The Current Situation And Risk Factors Of Nosocomial Infection Among Patients Undergoing Colorectal Surgery

Objectives By using of objective monitoring of nosocomial infection among patients with colorectal surgery, we aimed to understand the current situation of nosocomial infection and to determine risk factors behind it in order to make recommendations for the prevention of surgical site infections in patients with colorectal surgery.Methods By using of cluster sampling methods, we selected all patients with colorectal cancer surgery who were admitted to a Surgery in General ward in a tertiary hospital of Shandong Province during the period of 1st January 2015 and 31st December 2015. The contents of study included two aspects:(1) Current situation of nosocomial infection in patients undergoing colorectal surgery; (2) Study on risk factors of surgical site infection in patients with colorectal surgery:filling in the self-designed questionnaire named "Study of the current situation and risk factors of nosocomial infection in patients with colorectal surgery". Information were inputted into spss 19.0 (statistical package for social sciences, version 19.0) for further statistical analysis. The discription of general information used Average±Standard Deviation, Median, Interquartile Range, Rate, Proportion and so on; Analysis of risk factors of surgical site infection used nonparametric tests, Chi-square test, univariate and multiple Logistic regression analysis.Results1.448 eligible cases were included, including 265 men (59.2 per cent) and 183 female (40.8 per cent). The age of the patients ranged from 23 to 92 years, average age was 59.84±12.83 years. There were 172 patients with colon cancer surgery and 276 patients with rectal cancer surgery, meanwhile 123 patients with laparoscopic surgery and 323 patients with open abdominal surgery.2.45 cases with 48 episodes occurred nosocomial infection, the rate of nosocomial infection was 10.04 per cent, the incidence of nosocomial infection cases was 10.71 per cent, and density of nosocomial infection was 4.78 per thousand, surgical site infection rate was 4.91 per cent. Locations of nosocomial infection included:Surgical Site Infection (Proportion,45.83 per cent), Lower Respiratory Tract Infection (Proportion,35.42 per cent), Urinary Tract Infection (Proportion, 10.42 per cent), Upper Respiratory Tract Infection (Proportion,6.25 per cent) and Digestive Tract Infection (Proportion,2.08 per cent).3. In total, there were 18 infectious samples tested, with a testing rate of 37.5 per cent. Submission sites include pus culture in 6 cases,4 cases sputum culture, followed by ascites culture, fecal culture and so on. A total of 20 strains were detected, including 11 strains of Gram-negative bacteria (G- bacteria), constituting 55.00 per cent and 9 strains of Gram-positive bacteria (G+ bacteria), accounting for 45.00 per cent. The most often detected G- bacteria was Escherichia coli and G+ bacteria were Streptococcus viridans and terads.4. In single factor analysis of risk factors of surgical site infection in patients with colorectal surgery, the indicators with statistical significance included:age, hospital stays, the duration of the operation, the duration of anesthesia, whether laparoscope, NNIS, the duration of drainage, anastomotic fistula, the duration of preoperative use of antibiotics, the content of total protein, albumin, white blood cell count and the percentage of neutrophils on the 5th day after the operation, albumin on the 8th day after the operation, urine output, infusion input, crystal solutions input and colloidal solution input during operation, the days of starting ordinary diet, preoperative use of drugs for bowel preparation, body temperature during the first three days after operation.5. According to multivariate logistic regression analysis, risk factors for surgical site infection in patients with colorectal surgery included duration of the surgery, hospital stays, body temperature on the 1st day after operation, white blood cell count on the 5th day after operation, the days of starting ordinary diet. These factors were independently associated with the occurrence of surgical site infection in patients with colorectal surgery.Conclusions High rate of nosocomial infection was observed in patients undergoing colorectal surgery. Independent risk factors for surgical site infection were duration of the surgery, hospital stays, body temperature on the 1st day after operation, white blood cell count on the 5th day after operation, the days of starting ordinary diet. If conditions permit, medical personnel should shorten the time of surgery and hospitalization stays of patients as much as possible, arrange early ordinary diet with oral for patients. By body temperature on the 1st day and white blood cell count on the 5th day after operation, medical staff could forecast or auxiliary diagnose of nosocomial infection, aiming to take effective measures to reduce the incidence of surgical site infection.