文摘翻译有奖（2010年国外医院感染相关杂志）

gemao

美国感染控制与流行病学杂志2010年第6期
62、Occurrence of Skin and Environmental Contamination with Methicillin-Resistant Staphylococcus aureus before Results of Polymerase Chain Reaction at Hospital Admission Become Available入院MRSA皮肤和环境污染PCR检测
背景：健康机构动态监测以发现MRSA定植的病人实践不断增加的，但是在进行正确的预防措施之前，住院病人已经成为传染源。
目的：在病人携带状态知道之前，监测一般接触皮肤和环境表面的MRSA污染频率。
方法：我们进行6周前瞻性研究，通过PCR发现住院时已经有鼻腔MRSA定植的病人。在完成PCR筛选后的数小时内评估皮肤和环境污染。
结果：在2008年4月中旬至5月份，116例病人经过PCR检查发现鼻腔MRSA定植，其中83例（72%）纳入我们的研究。总体上，在74名病人中的38人(51%)皮肤上发现MRSA，在83名病人的环境中有37例(45%)发现MRSA。在83例环境培养标本中，63(76%)例在PCR筛选后7小时内获得，73(88%)例在进入病房之前告知PCR结果。83例MRSA定植的病人，15(18%)例在入院后25小时污染他们的环境，29 (35%)例在住院后33小时污染他们的环境。83例病人中有32 (39%)例是同病房，其中13(41%)例污染他们的环境。从住院到PCR结果出来的中位时间是20小时，从PCR结果到通知的中位时间是23小时。从鼻腔标本中获得的MRSA培养增加数目与污染有明显相关。
结论  在接触隔离警示落实之前，新发现的MRSA携带者经常已经用MRSA污染他们周围的环境，污染通常在皮肤上检测到。在进行主动性监测的医院需要尽可能缩短筛选延迟或先发制人地发现有散播MRSA高位风险的病人。

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美国感染控制与流行病学杂志2010年第6期
64、Potential Role of Active Surveillance in the Control of a Hospital-Wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae Infection主动监测在碳青霉烯类耐药肺炎克雷伯菌感染暴发控制中的角色
Background.The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for hospitalized patients, and effective strategies are needed.

Objective.To assess the effect of an intensified intervention, which included active surveillance, on the incidence of infection with carbapenem-resistant Klebsiella pneumoniae.

Setting.Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.

Design.Quasi-experimental study.

Methods.The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series analysis was performed.

Results.The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K. pneumoniae infection.

Conclusions.The use of active surveillance and contact precautions, as part of a multifactorial intervention, may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K. pneumoniae colonization or infection

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美国感染控制与流行病学杂志2010年第6期
65、Hospital-Acquired Catheter-Associated Urinary Tract Infection: Documentation and Coding Issues May Reduce Financial Impact of Medicare’s New Payment Policy 医院获得性导管相关尿路感染
Objective.To evaluate whether hospital-acquired catheter-associated urinary tract infections (CA-UTIs) are accurately documented in discharge records with the use of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes so that nonpayment is triggered, as mandated by the Centers for Medicare and Medicaid Services (CMS) Hospital-Acquired Conditions Initiative.

Methods.We conducted a retrospective medical record review of 80 randomly selected adult discharges from May 2006 through September 2007 from the University of Michigan Health System (UMHS) with secondary-diagnosis urinary tract infections (UTIs). One physician-abstractor reviewed each record to categorize UTIs as catheter associated and/or hospital acquired; these results (considered “gold standard”) were compared with diagnosis codes assigned by hospital coders. Annual use of the catheter association code (996.64) by UMHS coders was compared with state and US rates by using Healthcare Cost and Utilization Project data.

Results.Patient mean age was 58 years; 56 (70%) were women; median length of hospital stay was 6 days; 50 patients (62%) used urinary catheters during hospitalization. Hospital coders had listed 20 secondary-diagnosis UTIs (25%) as hospital acquired, whereas physician-abstractors indicated that 37 (46%) were hospital acquired. Hospital coders had identified no CA-UTIs (code 996.64 was never used), whereas physician-abstractors identified 36 CA-UTIs (45%; 28 hospital acquired and 8 present on admission). Catheter use often was evident only from nursing notes, which, unlike physician notes, cannot be used by coders to assign discharge codes. State and US annual rates of 996.64 coding (1% of secondary-diagnosis UTIs) were similar to those at UMHS.

Conclusions.Hospital coders rarely use the catheter association code needed to identify CA-UTI among secondary-diagnosis UTIs. Coders often listed a UTI as present on admission, although the medical record indicated that it was hospital acquired. Because coding of hospital-acquired CA-UTI seems to be fraught with error, nonpayment according to CMS policy may not reliably occur.

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美国感染控制与流行病学杂志2010年第6期
66、An Electronic Hand Hygiene Surveillance Device: A Pilot Study Exploring Surrogate Markers for Hand Hygiene Compliance一种电子手卫生监测装置Objective.To evaluate the feasibility of using an electronic hand hygiene surveillance and feedback monitoring device.

Design.A 2-phase pilot study included initial direct observation of hand hygiene practices as part of routine hospital quality assurance (phase I) and subsequent monitoring using an electronic hand hygiene surveillance device (phase II).

Setting.A 700-bed tertiary care teaching hospital.

Participants.Phase I included a convenience sample of healthcare workers. Phase II included 7 medical interns and 7 registered nurses recruited through email and at work-related meetings.

Methods.During phase I, healthcare workers were directly observed at patient room entry and exit during the period April through November 2008. During phase II, hand hygiene data were gathered through indirect observation using the electronic device during a 4-week period in August 2009. Twenty patient rooms were fitted with electronic trigger devices that signaled a reader unit worn by participants when they entered the room, and 70 dispensers for liquid soap or hand sanitizer were fitted with triggers that signaled the reader unit when the dispenser was used. The accuracy of the devices was checked by the principal investigator, who manually recorded his room entries and exits and dispenser use while wearing a reader unit.

Results.During phase I, hand hygiene occurred before room entry for 95 (25.1%) and after room exit for 149 (39.4%) of 378 directly observed patient room visits, for a cumulative composite compliance rate of 32.3%. Among the 378 room visits, 347 (91.8%) involved contact with the patient and/or environment. During phase II, electronic monitoring revealed a cumulative composite compliance rate of 25.5%. The electronic device captured 61 (98%) of 62 manually recorded room entries and 133 (95%) of 140 manually recorded dispensing events.

Conclusions.The electronic hand hygiene surveillance device seems to be a practical method for routinely monitoring hand hygiene compliance in healthcare workers.

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英国医院感染杂志2010年第6期
（已翻译）67、Efficacy of a standard meticillin-resistant Staphylococcus aureus decolonisation protocol in routine clinical practice 临床实践中MRSA去定植策略效果
Summary
Decolonisation may reduce the risk of meticillin-resistant Staphylococcus aureus (MRSA) infection in individual carriers and prevent transmission to other patients. The aims of this prospective cohort study were to determine the long-term efficacy of a standardised decolonisation regimen and to identify factors associated with failure. Patients colonised with MRSA underwent decolonisation, which was considered to be successful if there was no growth in three consecutive sets of site-specific screening swabs obtained weekly post treatment. If patients were successfully decolonised, follow-up cultures were performed 6 and 12 months later. Of 137 patients enrolled, 79 (58%) were successfully decolonised. Of these 79, 53 (67%) and 44 (56%) remained decolonised at 6 and 12 months respectively. Therefore only 44/137 (32%) patients who completed decolonisation were MRSA negative 12 months later. Outcome was not associated with a particular strain of MRSA. Successful decolonisation was less likely in patients colonised with a mupirocin-resistant isolate (adjusted odds ratio: 0.08; 95% confidence interval: 0.02–0.30), in patients with throat colonisation (0.22; 0.07–0.68) and in patients aged >80 years (0.30; 0.10–0.93) compared with those aged 60–80 years. These findings suggest that although initially successful in some cases, the protocol used did not result in long-term clearance of MRSA carriage for most patients.

Keywords: Chlorhexidine; Decolonisation; Meticillin-resistant Staphylococcus aureus; Mupirocin; Pulsed-field gel electrophoresis

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英国医院感染杂志2010年第6期
68、Impact of admission screening for meticillin-resistant Staphylococcus aureus on the length of stay in an emergency department 急诊部门MRSA入院筛查的影响因素
Summary
Preventing and controlling meticillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as ‘risk group’ (RG) on their arrival in the ED and were compared with ‘non-risk group’ (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9 h, respectively. Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them.

Keywords: Boarders; Emergency department; Meticillin-resistant Staphylococcus aureus

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英国医院感染杂志2010年第6期
（已翻译）69、Speed of molecular detection techniques for meticillin-resistant Staphylococcus aureus admission screening in an acute care hospital MRSA入院筛查分子生物学快速检测Summary
Active surveillance for meticillin-resistant Staphylococcus aureus (MRSA) carriers is considered an essential component of MRSA control strategies in acute care hospitals. Recently, molecular assays for MRSA screening have been proposed with significant reduction of the sample processing time. Using a time analysis model, we investigated the time gain after the introduction of a molecular assay and compared this with a preceding control period, using culture-based techniques. During a four-month period all high risk patients (N = 44) and all known MRSA-positive patients readmitted to the hospital (N = 41) were screened for MRSA upon admission. In both groups the long pre-analytical phase – time from admission to sampling and transportation of samples to the laboratory – was the determining factor in the entire process. A substantial reduction of the sample processing time was achieved using molecular assays, compared with conventional culture. Due to the long pre-analytical phase, in addition to the high costs associated with polymerase chain reaction (PCR) testing, molecular techniques were not introduced for the admission screenings. In the group of the readmission screenings, however, a fast test result could save a substantial number of unnecessary isolation days, resulting in an economic benefit for the hospital. PCR testing might be of interest for the readmission screenings. In conclusion, local policies for MRSA screening should be investigated before introducing expensive PCR technology.

Keywords: Acute care hospital; Meticillin-resistant Staphylococcus aureus; Polymerase chain reaction; Screening; Time analysis

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英国医院感染杂志2010年第6期
（已翻译）70、When are the hands of healthcare workers positive for meticillin-resistant Staphylococcus aureus? 医护人员手部MRSA携带Summary
Hand hygiene is a key component in reducing infection. There are few reports on the prevalance of meticillin-resistant Staphlococcus aureus (MRSA) on healthcare workers' (HCWs') hands. The aim of this study was to establish whether HCWs' fingertips were contaminated with MRSA in a clinical hospital setting. The study was conducted in an acute tertiary referral hospital on four MRSA wards that were part of a larger research study on MRSA epidemiology and four other wards not included in the study. The fingertips from all categories of 523 HCWs were sampled on 822 occasions by the imprinting of fingertips on MRSA chromogenic agar plates. The type of hand hygiene agent used, if any, and the immediate prior activity of the HCW were recorded. Overall, 38/822 (5%) fingertips from 523 HCWs were MRSA-positive; 12/194 (6%) after clinical contact, 10/138 (10%) after contact with the patient's environment and 15/346 (4%) after no specific contact. MRSA was recovered on 2/61 (3%) occasions after use of alcohol hand rub, 2/35 (6%) after 4% chlorhexidine detergent, 7/210 (3%) hand washing with soap and water, and 27/493 (5%) when no hand hygiene had been performed. MRSA was recovered from HCWs on seven of the eight wards. MRSA was more frequently present on fingertips on the four non-study wards vs the four MRSA study wards [18/250 (7%), 3/201 (1%), respectively; P ≤ 0.004]. The isolation of MRSA from HCWs' fingertips, including after hand hygiene, indicates that more educational programmes are necessary to improve the quality of hand hygiene to prevent transmission of MRSA.

Keywords: Hand hygiene agents; Hand hygiene occasions; MRSA screening; Staff hand sampling

莲雾

我也来翻译一下。
16. Resistance of Legionella pneumophila serotype 1 biofilms to chlorine-based disinfection 血清1型嗜肺军团菌生物膜对含氯消毒剂的抵抗力
Journal of Hospital Infection
Volume 74, Issue 2, February 2010, Pages 152-159
summary
The presence of Legionella spp. in potable water systems is a major concern to municipal water providers and consumers alike. Despite the inclusion of chlorine in potable supplies and frequent chlorination cycles, the bacterium is a recalcitrant human pathogen capable of causing incidents of Legionnaires' disease, Pontiac fever and community-acquired pneumonia in humans. Using two materials routinely employed for the delivery of potable water as a substratum, copper and stainless steel, the development of Legionella pneumophila biofilms and their response to chlorination was monitored over a three-day and a three-month period, respectively. Preliminary in vitro studies using broth and sterile tap water as culture media indicated that the bacterium was capable of surviving in low numbers for 28 days in the presence of chlorine. Subsequently, biofilms were grown for three days, one month and two months, respectively, on stainless steel and copper sections, which are widely used for the conveyance of potable water. Immediately after exposure to 50 mg/L chlorine for 1 h, the biofilms yielded no recoverable colonies, but colonies did reappear in low numbers over the following days. Despite chlorination at 50 mg/L for 1 h, both one- and two-month-old L. pneumophila biofilms were able to survive this treatment and to continue to grow, ultimately exceeding 1 × 106 cfu per disc. This research provides an insight into the resistance afforded to L. pneumophila against high levels of chlorine by the formation of biofilms and has implications for the delivery of potable water.
Keywords: Biofilm; Chlorine; Disinfection; Legionella pneumophila; Water
摘要  军团菌出现于饮用水系统与市政供水源和消费者有关。尽管在饮用水中加入氯消毒剂，并且经常用氯处理循环管道，这种顽固的人类病原菌仍存在。军团菌可引起军团病，庞蒂亚克热和社区获得性肺炎。本研究以两种经常用于运输饮用水的材料（铜和不锈钢）为基质建立嗜肺军团菌生物膜，并监测它们与含氯消毒剂的反应，实验时间分别为3天和3个月。体外预实验采用肉汤和无菌自来水作为培养基，结果显示：在含氯培养基中，少量军团菌存活28天。随后，分别在铜和不锈钢片段上生长3天、1个月和2个月生物膜。生物膜直接暴露于50 mg/L 氯1h，基质上没有回收到任何菌落，但随后几天少量菌落再次出现。尽管50 mg/L氯化处理1h，1个月和2个月嗜肺军团菌生物膜仍能存活并继续增长，最终浓度超过1×106/片。本研究证明，嗜肺军团菌通过形成生物膜对高水平氯耐受，提示饮用水运输中也存在这个问题。
关键词：生物膜；氯；消毒；嗜肺军团菌；水

莲雾

30. Epidemiology and clonality of multidrug-resistant Acinetobacter baumannii from a healthcare region in Hong Kong 香港医疗机构中多重耐药鲍曼不动杆菌的流行病学及克隆
Journal of Hospital Infection
Volume 74, Issue 4, April 2010, Pages 358-364
Summary
We assessed the risk factors and molecular epidemiology of multidrug-resistant Acinetobacter baumannii (MDR-AB) in Hong Kong. The patients were treated in five hospitals in a healthcare region during 2005–2006. We performed genomic identification by amplified rRNA gene restriction analysis (ARDRA) and investigated the existence of metallo-β-lactamases and the clonality of representative MDR-AB strains by phenotypic and molecular methods. Forty-five subjects with MDR-AB were compared with 135 controls (patients with no MDR-AB). In the logistic regression, chronic wound (odds ratio: 29.5, 95% confidence interval: 8.1–107.2; P < 0.001) was the only factor independently associated with MDR-AB colonisation or infection. ARDRA identified all 45 MDR-AB as genomic species 2TU. Pulsed-field gel electrophoresis clustered all except two isolates into two clonal types, designated HKU1 and HKU2 with 24 and 19 isolates, respectively. The main features of HKU1 strains were ST26, adeB type XII, positivity for blaOxA-23-like and blaOxA-51-like genes and high level resistance to carbapenems. Most HKU1 strains retained susceptibility to gentamicin, cotrimoxazole and minocycline. By contrast, HKU2 strains exhibited ST22, adeB type II, and were usually positive only for the blaOxA-51-like gene and resistant to gentamicin, cotrimoxazole and minocycline. Both clones were found to have disseminated widely. In conclusion, clonal expansion is playing major roles in the increase of MDR-AB in these hospitals in Hong Kong. The findings highlight the need to enhance infection control measures.
Keywords: Acinetobacter baumannii; Molecular epidemiology; Multilocus sequence typing; Risk factors

摘要  评估香港地区多重耐药鲍曼不动杆菌（MDR - AB）的危险因素和分子流行病学。收集2005-2006年间5所医疗机构治疗病人中分离的AB。我们采用rRNA基因限制性扩增分析（ARDRA）进行了基因鉴定，并检测金属β-内酰胺酶的存在，以及采用表型和分子克隆方法确定典型的MDR – AB克隆。45位MDR – AB携带受试者和135位对照者（非MDR-AB患者）入组。logistic回归分析显示，慢性伤口（OR值：29.5，95％可信区间：8.1-107.2；P <0.001）是与MDR-AB定植或感染相关的唯一独立危险因素。ARDRA确定所有45株MDR-AB的基因组学种类均为2TU。除2株MDR-AB以外，脉冲场凝胶电泳将所有菌株分成两个克隆型，第24和19株分别被指定为HKU1和HKU2。HKU1株的主要特点是ST26，adeB XII型， blaOxA -23样和blaOxA - 51 样基因阳性，对高水平碳青霉烯类耐药。大多数HKU1菌株对庆大霉素，复方新诺明和米诺环素敏感。相比之下，HKU2株显示为ST22，adeBII型，通常只有blaOxA - 51 –样基因阳性，耐庆大霉素，复方新诺明和米诺环素。这两个克隆已被广泛传播。总之，克隆扩散在香港医院的MDR – AB增加中起主要作用。调查结果强调有必要加强感染控制措施。
关键词：鲍曼不动杆菌；分子流行病学；多位点序列分型；危险因素

gemao

70、When are the hands of healthcare workers positive for meticillin-resistant Staphylococcus aureus? 医护人员手部MRSA携带
Summary
手卫生是降低感染的重要组成部分。已经有一些关于健康工作人员手部MRSA流行率的报告。本研究目的是评价在临床工作环境中健康工作人员手指指尖是否被MRSA污染。研究在一家急诊三级医院进行，有4间MRSA病房，是一项研究MRSA流行病学大型研究项目的组成部分，和另外4间不属于MRSA流行病学研究的病房参加本项研究。从所有523明健康工作者中采集指尖 共获得的822个样本。指尖印在在 MRSA 产色琼脂平板上。如果可能，记录使用手卫生消毒剂型号和健康工作人员先前刚刚的活动。总体上，523名健康工作者有38/822（5%）MRSA阳性；其中12/194（6%）在临床接触后，10/138（10%）在与病人环境接触后，15/346 (4%)没有特殊接触。在使用酒精凝胶后2/61（3%）发现MRSA，在4%洗必泰去污剂后有2/35（6%）发现MRSA；用肥皂和水洗手后，7/210（3%）发现，没有任何手卫生的27/493（5%）发现MRSA。在8间病房中有7间的工作人员发现有MRSA。在4间非研究病房中的发现MRSA的频率高于4间MRSA研究病房[分别是18/250 (7%), 3/201 (1%),; P ≤ 0.004]。.从健康工作者手部获得的MRSA菌株，包括手卫生后显示需要更多的教育项目提高手卫生的质量，防止MRSA传播。

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英国医院感染杂志2010年第6期
71、Effects of ‘bare below the elbows’ policy on hand contamination of 92 hospital doctors in a district general hospital 肘部以下裸露政策在医生手卫生方面的实施效果
Summary
Despite a lack of evidence the UK's Department of Health introduced a policy of ‘bare below the elbows’ attire in order to try to reduce the incidence of nosocomial infection. This study investigates the link between this state of dress and hand contamination. A prospective observational study of doctors working in a district general hospital was carried out. The fingertips of each hand were imprinted onto culture medium, and resultant growth assessed for number of colony-forming units and presence of clinically significant pathogens or multiply resistant organisms. These findings were correlated with attire, grade, sex and specialty. Ninety-two doctors were recruited of whom 49 were ‘bare below the elbows’ compliant and 43 were not. There was no statistically significant difference between those doctors who were ‘bare below the elbows’ and those that were not, either for the number of colony-forming units or for the presence of clinically significant organisms. No multiply resistant organisms were cultured from doctors' hands. ‘Bare below the elbows’ attire is not related to the degree of contamination on doctors' fingertips or the presence of clinically significant pathogens. Further studies are required to establish whether investment in doctors' uniforms and patient education campaigns are worthwhile.

Keywords: Hand hygiene; Hand washing; Bare below the elbows; Hospital-acquired infection

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英国医院感染杂志2010年第6期
（已翻译）72、Can ‘search and destroy’ reduce nosocomial meticillin-resistant Staphylococcus aureus in an Irish hospital? 搜索并摧毁计划能减少MRSA医院感染吗？
Summary
In Ireland, the Department of Health and Children recommends admission screening of patients at increased risk of meticillin-resistant Staphylococcus aureus (MRSA), isolation of these patients until proven negative, and eradication of any MRSA identified. These actions form the basis of a programme called ‘search and destroy’ that has successfully reduced MRSA in Scandinavia. There is, however, very little information published on the use of search and destroy in Ireland. This study was carried out using a quantitative, quasi-experimental design in the form of an interventional cohort study. The effect of reducing the turnaround time for MRSA results (2007) and the introduction of pre-emptive isolation (2008) was examined in a hospital with an established admission screening programme for MRSA. Rates of MRSA infection and colonisation were monitored post-intervention and compared to baseline rates prior to the intervention (2005–2006). Rates of hospital-acquired (nosocomial) MRSA infections and colonisation fell in both 2007 and 2008. However, due to the quasi-experimental design of the study and the low endemic level of MRSA in the hospital, a causal link could not be established.

Keywords: Admission screening; Meticillin-resistant Staphylococcus aureus; Pre-emptive isolation; Search and destroy

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英国医院感染杂志2010年第6期
（已翻译）73、Psychological impact of short-term isolation measures in hospitalised patients 住院病人短期隔离措施的心理影响
Summary
Unintended negative effects, such as anxiety and depression, have been demonstrated in patients subjected to infection control strategies, such as isolation for long periods. Yet isolation precautions are mostly short-term. We therefore determined levels of anxiety, depression and quality of life in patients exposed to short-term isolation. In a cross-sectional matched cohort study, performed in a single university hospital, patients isolated for infection control were evaluated with the Hospital Anxiety and Depression Scale [HADS-A (Anxiety) and HADS-D (Depression)], Visual Analogue Scale of EQ-5D (EQ VAS) and an isolation evaluation questionnaire within 24–48 h after start of isolation. Two matched controls were selected for each isolated patient. Isolated patients (N = 42) and control patients (N = 84) had comparable HADS-A (4.5 vs 5.0), HADS-D (4.0 vs 5.0) and EQ VAS (65 vs 62) scores. In multiple regression analysis comorbidity was associated with EQ VAS outcome (P = 0.005), whereas all other variables, including being in isolation, were unrelated to HADS and EQ VAS scores. Patients reported positive associations with isolation measures. The quality of care provided by physicians and nurses, as perceived by isolated patients, was not negatively affected in 74% and 71% of patients, respectively. In conclusion, short-term infection control measures do not influence hospitalised patients' levels of anxiety and depression and quality of life. Isolated patients had a positive attitude towards the precautions taken.

Keywords: Infection control; Isolation measures; Psychological impact; Quality of life

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英国医院感染杂志2010年第6期
（已翻译）74、Patients with meticillin-resistant Staphylococcus aureus infection: twenty-first century lepers 病人MRSA感染：21世纪的麻风病人？summary
In the recent past, there has been a rapid increase in the incidence of meticillin-resistant Staphylococcus aureus (MRSA) infections, especially community-associated (CA)-MRSA. Many media descriptions of MRSA are sensational and focus on its potential for severe disease and contagiousness. Our objective is to describe psychological and social morbidity associated with MRSA infection via a case series of five patients with CA-MRSA infection. We also analyse the resulting stigmatisation associated with being diagnosed with MRSA infection. We learned that patients describe a variety of stigmatisation related to their diagnosis of MRSA, including being shunned at home and in the workplace. Patients describe being asked by family, colleagues, and clients to take extraordinary measures to prevent MRSA transmission. Consequences of MRSA diagnoses have included erosion or termination of key personal and business relationships. In conclusion, stigmatisation resulting from the diagnosis of MRSA can have profound personal and social morbidity. Media and public health awareness of MRSA infection needs to be balanced with information about how MRSA transmission is usually preventable with simple hygienic measures.

Keywords: MRSA; Community; Infection; Stigma; Media

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英国医院感染杂志2010年第6期
病人MRSA感染：21世纪的麻风病人？
摘要：在过去几年中，MRSA感染的发生率不断增加，特别是CA-MRSA。许多媒体把MRSA 描述成轰动性的，注意力集中在它们可能造成的严重疾病和接触性传染。我们的目的是通过一组5个CA-MRSAS感染的病人描述与MRSA有关的心理和社会病态。我门懂得病人描述有各种各样与MRSA诊断的不好名声，包括在家里和工作场所被回避。病人描述道经常被家人、同时和职员要求采取额外的措施防止MRSA 传播。病人诊断为MRSA的结果内含破坏或终止关键的个人和商业关系。总之，由于诊断MRSA造成的恶劣名声有深刻的个人和社会病态。媒体和公众健康对MRSA 感染的认识需要平衡MRSA感染如何通过简单的手卫生就成预防的信息。

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英国医院感染杂志2010年第6期
73、Psychological impact of short-term isolation measures in hospitalised patients 住院病人短期隔离措施的心理影响
摘要：
已经证实，在针对感染控制的病人中如长期的隔离，出现诸如焦虑和抑郁等非故意的负性作用。尽管隔离警示通常是短期的。因此我们决定研究处于短时间内隔离病人的焦虑、抑郁的程度和生活质量。在一家大学医院进行的横断面配对cohort研究中，病人因感染控制而进行隔离，在病人隔离开始后24-48小时，对其进行医院焦虑和抑郁评分[HADS-A (Anxiety) and HADS-D (Depression)]，EQ-5D的视觉模拟评分，和隔离评价调查表。每个隔离病人选择2名病人进行配对对照，隔离病人（n=42）和对照病人（n=84）对比各项评分HADS-A (4.5 vs 5.0), HADS-D (4.0 vs 5.0) and EQ VAS (65 vs 62)。在多因素回归分析后，发现合并症与EQ-VAS 有相关性（p=0.005）；而其他变量，包括被隔离，与HADS和EQ没有直接关系，报道的病人与隔离措施有正性相关。医生和护士的护理质量，作为 隔离病人感受，分别在74%和71%的病人中没有负性影响。总之，短期感染控制措施不会影响住院病人的焦虑和抑郁水平，以及生活质量，隔离病人对采取的措施有积极的态度。

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67、Efficacy of a standard meticillin-resistant Staphylococcus aureus decolonisation protocol in routine clinical practice 临床实践中MRSA去定植策略效果
Summary
去除定植的MRSA可以减少个体携带者感染的风险，防止传播给其他病人。本前瞻性cohort研究的目的是确定标准化去定植方法的远期效果，寻找失败因素。定植的病人经过去定植，如果在治疗后连续3次每周特异部位筛选拭子没有细菌生长，则认为成功。如果病人成功去定植，在6个月和12个月后进行随访培养。137例病人纳入研究，其中79例(58%)成功去定植，79例中，53例(67%)和44例(56%)分别在6个月和12个月仍无定植。因此在12个月后只有44/137(32%)病人完全去定植，MRSA阴性。结果与MRSA特殊菌株没有关系，在有定植有耐莫匹罗星菌株的病人（调整优势比: 0.08; 95%可信区间: 0.02–0.30)、喉部有定植的病人(0.22; 0.07–0.68)，在年龄超过80岁的病人(0.30; 0.10–0.93)，与那些年龄60-80岁的病人对比成功去定植不太可能。这些发现提示：尽管在在某些病例开始时是成功的，但使用的规程在绝大部分携带MRSA的病人中不会产生远期的清除。

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美国感染控制与流行病学杂志2010年第6期
医院获得性导管相关尿路感染：记录和编码问题可能会降低医疗护理新支付政策的财务冲击
目的：为评价医院获得性尿路感染是否在出院记录中被准确记录，（使用9版疾病国际分类，ICD-9）,修正诊断编码以致触发不支付，正如Medicare and medicalservice中心对待医院获得性感染主动要求。
方法：我们进行了回顾性研究，在2006年5月早2007年9月，从密西根健康系统中随机选择了第二诊断是尿路感染的80例。有一个医生分拣者，检查每一份病例，把它们分为导管相关和/医院获得；这些结果（被认为金标准）与医院编码者编写的诊断编码进行比较。通过使用健康费用和使用计划数据比较UMHS编码者导管相关编码的年使用比例，与州和国家。
结果：病人的平均年龄58岁，其中56例(70%)是女性，中位住院时间是6天，50名(62%)病人在住院期间使用导尿管。住院编码者列出20个(25%)第二诊断是UTIS为医院获得，而医师分拣者显示37(46%)例是医院获得。医院编码者发现没有CA-UTIs(没有使用996.64编码)，而医师分拣发现36个CA-UTIs(45%; 28是医院获得性，8个在住院时就已经存在)。导管使用通常是来自护士的记录，不是医生的医嘱，编码者不能用于出院编码，州和国家的年96.64编码率(1% 的第二诊断是CA-UTIs)与UNHS的数据相似。
结论：在第二诊断为UTI的病人中，医院编码者很少使用导管相关性编码用于发现CA-UTI。编码者通常把UTI作为入院时的表现，尽管医疗记录显示其是医院获得性的。因为医院获得性CS-UTI的编码似乎充满着错误，根据CMS不支付原则，可能发生不可靠。

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英国医院感染杂志2010年第6期
72、Can ‘search and destroy’ reduce nosocomial meticillin-resistant Staphylococcus aureus in an Irish hospital? 搜索并摧毁计划能减少MRSA医院感染吗
在爱尔兰，健康和儿童机构推荐在入院时对MRSA的高危病人进行筛选，隔离这些病人直到证明MRSA阴性，清除任何发现的MRSA。这些措施根据一项称为“搜索、摧毁”计划，据说在斯堪的纳维亚使用此计划成功减少了MRSA。但是在爱尔兰很少有关于“搜索摧毁”计划的报告。本研究为一项采用干预队列研究进行设计的定量准实验研究。在医院中已经使用减少MRSA报告时间（2007）和先发隔离措施（2008），并制定住院MRSA筛选计划。监测干预后的MRSA感染率和定植率，并与干预前的基线比率进行对比。在2007年和2008年，院内MRSA感染率和定植率均有下降。但是由于研究是准实验设计和医院内MRSA流行低，因此没有建立因果联系。