The study aims to compare the role of two different types of electronic hand hygiene monitoring systems (EHHMSs) in promoting HH of healthcare workers (HCWs) in the intensive care unit (ICU). METHODS: In a 16-bed ICU of a general tertiary hospital in Shenzhen, the research was divided into three stages with interrupted time series (ITS) design. In the first stage, the direct observation method was used to monitor and feed back the HH compliance rate of HCWs monthly. In the second stage, the type1 EHHMS was applied to monitor and feed back the individual number of HH events monthly. In the third stage, the type2 EHHMS with a function of instant reminder and feedback was employed, and the personal HH compliance rates were fed back monthly. Meanwhile, direct observation continued in the last two stages. RESULTS: In the second stage, The HH compliance rate increased. However, there was no significant difference in the trajectory of the rate compared with the first stage. In the first month of the third stage, the HH compliance rate increased by 12.324% immediately and then ascended by 1.242% over time. The number of HH events per bed day and HH products' consumption per bed day were consistent with the change of HH compliance rate observed. CONCLUSION: Monitoring and feedback can improve the HH of HCWs. The EHHMS, with the function of real-time reminders and feedback, has a more noticeable effect on promoting HH.

Impact of a quality control circle on the incidence of catheter-associated urinary tract infection: An interrupted time series analysis.

BACKGROUND: To report a quality control circle (QCC) activity on the theme of reducing the incidence of catheter-associated urinary tract infection (CAUTI), and used an interrupted time series analysis to evaluate the impact of the QCC. METHODS: In a general tertiary hospital in Shenzhen, China, we carried out a QCC activity with the theme of reducing CAUTI from April 2017 to December 2017. Before the QCC, we carried out the routine measures; during the QCC, we implemented usual measures and the countermeasures of QCC, and after the QCC, we performed the routine measures and adhered to the core measures of QCC. The interrupted time series analysis method was used to analyze the changes in the CAUTI incidence during the 3 stages. RESULTS: Before, during, and after the QCC activities, the catheter use ratios and mean indwelling time both had a downward trend; meanwhile, the compliance rate of CAUTI prevention measures showed an upward trend. After the interventions, the CAUTI incidence decreased by 1.317‰ immediately, then gradually decreased by 0.510‰ per month. After the completion of QCC, the CAUTI incidence increased by 0.266‰ immediately and increased by 0.070‰ over time, but the difference was not statistically significant. CONCLUSIONS: The CAUTI incidence is reduced through QCC, providing a useful reference for the prevention of CAUTI and the development of medical quality improvement activities.