Analysis Of Major Monitoring Data Of Nosocomial Infection In Medical Institutions Of Banan District In Chongqing From 2003 To 2013

Banan district is in the south of the main city of Chongqing, which is one of the 9 major districts of Chongqing. It covers an area of 1825 square meters, has jurisdiction over 14 towns and 8 streets, and has a population of 1 million, characterized by typical territory of the large city and large countryside. In recent years, with the rapid economic development of the city, the health undertakings of Banan have developed swiftly. Construction of public health system and health clinics in towns is strengthened continuously, and community health agencies are expanding from the city to the countries gradually. Meanwhile, the health level of rural and urban citizens has improved to a large extent. With the rising construction of medical institutions of different levels, how to monitor and improve the quality of medical work and put national policies and measures on nosocomial infection control has become one of the major tasks of the centers for disease control and prevention.ObjectiveThe purpose of the thesis is to observe the situation of the environmental microorganism control and nosocomial infection in medical institutions of Banan District and analyze the weak link in hospital disinfection and infection control so as to provide decision basis for prevention and control of nosocomial infection.Method1. Case analysis of nosocomial infection:Taking a hospital with regional representative as the object, the author collects the case load of nosocomial infection in this hospital, kinds of pathogenic bacteria and drug resistance of major pathogenic bacteria from 2011 to 2013, compares the difference in infection case constitution in terms of different time, departments and parts so as to analyze and describe the pathogen types and drug resistance of nosocomial infection.2. Quality analysis of environmental sample microorganism control:Taking all medical institutions in Banan District as objects, the author collects the testing result data of environmental monitoring samples from the monitoring institution from 2003 to 2012. Relevant sample collection derive from indoor air, object surface, hands of medical staff, disinfectant in use and pressure team sterilizer. According to the requirements of Technical Standard For Disinfection and Hygienic Standard For Disinfection In Hospital, detection and quality evaluation is carried out. Relevant data is classified according to different years, months, levels (district-level medical institutions, health clinics in towns, village clinics, and private clinics), property (public or private) and sample types and the distribution law of unqualified test data is compared.3. Analysis of the weak link of nosocomial infection control:This is done based on the research purpose as well as the method and steps of qualitative research. According to the level, scale, property and distribution of medical institutions, representative related medical staff are selected to carry out individual and group interview. Based on information saturation, certain number of people is included into the survey. By mapping out investigation outline and doing deep interviews, the author tries to know about the organization structure, personnel level and work implementation on sterilization of the medical institutions. And with the theme frame analysis method, the author analyzes the weak link in this work field.Results1. Occurrence trend and characteristic of pathogen types of nosocomial infection in a hospital of Banan① Distribution characteristics of infection casesFrom 2011 to 2013, there are totally 1216 cases of nosocomial infection, the total nosocomial infection rate is 1.18% and the nosocomial infection rate of the three years is respectively 1.17%,1.18% and 1.19%, the difference of which isn’t of statistical significance (χ2=0.070,P>0.05); the nosocomial infection rate difference in different departments has statistical significance (χ2=264.486,P<0.05), whose ranking order is as follows:surgery (2.03%), internal medicine (1.35%), obstetrics (0.88%), gynaecology (0.74%),paediatrics (0.47%) and ophthalmology and otorhinolaryngology (0.21%); the component ratio of major infection parts among the nosocomial infection cases are successively lower respiratory tract (34.83%), upper respiratory tract (15.57%), urinary tract (11.32%), gastrointestinal tract (9.39%), shallow notch (8.83%) and skin soft tissue (7.38%).(2) Pathogen characteristicsWithin the three years,386 pathogenic bacteria are totally detected, which mainly centers on gram-negative bacteria (75.13%),and gram-positive bacteria is 23.06%, and the fungus is 1.81%; it is detected that the top 5 pathogens with the most bacterial strains are respectively escherichia coli (23.32%), staphylococcus aureus (12.95%), pseudomonas aeruginosa (11.66%), Klebsiella (11.14%) and Acinetobacter (9.33%); the five major pathogenic bacteria all have resistance to multiple antibacterial agents. Ranked according to over 30% drug resistance of pathogenic bacteria, they are respectively escherichia coli (10 types), Acinetobacter (8 types), klebsiella (7 types), staphylococcus aureus (4 types) and pseudomonas aeruginosa (1 type).2. Distribution difference analysis of qualification rate of environmental microorganism monitoring samples in medical institutions of Banan District① Distribution characteristics of timeThe total number of monitoring samples in medical institutions of Banan District from 2003 to 2012 is 30303, whose total qualification rate is 81.36%. from 2003 to 2012, the number of monitoring samples in each year is respectively 2413 (qualification rate 67.59%), 2479 (qualification rate 74.99%),2591 (qualification rate 75.34%),2972 (qualification rate 78.90%),3032 (qualification rate 76.15%),3372 (qualification rate 83.19%),2623 (qualification rate 87.34%),3873 (qualificationrate 85.41%),3479 ((qualification rate 88.13%) and 3469 (qualification rate 89.05%). The difference in qualification rate of different years has statistical significance (χ2=847.421, P<0.05). The annual qualification rate is on the increase (χ2 trend=765.917, P<0.05).The qualification rate of different months is respectively 2.73%,86.59%,83.64%, 80.00%,88.78%,80.97%,76.67%,73.08%,81.84%,76.68%,82.49% and 80.57%, whose difference has statistical significance (χ2=240.775,P< 0.05). Among all months, the qualification rate of May is the highest, and that of January is the lowest.② Distribution characteristics of different placesThere are 7269 indoor air samples, whose qualification rate is 57.79%; there are 7395 object surface samples, whose qualification rate is 86.92%; there are 9325 samples of medical staff’s hands, whose qualification rate is 85.81%; there are 5597 disinfectant samples in use, whose qualification rate is 96.75%; there are 717 biological monitoring samples of pressure steam sterilizer, whose qualification rate is 84.94%. the difference in qualification rate among different items has statistical significance (χ2=3815.086,P<0.05). Among the five different disinfection monitoring items, the qualification rate of every two items is compared and it is found that indoor air and disinfectant in sue both have statistical significance with the qualification rate of the other four items (P<0.05), while the sample qualification rate among object surface, medical staff’s hands and pressure steam sterilizer is not of significant difference (P>0.05). Among the five items, the qualification rate of indoor air is the lowest, and that of the disinfectant in use is the highest.Within the ten years, the number of monitoring samples of district-level medical institutions, health clinics in towns, village clinics and private clinics is respectively 8047 (qualification rate 95.95%),3674 (qualification rate 90.20%),10225 (qualification rate 71.28%) and 8357 (qualification rate 75.77%). The qualification rate difference among the four kinds of medical institutions of different levels has statistical significance (χ2=2176.667,P<0.05). Comparison among groups (institutions of different levels) still has significant difference. The total qualification rate of public and private medical institutions is respectively 83.16% and 77.11%, which is of statistical significance (χ2=153.342,P< 0.05). The qualification rate of the disinfection monitoring samples in public and private medical institutions is on the increase year by year (χ2 trend=353.260, P<0.05;χ2 rend =442.609, P< 0.05).3. Analysis of the weak link of nosocomial infection control and disinfectionThe qualitative research information shows by 2014, there are totally 611 medical institutions in the whole district, among which there are 20 district-level medical institutions, 18 health clinics in towns,354 village clinies and 219 private clinics; in recent years, the number of village clinics, private clinics and hospitals is increasing rapidly; the hospital management in public district-level medical institutions is better than that in other medical institutions. In the whole district, there are only 11 medical institutions equipped with standard supply rooms, among which 6 are district-level public hospitals,2 private hospitals, and 3 health clinics in towns; there are only 4 medical institutions equipped with special health infection department and specially-assigned person management, all of which are district-level public hospitals. And so far, those that can independently disinfection quality are mostly district-level public hospitals. The research of frame analysis shows the core problem of hospital infection control and disinfection among all medical institutions is the weak management. The sub-theme involves incomplete institutions, incomplete supervision mechanism, no reserve of talents and cultivation measures.Conclusion1. In recent years, the monitoring data of nosocomial infection in medical institutions of Banan District basically presents a good tendency. The nosocomial infection rate is lower than national standards, and the qualification rate of environmental microorganism monitoring is on the increase year by year. It generally indicates that the control over nosocomial infection in existing medical institutions has achieved certain effect.2. Under the current operation mechanism, some targeted measures and technology must be carried out in some important links to further improve the level of nosocomial infection control for the purpose of reducing nosocomial infection rate of surgical patients, reducing the nosocomial infection of respiratory tract as well as reducing the increasingly serious problem of pathogenic bacteria’s drug resistance to antibiotics. Introduction of advanced hospital disinfection, sterilization technology and methods can help improve the control effect of environmental microorganism.3. With the rise of medical construction within the district, the weak management of nosocomial infection control is a potential medical risk, which is urgent for some departments to make decisions on institution building, monitoring management and talent cultivation.