文摘翻译有奖（2010年国外医院感染相关杂志）

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贵在参与！认领26号，谢谢版主的创意！

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回复 41# ygzs
欢迎参加有奖翻译活动！

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英国医院感染杂志
(已翻译）32、Elimination of vancomycin-resistant enterococci from a neonatal intensive care unit following an outbreak 新生儿ICUVRE爆发处置
  Journal of Hospital Infection
Volume 74, Issue 4, April 2010, Pages 370-376
Summary
A policy of weekly faecal cultures for vancomycin-resistant enterococci (VRE) was instituted following the investigation of an outbreak of VRE in our neonatal intensive care unit in 2005. We found that 11 of 18 patients were infected or colonised during the outbreak, including three cases of bloodstream infection and one case of meningitis. This report describes the utility of the surveillance policy in maintaining a VRE-free environment. The outbreak investigation showed that all VRE isolated were Enterococcus faecium of the vanA type. Pulsed-field gel electrophoresis suggested that the outbreak was caused by a single strain. Control of the outbreak was achieved by enhanced contact isolation precautions, cohorting of patients and staff, improved environmental decontamination and closure of the unit to new admissions. The patients with bloodstream infections and meningitis were treated successfully with linezolid. Approximately one year after the outbreak, weekly surveillance detected two patients with faecal carriage of VRE whose periods of admission overlapped. Early intensive intervention was associated with disappearance of the organism from the neonatal intensive care unit. No further cases of colonisation or disease have occurred in the unit in the two and a half years since then.

keywords: Bloodstream infection; Infection control; Linezolid; Meningitis; Neonatal intensive care unit; Vancomycin-resistant enterococci

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英国医院感染杂志
（已翻译）33、Characterisation of vancomycin-resistant enterococci from hospitalised patients at a tertiary centre over a seven-year period住院病人VRE感染特点
  Journal of Hospital Infection
Volume 74, Issue 4, April 2010, Pages 377-384
Summary
Vancomycin-resistant enterococci (VRE) were isolated from 41 patients at a medical centre in southern Taiwan from 1999 to 2005. This accounted for 0.55% of 7449 patients with clinical colonisation or infection due to Enterococcus species. Nine (22%) patients had clinical infections caused by VRE. Twenty-five (61%) VRE isolates were Enterococcus faecalis with VanA phenotype and vanA gene cluster, the remaining 16 (39%) isolates were Enterococcus faecium with VanB phenotype and vanB (15 isolates) or vanA (1 isolate) gene cluster. The esp gene cluster was found in 6 (24%) E. faecalis isolates and 14 (87.5%) E. faecium isolates, and hyl in 2 (8%) E. faecalis and 6 (37.5%) E. faecium isolates. Analysis of SmaI-digested DNA by pulsed-field gel electrophoresis revealed that most isolates of E. faecalis were distinct, indicating a limited person-to-person spread or sporadic nature of spread. By contrast, 10 (67%) of 15 VanB phenotype E. faecium isolates were identical, suggesting the presence of an occult and limited clonal spread at the hospital. The presence of the esp or hyl gene was not associated with the virulence or outbreak of VRE. In summary, epidemiological data and molecular typing suggest that there was occult clonal spread of VanB phenotype–vanB genotype E. faecium in the surgical ICU, and the limited person-to-person spread or sporadic nature of E. faecalis. Infection control measures are warranted due to the potential for spread of VRE.

Keywords: Enterococcus faecalis; Enterococcus faecium; Vancomycin resistance

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英国医院感染杂志
34、Vomiting calls to NHS Direct provide an early warning of norovirus outbreaks in hospitals诺如病毒爆发早期预警 Journal of Hospital Infection
Volume 74, Issue 4, April 2010, Pages 385-393
Summary
A wintertime peak of norovirus activity occurs each year, affecting institutions including schools and hospitals. Traditional laboratory and outbreak surveillance systems for norovirus are too vulnerable to reporting delay to act as a timely signal of activity in the community. Calls to the National Health Service (NHS) telephone service NHS Direct have the potential to be an early warning tool for public health purposes. We investigated whether NHS Direct vomiting calls can be used as a reliable indicator of norovirus activity and, if so, whether the increase in calls precedes the epidemic of hospital outbreaks. Laboratory reports were used as the reference standard to define the norovirus season. From 2004 to 2008, four series of NHS Direct call data were compared with laboratory data held at the Health Protection Agency Centre for Infections in order to identify the best predictor of the season start. The four series included: (1) modelled and extracted the proportion of calls likely to be for ‘non-rotavirus’ gastroenteritis; (2) the mean proportion of weekly vomiting calls in children aged <5 years; (3) the mean proportion of weekly vomiting calls for all ages; (4) the slope of the vomiting call data. Issuing an alert when 4% or more of NHS Direct vomiting calls in all age groups for two weeks in a row should provide up to four weeks' advance warning of forthcoming norovirus pressures on the health service.

Keywords: Early warning; Norovirus; Syndromic surveillance

wney

回复 17# 潮水


    18，分析了二氧化氯对炭疽芽孢杆菌（Sterne株）二氧化氯消毒剂杀灭炭疽杆菌芽胞效果分析消毒剂杀芽胞活动
医院感染杂志
74卷，第2期，2010年2月，页178-183
摘要
常规表面消毒是必要的医院和实验室的程序，但有效的名单，即非腐蚀性消毒剂杀孢子是有限的。我们研究了一水二氧化氯溶液杀芽胞潜力，遇到了一些意想不到的问题。定量细菌培养方法被用来确定炭疽芽孢杆菌（Sterne株）3分钟后孢子暴露在室温的密封管温度的二氧化氯水溶液中不同浓度的解决方案，以及到塑料和不锈钢表面喷涂在用LOG10减少生物安全柜。串行10倍稀释处理后的孢子然后镀5％绵羊血琼脂平板，并列举了殖民地的幸存者。孢子悬浮液中氯消毒的水密封microfuge管二氧化碳的解决办法是非常有效的，减少了8用LOG10只有3分钟的可行孢子计数。与此相反，喷涂或传播到只有1用LOG10杀死，因为二氧化氯气体迅速气化产生的解决方案从表面的消毒过程。充满水的喷洒二氧化氯溶液效力恢复了准备在5％漂白水（0.3％次氯酸钠）的二氧化氯溶液。二氧化氯的波动会导致治疗失败，构成为用户不知情的严重危害。补充5％漂白水（0.3％次氯酸钠）全面恢复效力和二氧化氯溶液的稳定性提高了一个星期。

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回复 20# 潮水
19日，犯人之间的身体艺术实践：为血源性感染的传播影响罪犯的人体艺术（纹身）：对血源性传染病传播的影响
背景
未经消毒的机构之间的囚犯有牵连的艺术实践中的血源性病毒的传播。本研究的目的是确定犯人之间的纹身和身体穿孔率，认同接受，在监狱纹身相关因素，并探讨在监狱纹身和身体穿孔的情况下。

方法
一个横断面调查是在17间在伊利诺伊州的监狱犯人随机选择，一个最近发表exprisoners在伊利诺伊州芝加哥，方便取样在焦点小组讨论（FGDs）参加了会议。

结果
作者：1819（1293男性和526名妇女）在囚人士参加了调查，47 exprisoners在FGDs参加了会议。 67个调查样本有百分之纹身，60％有身体穿孔。更多的男性（19.3％）比女性（8.7％）曾接受纹身在监狱（胜算比为0.40; 95％信赖区间：0.29-0.56）;在狱中刺穿身体患病率较低（1.3％），男性和类似妇女。在监狱纹身相关的因素包括：1年或更长时间监禁，并有过男女之间在监狱中的性别;妇女nonheterosexual身份仅及男性，而30-39岁，被关押4次以上;有历史的共用针头，多性伴侣阴道，并在6个月前被捕的不一致使用安全套。焦点小组提供的关于监狱的人体艺术实践的信息。犯人有一个用于获取人体艺术由于种种原因，设备往往是相通的，清洁剂并不能轻易获得。

结论
纹身和身体穿孔的做法，并可能存在于监狱的血源性病毒构成传染的风险。干预措施，以减少这些风险进行了讨论。

关键词：人体艺术，风险，感染，囚犯

wney

回复 16# 潮水

英国医院感染杂志2010年2月份论文：
17，医疗器械去除生物膜清洁工：生物反应器检测两个检测两种生化方法检测医疗器械清洗去除生物膜效果比较比较
医院感染杂志
74卷，第2期，2010年2月，页160-167
摘要
目前，有医疗设备的测试没有标准清洁功效。随着朊病毒传播，医疗设备残余蛋白的恐惧需要最小化。生物反应器模型，采用生长在聚四氟乙烯券绿脓杆菌生物膜。生物膜受到各种清洁剂和残余生物膜可能是由结晶紫法（CRV）的蛋白质或商用试验（PA）的生物膜水解后的检测。生物膜减少百分比相较于未经处理的对照组3个独立的测试。有没有显着差异百分比减少生物膜无论CRV专用或PA检测残留生物膜。附杆内的生物反应器杆券和优惠券的立场处理对清洗效率或残留生物膜检测无显着影响。内部运行与管理的变化是非常好的清洁剂低，如10 g / L的氢氧化钠，禅宗，和3M快速多酶清洗剂（RMEC）70500，但如吐温20个，取消了贫困清洁工较高低超过20年的生物膜％。共聚焦显微镜和电子显微镜检测结果提供了视觉确认。我们建议，这种方法是，作为评估在消除生物膜手术器械清洁剂药效试验方法适当，因为两者在经营与管理的变化较低，生物膜残留检测可以使用任何CRV专用或PA，和该仪器使用方便，价格便宜，容易获得。

关键词：生物膜，结晶紫;医疗设备清洗;蛋白检测

wney

我认领4号
4通用筛查耐甲氧西林金黄色葡萄球菌：从苏格兰国民保健探路者projectMRSA普查中期业绩 - 苏格兰国民保健服务项目初步结果
医院感染杂志
74卷，第1期，2010年1月，页35 41Summary
以下从卫生技术评估（HTA中）是耐甲氧西林金黄色葡萄球菌（MRSA）的所有招生（&ntilde; = 29 690）检查，以6急症医院在3个前瞻性队列研究表明，苏格兰地区的7.5％的患者被建议殖民者对入院。与殖民化有关的因素包括：重新入院，入院在肾脏病学专业（最高，照顾老人，皮肤科，血管外科），年龄增加，以及入学源（护理院或其他医院）。百分之三的所有那些谁被作为殖民发展医院相关MRSA感染确定的，而只有0.1％的人不被殖民。与殖民入院率很高的专业也有MRSA感染的比率较高。极少数患者拒绝检查（11例，0.03％），或推迟了治疗（14例，0.05％）。确定了若干组织问题，包括实现完全吸收筛查（88％）或殖民化（41％）的困难，后者主要是由于逗留和周转时间短的测试结果的时间。病人运动导致决定decolonise所有阳性患者，而不是只在高风险的HTA中提出的专业人士。问题还包括隔离设施缺乏管理与MRSA的病人。这项研究提出了关于非殖民化的贡献重大关切，降低医院因逗留时间短的风险，并加强对感染控制措施的核心作用。进一步的研究之前，需要在HTA模型可以重新运行和结论的成本和普遍筛查MRSA的临床效果重绘。
关键词：医院获得性感染，感染控制，耐甲氧西林金黄色葡萄球菌;普遍筛查

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6两步谷氨酸脱氢酶抗原的实时聚合酶链反应法检测产毒素艰难梭菌两步法谷氨酸脱氢酶抗原聚合酶链反应检测产毒艰难梭菌
医院感染杂志
74卷，第1期，2010年1月，页48-54
摘要
艰难梭菌感染的（CDI）的诊断依赖于电流通过酶免疫法粪便[环境影响评估（甲/乙）]后，毒素检测的A / B。这种策略并不理想，因为它具有低灵敏度重大假阴性结果。我们研究了一种新的课程发展处诊断两步算法的性能利用谷氨酸脱氢酶（GDH）检测。粤海阳性样本对艰难梭菌毒素B基因（tcdB）通过聚合酶链反应（PCR）。这两个步骤的协议性能进行了比较毒素通过经络总理连续环评500课程发展处疑似病人从粪便样本中检测试剂盒。样品中受到任何环境影响评估（甲/乙）或粤海细胞毒素中和试验是文化（文化/箱积极的参考标准）。 36名（7％）的500个样本是被当作文化/箱真阳性鉴定。环境影响评估（甲/乙）确定了22个假阴性和假阳性的两个阳性标本14。两步协议确定了两个假阳性和假阴性2阳性标本34。环境影响评估（甲/乙）有39％的敏感性，特异性99％，阳性88％，阴性预测值的95％预测值。这两个步骤的算法表现较好，有94％，99％，94％和99％的相应值分别。粤海筛选为阳性之前确认的PCR比所有标本经PCR筛选便宜，是日常使用的有效方法。当前环境影响评估（甲/乙）为课程发展处试验是不够敏感，应更换;然而，这可能会在课程发展处率明显变化的结果，将需要在国家监测统计解释。
关键词：算法;艰难梭菌毒素;诊断;酶免疫法;谷氨酸脱氢酶

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回复 50# wney
欢迎参加有奖翻译，请对部分词汇和句子重新编辑。

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32 ＮICU VRE爆发处置
　　每周对患儿进行耐万古霉素肠球菌粪便检测的策略是在2005年我们的新生儿重症监护病房发生了VRE爆发后施行的。暴发期间该病区18例新生儿中有11人感染或携带VRE，其中包括3例发生血液感染和1例脑膜炎。这份报告阐述了避免耐万古霉素肠球菌环境感染所使用的监测方法。疫情调查表明，所有分离出抗万古霉素肠球菌均为瓦纳A型（？）肠球菌。脉冲场凝胶电泳表明疫情是由单一菌株引发的。暴发疫情由加强了接触隔离措施，包括病人和工作人员，加强环境清洁消毒和停止新收病人入该病区等措施得到了控制。同时，我们应用linezolid（利奈唑酮？）治疗血液感染和脑膜炎患者取得了成功。暴发后大约一年，通过执行每周监测，仅发现2例患儿粪便携带VRE，且他们的住院期是重叠的。我们认为早期积极的干预措施对消除该菌在NICU侵袭有密切关系。（从那以后的）两年半以来，我们未发现携带或显性感染该菌的病例。

gemao

33、Characterisation of vancomycin-resistant enterococci from hospitalised patients at a tertiary centre over a seven-year period住院病人VRE感染特点
  Journal of Hospital Infection
Volume 74, Issue 4, April 2010, Pages 377-384
Summary
Vancomycin-resistant enterococci (VRE) were isolated from 41 patients at a medical centre in southern Taiwan from 1999 to 2005. This accounted for 0.55% of 7449 patients with clinical colonisation or infection due to Enterococcus species. Nine (22%) patients had clinical infections caused by VRE. Twenty-five (61%) VRE isolates were Enterococcus faecalis with VanA phenotype and vanA gene cluster, the remaining 16 (39%) isolates were Enterococcus faecium with VanB phenotype and vanB (15 isolates) or vanA (1 isolate) gene cluster. The esp gene cluster was found in 6 (24%) E. faecalis isolates and 14 (87.5%) E. faecium isolates, and hyl in 2 (8%) E. faecalis and 6 (37.5%) E. faecium isolates. Analysis of SmaI-digested DNA by pulsed-field gel electrophoresis revealed that most isolates of E. faecalis were distinct, indicating a limited person-to-person spread or sporadic nature of spread. By contrast, 10 (67%) of 15 VanB phenotype E. faecium isolates were identical, suggesting the presence of an occult and limited clonal spread at the hospital. The presence of the esp or hyl gene was not associated with the virulence or outbreak of VRE. In summary, epidemiological data and molecular typing suggest that there was occult clonal spread of VanB phenotype–vanB genotype E. faecium in the surgical ICU, and the limited person-to-person spread or sporadic nature of E. faecalis. Infection control measures are warranted due to the potential for spread of VRE.

Keywords: Enterococcus faecalis; Enterococcus faecium; Vancomycin resistance
7年间某一地区医院住院病人VRE感染特点
1999年至2005年，在台湾南部的一家医疗中心中有41例病人分离出耐万古霉素肠球菌（VRE）。这个数据占7449例临床定植或感染肠球菌病人中的0.55%。9（22%）例病人有VRE造成的感染。25例（61%）VRE分离标本是VanA 显性表达和VanA基因簇的粪肠球菌 （E faecalis），其余分离标本是VanB 显性表达的屎肠球菌（E faecium ），vanB（15例分离标本）或vanA（1例分离标本）基因簇。在6例（24%）粪肠球菌分离标本和14（87.5%）例屎肠球菌分离标本有esp 基因，在粪肠球菌中有2例（8%）有hyl基因，屎肠球菌分离中有6例（37.5%）。相反，在15例屎肠球菌标本中发现10例是VanB显性表达，提示医院内存在神秘的和有限的无性传播。Esp或hyl基因的存在与VRE的毒力或爆发无关。总之，流行病学数据和分子分类提示VanB 显性表达-vanB显性表达的屎肠球菌在外科ICU中神秘地无性传播。粪肠球菌在人-人之间的传播存在有限或散发的特性。由于存在VRE传播的可能性，警告做好感染控制。
关键词： 粪肠球菌，屎肠球菌，耐万古霉素

gemao

29、Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit 外科重症监护病房碳青霉烯类耐药铜绿假单胞菌感染爆发
Journal of Hospital Infection  Volume 74, Issue 4, April 2010, Pages 350-357
Summary
Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analysis, a case–control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa, environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates.  Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32–999) and therapy with quinolones (48.37; 3.71–999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.
Keywords: Case–control study; Carbapenem resistance; Nosocomial outbreak; Pseudomonas aeruginosa

德国大学医院的感染控制部门工作人员在进行监测活动时发现外科ICU中一群病人分离出耐碳青霉烯铜绿假单胞菌（CRPA）。爆发调查包括描述性分析， 15例CRPA病人与18例碳青霉烯敏感铜绿假单胞菌患者的病例对照研究，环境采样，和脉冲凝胶电泳PFGE对分离的铜绿假单胞菌进行分类。2006年7月1日至2006年10月31日间，在SICU 中出现15例获得性CRPA 病人，其中分离出11例菌株，进行PFGE，发现2个CRPA爆发菌株和一个散发菌株。2个爆发菌株对青霉素、头孢类、碳青霉烯类、氨基糖甙类和喹诺酮类耐药，仅对粘菌素敏感。最可能的传播方式是术后腹部和/或胸部引流换药时病人间的交叉感染（(odds ratio: 64.33; 95%可信区间: 5.32–999)，使用喹诺酮治疗存在获得CRPA的独立风险因子。在进行接触隔离预防措施和健康工作者注意可能的传播方式后，没有新的CRPA群体发现。研究显示在SICU中的复杂的CRPA流行病学包括与术后护理相关的2个CRPA菌株的交叉传播。
关键词：病例对照研究；碳青霉烯耐药，医院内感染，铜绿假单胞菌

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美国感染控制流行病学杂志2010年第5期
（已翻译）35、Comparison of 4 Different Types of Surgical Gloves Used for Preventing Blood Contact
4种手套预防血液感染比较
Background.Needlestick injuries are always associated with a risk of infection, because these types of punctures may expose healthcare workers to a patient's blood and/or body fluids.

Objective.To compare the efficacy of 4 different types of surgical gloves for preventing exposure to blood as a result of needlestick injury.

Methods.For simulation of needlestick injury, a circular sample of pork skin was tightened onto a bracket, and a single finger from a medical glove was stretched over the sample. First, a powder-free surgical glove with a gel coating was used to test blood contact. Second, a glove with a patented puncture indication system was used to test blood contact with a double-gloved hand. Third, 2 powder-free latex medical gloves of the same size and hand were combined for double gloving, again to test blood contact. Finally, we tested a glove with an integrated disinfectant on the inside. The punctures were carried out using diverse sharp surgical devices that were contaminated with 99Tc-marked blood. The amount of blood contact was determined from the transmitted radioactivity.

Results.For the powder-free surgical glove with a gel coating, a mean volume of 0.048 μL of blood (standard error of the mean [SEM], 0.077 μL) was transferred in punctures with an automated lancet at a depth of 2.4 mm through 1 layer of latex. For the glove with an integrated disinfectant on the inside, the mean volume of blood transferred was 0.030 μL (SEM, 0.0056 μL) with a single glove and was 0.024 μL (SEM, 0.003 μL) with 2 gloves. For the glove with the patented puncture indication system, a mean volume of 0.024 μL (SEM, 0.003 μL) of blood was transferred.

Conclusions.Double gloving or the use of a glove with disinfectant can result in a decrease in the volume of blood transferred. Therefore, the use of either of these gloving systems could help to minimize the risk of bloodborne infections for medical staff.

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美国感染控制流行病学杂志2010年第5期
36、Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?首次和再次整形手术的手术部位感染率区别
Objective.To compare the surgical site infection (SSI) rate after primary total hip arthroplasty with the SSI rate after revision total hip arthroplasty.

Design.Retrospective cohort study.

Setting.Mayo Clinic in Rochester, Minnesota, a referral orthopedic center.

Patients.All patients undergoing primary total hip arthroplasty or revision total hip arthroplasty during the period from January 1, 2002, through December 31, 2006.

Methods.We obtained data on total hip arthroplasties from a prospectively maintained institutional surgical database. We reviewed data on SSIs collected prospectively as part of routine infection control surveillance, using the criteria of the Centers for Disease Control and Prevention for the definition of an SSI. We used logistic regression analyses to evaluate differences between the SSI rate after primary total hip arthroplasty and the SSI rate after revision total hip arthroplasty.

Results.A total of 5,696 total hip arthroplasties (with type 1 wound classification) were analyzed, of which 1,381 (24%) were revisions. A total of 61 SSIs occurred, resulting in an overall SSI rate of 1.1% for all total hip arthroplasties. When stratified by the National Nosocomial Infection Surveillance (NNIS) risk index, SSI rates were 0.5%, 1.2%, and 1.6% in risk categories 0, 1, and 2, respectively. After controlling for the NNIS risk index, the risk of SSI after revision total hip arthroplasty was twice as high as that after primary total hip arthroplasty (odds ratio, 2.2 [95% confidence interval, 1.3–3.7]). In the analysis restricted to the development of deep incisional or organ space infections, the risk of SSI after revision total hip arthroplasty was nearly 4 times that after primary total hip arthroplasty (odds ratio, 3.9 [95% confidence interval, 2.0–7.6]).

Conclusion.Including revision surgeries in the calculation of SSI rates can result in higher infection rates for institutions that perform a larger number of revisions. Taking NNIS risk indices into account does not eliminate this effect. Differences between primary and revision surgeries should be considered in national standards for the reporting of SSIs.

gemao

35、Comparison of 4 Different Types of Surgical Gloves Used for Preventing Blood Contact
4种手套预防血液感染比较
背景： 针刺伤总是伴有感染风险，因为各种刺伤会使健康工作人员暴露于病人的血液和/或体液。
目的：比较4种不同类型的外科手套在防止针刺伤后血液暴露的有效性。
方法：绑在托架上的圆形猪皮肤用来模拟针刺损伤，从一只医用手套上取下一只指套拉伸放在在标本上，首先是用涂胶的无粉外科手套检测血液接触。第二，用有穿刺提示系统专利的手套，检测双层手套的血液接触。第三，同样大小的2层无粉乳胶医用手套联合使用，再次检查血液接触。最后，我们检测内层完全使用消毒剂的手套。用含有99鍀标记污染血液的锋利外科设备。血液接触的量通过透射的放射活性决定。结果：对于涂胶的无粉外科手套，使用自动手术刀穿透1层乳胶手套后，平均带入0.048μl的血液（平均值的标准误差0.077）。对于内层涂有消毒剂的单层手套，平均带入血液0.030μl（SEM 0.0056），2层手套是0.024μl（SEM0.003）。结论：使用双层手套或带有消毒剂的手套会减少带入的血液量。因此，使用这种方法应有助于使医务人员的血源性感染降至最低。

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美国感染控制流行病学杂志2010年第5期
37、Economic Burden of Ventilator‐Associated Pneumonia Based on Total Resource Utilization 呼吸机相关肺炎的经济学负担
Objectives.To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals.

Design and setting.We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3%).

Methods.Case patients with microbiologically confirmed VAP （N=30 ) were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP ( N=90). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups.

Results.Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients (P<0.001 ); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients (P<0.001 ). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients ( P=0.151). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P<0.001 ), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; p<0.001 ) and the median duration of hospitalization (26.5 days vs 14.0 days;  p<0.001). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care ( p<0.05) and respiratory therapy (p<0.05 ).

Conclusions.VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP.

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美国感染控制流行病学杂志2010年第5期
38、Case-Crossover Study of Burkholderia cepacia Complex Bloodstream Infection Associated with Contaminated Intravenous Bromopride洋葱伯克霍尔德菌血流感染病例交叉研究
Objective.To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI).

Design and setting.Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006.

Patients.Twenty-five patients with BCC-BSI.

Design.After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using SpeI.

Results.The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals.

Conclusion.Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.

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英国医院感染杂志2010年第5期
(已翻译）39、Deposits on the intraluminal surface and bacterial growth in central venous catheters 中心静脉导管的表明沉积物及微生物生长
Journal of Hospital Infection
Volume 75, Issue 1, May 2010, Pages 19-22
Summary
Central venous catheter (CVC) tip and blood cultures are generally used to diagnose a catheter-related infection. Such methodology does not confirm the presence of bacterial colonisation on parts of CVCs other than the CVC tip. In order to assess the extent of bacterial colonisation, 10 catheters were examined in detail from patients admitted to intensive care unit. Swabs from the lumen at several sites (hub, indwelling and non-indwelling) were cultured and the intraluminal surface of the device subjected to scanning electron microscopy (SEM). Bacteria were detected on five out of 10 catheters (50%), and bacterial contamination of CVCs was common in the hub area of the device. Deposits (crystallisation) that differed from bacterial colonisation or biofilm were observed on the intraluminal surface of used CVCs. SEM showed bacteria firmly anchored to the deposits. Experimental flow studies demonstrated that deposits were more likely to appear after exposure to solutions such as total parenteral nutrition rather than distilled water. These deposits facilitated bacterial colonisation 30 times more than CVCs free from deposits.

Keywords: Bacteria; Central venous catheterisation; Infection; Scanning electron microscopy