| BackgroudNosocomial infection refers to infections acquired in hospital for patients, including infections during hospitalizations or acquired during hospitalization but onset after discharge.It does not include the case which has been in the incubation period for the infection at or prior to hospital admission. Infection of hospital staff acquired in hospital belongs to Nosocomial. In recent years, with the increasing risk factors such as application of immunosuppressants, irrational use of antibiotics, increased incidence of infectious diseases, hospital infection not only affects the quality of medical care and medical safety, also causing a huge waste of medical resources. Prevention of hospital acquired Infection has become a matter of CDC and healthcare facilities. Implementation of hospital infection monitoring is an important basis for controlling hospital acquired infection.ObjectiveTo establish a nosocomial infection surveillance system in the military healthcare facilities, to design an information surveillance system network platform based on a real-time automatic transfer of nosocomial infection data, to improve level of informatization and the timeliness of nosocomial infection survellance. Cross-sectional survey was conducted to understand the situation of hospital acquired infection in military hospitals and to standardized network survellance, and to provide data for improving the quality and setting the target of nosocomial infection control.Methods1. Development of military nosomical infection surveillance network information system.Using system requirements analysis, compare survellance systems from China and other countries, and analyze the module design, data item selection, workflow design. Relying on military integrated information network platform, to use B / S architecture developed centralized network architecture, and to develop hospital infection surveillance network information system, using SQL Server 2000 to deploy the system database.2.Surveillance of nosocomial infection casesSurveillance of nosocomial infection was conducted during March 1, 2014 to November 30, 2014. The data collected included patient’s information, information on hospital infection, hospital infection pathogens, risk factors, use of antimicrobial agents, discharged situation and other. Data was reported by automatic pilot or online reporting through logining "Military Hospital Infection Surveillance Network Information System".3.Cross-sectional survey of nosocomial infectionSurvey was conducted during November 1, 2014 to December 31,2014,collected the information of nosocomial infection, pathogens and use of antibiotics who admitted to hospital during 0:00 to 24:00 prior to the survey day(which is called the survey date)(including discharged patients during thesurvey day, except patients admitted on survey day). Complete questionnaire and other form by logining the survey system, and completedata statistical analysis.Result1. Military Nosocomial Infection Surveillance System include network real-time automatic monitoring and construction for monitoringplatform. The basic condictions include information transmission equipment within the hospital network and external, unified and standardized nosocomial infection surveillance reporting format, also information monitoring and management systems.The main functions include: automatic data push capabilities, case report cards, monthly forms and outbreaks reports, decision support and early warning function.2. During March, 2014 to May, 2014,71 hospitals reported 17427 cases of nosocomial infections on the surveillance network. 67 hospitals reported 398 monthly reports. No outbreak was reported. Main infections were lower respiratory tract infection(40.9%), upper respiratory tract infection(16.8%), urinary tract infection(14.5%), blood infections(7.2%) and surgical site infections(6.3%).The most common sections of the report were cadres ward(10.7%), neurosurgery(10.4%), hematology(7.6%), neurology(6.3%), general surgery(6.2%) and oncology(5.4%). The first six pathogens hospitals reported infections : Pseudomonas aeruginosa(n=1686, 13.1%), Klebsiella pneumoniae(n=1623, 12.6%), Escherichia coli(n=1614, 12.5%), Acinetobacter baumannii(n=1479, 11.5%), Staphylococcus aureus(n=989, 7.7%) and Candida albicans(n=585, 4.6%), accounting for 62.0% of all isolated pathogens. The top five multi-drug resistant bacterias are gram-negative bacteria producing ESBLs(n=710, 20.9%), multi-drug resistant Pseudomonas aeruginosa(n=640, 18.8%), resistant to carbapenems Acinetobacter baumannii(n=599, 17.6%), methicillin-resistant Staphylococcus aureus(MRSA)(n=480, 14.1%) and carbapenemresistant Enterobacteriaceae(n=203, 6.0%), accounting for five of pathogens resistant to all isolates 77.4% drug resistant pathogens.3. 52 military hospitals participated the cross-sectional survey of military nosocomial infection in 2014, and reported data in accordance with the requirements of the survey. 47(90.4%) are third-grade class-A hospital hospitals, 50(96.2%) are general hospitals. A total of 53,939 patients hospitalized were inverstigated, including 1998 cases of nosocomial infection, the overall prevalence rate was 3.7%; 8545 cases of community acquired infections, the overall prevalence of community acquired infection was 15.8%. Among the 53,939 patients surveyed, there were 23119 males and 30820 females, respectively, their proportions were 42.9% and 57.1%. The prevalence of nosocomial in male patients was 5.8%, higher than females of 2.1%(P <0.001). Higher prevalence rates of nosocomial infection were reported in patients with 90 years and older, 80-89 years and 70-79 years, their prevalence were 13.0%, 7.5% and 4.5%, respectively. The noscomial infection prevalence in patients of 20-29 age group was the lowest(2.4%). The prevalence of community acquired infection in patients of 0 and 1-9 years group were the highest(50.8% and 43.1% respectively). The number of military and other personnel surveyed were 3725(6.9%) and 50,214(93.1%). The prevalence of nosocomial and community acquired infections in Military personals were 7.8% and 21.0%, respectively. In other staff, the prevalence of nosocomial and community acquired infections were 3.4% and 15.5%, respectively.. 1998 cases of nosocomial infections reported 2182 number of cases, the top three types of infection were 1029 cases of lower respiratory tract infection times(47.2%), 268 cases of urinary tract infection(12.3%) and 240 cases of upper respiratory tract infection(11.0%), these three infections accounted for 70.4% of all reported cases; The number of ventilator-associated pneumonia, catheter-related urinary tract infections and central catheter-related bloodstream infections were 79 cases(3.6%), 78 cases(3.6%) and 16 cases(0.7%), accounting for 7.9% of all hospital infections. The prevalence rate of nosocomial infection in hospital with more than 2000 beds was 4.7%, higher than that in hospital with less than 2,000 beds(P <0.001). A total of 18,206 cases(33.8%) of patients reported use of antimicrobial agents, including therapeutic, prophylactic and "therapeutically and preventive" purpose of use, respectively, their numbers were 10,401 cases(57.1%), 6289 cases(34.5%) and 1516 cases(8.3 %). Among 11,917 cases of patients with the therapeutic use of antibiotics, 4819 cases(40.4%) and 1723 cases(14.5%) before the start of treatment and after treatment was started microbial inspection respectively,, 5375 cases(45.1%) were not microbial inspection. 1998 cases of patients with nosocomial infection in 1015 cases(50.8%) patients reported the detection of various types of pathogens(n=1369), the top five most common hospital pathogens were Pseudomonas aeruginosa(206), Acinetobacter spp.(172), Klebsiella pneumoniae(160), Escherichia coli(145) and Staphylococcus aureus(110), accounting for 57.9% of all reported pathogens, the most common fungal pathogen was Candida albicans(57). The top five important resistant bacteria were carbapenem-resistant Acinetobacter, carbapenem resistant Pseudomonas aeruginosa, Klebsiella pneumoniae resistant to third generation cephalosporins bacteria, methicillinresistant Staphylococcus aureus and Escherichia coli resistant to third generation cephalosporins, accounting for 96% of all reported drug-resistant pathogens. Use of urinary catheter, intravenous catheter, ventilator, tracheotomy accepted risk factors hemodialysis and surgery were significantly associated with the presence of nosocomial infections(P <0.001). The median length of stay for nosocomial infection patients was 19 days, much higher than eight days for the patients without nosocomial infection(P <0.001). Prophylactic use of antimicrobial agents was protection factor for nosocomial infection in patients during hospitalization.Conclusion1. The development and application of military nosocomial infection surveillance network information system information system achieved direct reporting of nosocomial infection for the first time the military hospitals, improved the reporting timeliness and level of information, it will help to reduce hospital infection surveillance costs and facilitate management of hospital infection.2. A tertiary military nosocomial infection surveillance system based on three different levels has been established, it is very important for the management of nosocomial infection data and impovement of nosocomial infection control.3. Comparison of nosocomial infection surveillance and cross-sectional survey in 2014 showed that the distribution of main types of nosocomial infections and pathogens was nearly the same. The study acquired the prevalence data of nosocomial infections for the first time, demonstrated the the main types of nosocimial infections, the leading pathogens and risk factors, It imporved our understanding of epidemilogy of miltary nosocomial infection and standerdization of web-base nosocomial infection surveillance, provided many evidence for the continuous improvement of the quality and setting the targetof nosocomial infection prevention and control. |
PDF Full Text Request