ObjectiveTo analyze the trend of hospital infection, so as to provide a scientific basis for hospital infection prevention and control. MethodsFrom 2011 to 2013, according to the criteria of diagnosis of nosocomial infections set up by the Ministry of Health, the prevalence rates of nosocomial infections in patients who were hospitalized on the survey day were investigated by the combination of bedside investigation and medical records checking. ResultsThe incidence rates of nosocomial infections from 2011 to 2013 were 2.99%, 2.31% and 1.95%, respectively, presenting a downward trend. The rate of hospital infection was the highest in comprehensive Intensive Care Unit, and the main infection site was the lower respiratory tract. Gram-negative bacteria were the main pathogens causing hospital infections, including Klebliella pnermoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and Escherichia coli. The utilization rates of antibacterial agents in these three years were respectively 39.84%, 34.58% and 34.22%. ConclusionTargeted surveillance and management of key departments and sites should be strengthened. It is necessary to strengthen the surveillance and management of antibiotics, raise the submission rate of pathogens, and use antibiotics appropriately.
ObjectiveTo explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.MethodsThe children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.ResultsA total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.ConclusionsLong-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.
Objective To compare the epidemic status of nosocomial infections (NIs) among medical institutions at different levels. Methods The cross-sectional surveys on prevalence rates of NIs, distribution of NIs, and antimicrobial use were conducted through combination of bedside investigation and medical record reviewing among all in-patients of 20 medical institutions in Baoshan District, Shanghai from 00:01 to 24:00 on November 12th 2014, December 9th 2015, and November 30th 2016, respectively. Results A total of 18 762 patients were investigated, the prevalence rate of NIs in the first, second, and third class hospitals were 5.36%, 2.37%, 1.68%, respectively (χ2=88.497, P<0.05). The main NIs sites were lower respiratory tract, urinary tract, and upper respiratory tract in the first and second grade hospitals; while were other unclassified sites, respiratory tract, and upper respiratory tract in the third grade hospitals. The utilization rates for antimicrobial in the first, second, and third grade hospitals were 5.88%, 31.64%, and 42.11%, respectively (χ2=928.148, P<0.05); submission rates for specimen were 9.82%, 48.89%, and 82.39%, respectively (χ2=601.347, P<0.05). Four cases of pathogen were reported in the first grade hospitals, 94 in the second grade hospitals, and 96 in the third grade hospitals. The in-patients in different hospitals with different genders, ages, and departments had a statistical difference in prevalence rate of NIs (P<0.05) . Conclusion The first grade hospitals need to enhance the etiological examination; the third grade hospitals should severely restrict the antimicrobial utilization, and refine the prevention and control work for NIs.
ObjectiveTo identify the risk factors of Intensive Care Unit (ICU) nosocomial infection in ICU ward in a first-class hospital in Wuxi, and discuss the effective control measures, in order to provide evidence for making strategies in preventing and controlling nosocomial infection. MethodsAccording to the principle of random sampling and with the use of case-control study, a sample of 100 nosocomial infection patients were selected randomly from January 2012 to December 2014 as survey group, and another 100 patients without nosocomial infection as control group. The data were input using EpiData 2.0, and SPSS 13.0 was used for statistical analysis; t-test and χ2 test were conducted, and the risk factors were analyzed using multi-variate logistic regression model. The significant level of P-value was 0.05. ResultsBased on the results of univariate analysis, there were 13 risk factors for ICU nosocomial infection, including diabetes mellitus, hypoproteinemia, being bedridden, surgical operation, immunosuppression, glucocorticoids, organ transplantation, tracheal intubation, length of hospitalization, length of mechanical ventilation, length of central venous catheter, length of urinary catheter, and length of nasogastric tube indwelling. Multi-variate logistic analysis indicated that hospitalization of 7 days or longer[OR=1.106, 95%CI (1.025, 1.096), P=0.001], diabetes mellitus[OR=2.770, 95%CI (1.068, 7.186), P=0.036], surgical operation[OR=7.524, 95%CI (2.352, 24.063), P=0.001], mechanical ventilation of 7 days or longer[OR=1.222, 95%CI (1.116, 1.339), P<0.001], and nasogastric tube indwelling of 7 days or longer[OR=1.110, 95%CI (1.035, 1.190), P=0.003] were considered as independent risk factors for ICU nosocomial infection. ConclusionHospitalization of 7 days or longer, diabetes mellitus, surgical operation, tracheal intubation of 7 days or longer, and gastric intubation of 7 days or longer are the major risk factors for nosocomial infection in ICU ward. Advanced intervention and comprehensive prevention measures are helpful to reduce the nosocomial infection rate and ensure the safety of medical treatment.
ObjectiveTo know the situation of nosocomial infection in 2014 in a western region hospital, in order to provide a scientific basis for hospital infection control and management. MethodWe selected the patients on August 14th in 2014 during the time from 00:00 to 24:00 as our study subjects. Bedside investigation and medical records investigation were combined to study the cross-sectional survey of nosocomial infection. We completed the questionnaire, and used statistical methods to count related data about nosocomial infections and community-acquired infections. ResultsA total of 1 908 patients were investigated. The nosocomial infection prevalence rate was 4.45%, and the community-acquired infection prevalence rate was 29.09%. The highest prevalence of nosocomial infection department was the Intensive Care Unit (38.10%); the top three surgical systems were Thoracic Surgery (18.67%), General Surgery (16.67%), and Neurosurgery (10.53%), and the top three medical systems were Endocrinology (11.11%), Neurology (6.67%), and Infectious Diseases Department (5.88%). The top three community-acquired infections occurred in Pediatrics Department (non-neonatal group) (95.37%), Burn surgery (92.31%), and Respiratory Medicine (86.46%). The main infection site for both nosocomial and community-acquired infection was lower respiratory tract (58.24%). Pathogens were mainly Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. Hospital and community-acquired infection bacterial spectrum were consistent. And the rate of antibiotics use was 40.82%, in which 126 patients used for prevention (6.60%), and 599 patients used for treatment (31.39%). For patients using the drugs for treatment, bacterial culture submission rate was 80.71%, and the positive rate was 43.78%. ConclusionsThe prevalence of nosocomial infection is reliable, which provides a data support for nosocomial infection prevention and control.
ObjectiveTo investigate the educational background of practitioners from the hospital infection control departments located in the mainland of China and reveal the necessity and employment prospects of setting up a major of hospital infection control for a bachelor degree in universities.MethodsA self-designed questionnaire was used to conduct an online survey on the Shanghai International Forum for Infection Control and Prevention and the WeChat group of nosocomial infection control from March 12th to March 25th, 2018. The convenient sampling method was used to investigate the leader of infection prevention and control department in each hospital. The survey included the regional distribution, attention on nosocomial infection control, existing staff structure, future staff needs and employment prospects of hospitals in 2018, and the attention on nosocomial infection control in the same period in 2014.ResultsA total of 1 654 questionnaires were obtained, from 30 provincial-level regions, including 103 maternal and child health hospitals, 143 other special hospitals, 258 hospitals of traditional Chinese medicine, and 1 150 general hospitals. Hospitals upgraded more attention on nosocomial infection control in 2018 than in 2014 [(3.76±0.98) vs. (2.94±1.14) points; t=-36.112, P<0.001]. Currently, there were 5 068.5 labors engaged in nosocomial infection control. The educational background of the current practitioners was mainly nursing [60.52% (3 067.5)]. In the next 5 years, 83.50% (820/982) of the hospitals that had recruitment plans planed to recruit graduates specialized in the hospital infection control, and respectively, 44.86% (742/1 654) and 17.35% (287/1 654) of the respondents believed that the employment prospects of graduates with bachelor degree specialized in the hospital infection control were good or very good.ConclusionThere is a tremendous demand for the graduates specialized in the hospital infection control, and it is imperative to set up this undergraduate major.
ObjectiveTo investigate the incidence of nosocomial infection in acute and serious schizophrenic inpatients and its risk factors. MethodsBetween January 1st and December 31st, 2012, we investigated 1 621 schizophrenic patients on the status of nosocomial infections according to the hospital standard of nosocomial infection diagnosis. They were divided into infected group and uninfected group according to the survey results. The risk factors were analyzed by logistic regression method. ResultsTwenty-nine infected patients were found among the 1 621 patients, and the incidence rate was 1.79%. Among the nosocomial infections, the most common one was respiratory infection (79.31%), followed by gastrointestinal infection and urinary infection (6.90%). There were significant differences between the two groups of patients in age, hospital stay, positive and negative syndrome scale (PASS), combined somatopathy, the time of protective constraint, modified electraconvulsive therapy (MECT), using two or more antipsychotics drugs, using antibiotics and side effects of drugs (P<0.05). However, there were no statistical differences in gender, age classes, the course of disease, frequency of hospitalization and seasonal incidence of hospital infection (P>0.05). The results of multivariate analysis showed that hospital stay, positive symptom score, negative symptom score, the time of protective constraint, MECT, using two or more antipsychotics drugs and side effects of drugs were the main risk factors for nosocomial infection of inpatients with psychopathy (P<0.05). ConclusionBased on the different traits and treatments of acute and serious schizophrenia, a screening table of infections should be set. For the high risk group of nosocomial infection, effective measures should be taken to prevent and control the nosocomial infection of patients with schizophrenia.
ObjectiveTo compare the clinical characteristics of patients with nosocomial and community infections with extended-spectrum beta-lactamase-containing Klebsiella pneumoniae (ESBL-KP) and non-ESBL-KP so as to improve clinical diagnosis and treatment outcomes.MethodsThis retrospective study determined the clinical features of patients with nosocomial and community infections with KP who were admitted to our hospital from January 1st, 2017 to June 30th, 2018. The chi-square test or Fisher's exact probability method were used to compare different groups.ResultsWe identified 334 strains of KP, and 83 (24.9%) of them strains were EBSL-KP. The percentages of ESBL-KP infections among those with nosocomial and community infections were similar (31.25% vs. 22.27%, χ2=2.955, P=0.086). Significantly more females than males had ESBL-KP infections (32.32 vs. 21.70%, χ2=4.208, P=0.040). The percentages of ESBL-KP infections were similar among <18 years-old group, 18 to 45 years-old group, 45 to 60 years-old group, and ≥60 years-old group. The three major locations of KP infections were the lower respiratory tract, urinary tract, and bloodstream (bacteremia). Among nosocomial KP infections, there were no significant differences in the percentages of ESBL-KP infections at different sites, nor in the hospital departments where patients were treated; among community KP infections, there were significant differences in the percentages of ESBLs-KP infections at different sites, and in the hospital departments where patients were treated. For community KP infections, the two most common infection sites were the urinary tract (37.74%) and the skin and soft tissue (30.77%), and most patients were treated in the urology department (40.00%) and respiratory medicine department (38.10%). ESBL-KP isolates had greater resistance than non-EBSL-KP isolates to 16 tested antibiotics (P<0.05). There were no statistically significant differences in the percentages of nosocomial infections and community infections among those with ESBL-KP and among those with non-ESBL-KP (P>0.05).ConclusionsOur population have high rates of nosocomial and community KP infections and of infections with ESBL-KP. It is necessary to strengthen the management and clinical use of antibiotics and to provide real-time surveillance of KP infections, especially for patients with ESBL-KP infections. Increased vigilance is required for KP infections of females and community KP infections to improve control of nosocomial infections and reduce the prevalence of cross-infections.
Objective To establish the control range of monthly nosocomial infection incidences in different departments and put them into practice, to provide a scientific and effective method for nosocomial infection control. Methods The surveillance data about nosocomial infection cases in Nanchong Central Hospital from January 2016 to December 2018 were used to set the warning limits and control limits in different departments based on the theory of medical reference range. From January 2019, the clinical departments would be alerted if their nosocomial infection incidences were beyond the warning limits, and investigated and intervened if the incidences were beyond the control limits. Results The control range of monthly nosocomial infection incidences in different departments had been made. For identifying risk events, the sensitivity was 83.3%, the specificity was 96.2%, the positive predictive value was 29.4%, the negative predictive value was 99.7%, the coincidence rate was 96.0%, and the consistency was medium (kappa=0.419, P<0.001). The effective rate of the initial alert intervention was 83.3%, and the effective rate of the field intervention was 100.0%. Conclusion The establishment and application of the control range of monthly nosocomial infection incidences in different departments can identify potential risk events and realize precise nosocomial infection control.
Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection( CLABSI) in intensive care unit( ICU) .Methods A retrospective study was made to investigate the CLABSI epidemic data in ICU from June 2006 to June 2009. Clinical and physiological parameters were summarized and compared between these patients, which were divided into two groups based on the clinical outcome. Meanwhile, events including blood transfusion,mechanical ventilation, as well as cost of hospitalization were also reviewed. Logistic regression method was introduced to investigate the potential prognostic risk factors. Results There were 49 patients were diagnosed as nosocomial CLABSI, in which 19 cases( 38. 8% ) died in the hospital and 30( 61. 2% ) weresurvival. In univariate analysis, differences in body temperature, central venous pressure, acute physiology and chronic health evaluation( APACHEⅡ ) score, blood transfusion amount, pH value, D-dimer, blood serum alanine transarninase, blood urea nitrogen level, serumcreatinine, serumpotassiumbetween the survivors andthe non-survivors were significant( P lt;0. 05) . However, no significant differences were observed between the two groups in in-hospital days, ICU days and hospitalization cost ( all P gt; 0. 05) . With multiple logistic regressions, higher APACHEⅡ score( OR 0. 78; 95% confidence interval: 0. 66-0. 94; P = 0. 007) , APTTlevel( OR 0. 87; 95% confidence interval: 0. 77-0. 98; P = 0. 026) and serum potassium( OR 0. 09; 95% confidence interval: 0. 01-0. 80; P = 0. 031) were independent predictors of worse outcome. Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLABSI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLABSI patients with different prognosis.