A Cross-sectional Study On Healthcare-Associated Infections In Public Medical Institutions In A District Of Shanghai

Objective:Depicting distributions of Healthcare-associated infections(HCAs)of public medical institutions in a District of Shanghai,from different time points and different institution levels,and analyze reasons,so as to provide scientific basis for regulators to manage HCAs control and prevention.Methods:1.Prevalence survey of HCAs:Cross-sectional surveys were conducted through combination of bedside investigation and medical record revising by the given days of Quality Control center for HCAs in Shanghai on all hospitalized patients of all public medical institutions in a District of Shanghai,collecting information like basic situation,infection situation,risk factors,antimicrobial usage.2.Statistical analysis:Using frequency,percentage,line graph,circular graph,percentile graph,et al,to do descriptive analysis.Using Pearson chi square test,Fisher exact probability method to compare rate,composition ratio.Using chi square trend test to analyze whether rates are stratified.Using Spearman correlation,contingency table analyze correlation.Results:1.The prevalence rates of HCAs of 2013-2017 in first-level medical institutions were 6.28%,5.30%,5.07%,5.72%,6.34%(χ~2=1.529,P=0.822)respectively,second-level 2.33%,2.10%,2.43%,2.56%,2.55%(χ~2=1.978,P=0.740),third-level1.72%,1.33%,1.96%,1.65%,1.56%(χ~2=2.799,P=0.592).The higher the level of medical institution,the lower the prevalence rates of HCAs(χ~2=131.976,P=0.000).2.The total number of HCAs cases of 2013-2017 in first-level medical institutions was 184,the top three constituent ratio were lower respiratory tract,urinary tract and upper respiratory tract,second-level 402,the top three were lower respiratory tract,upper respiratory tract and urinary tract,third-level 203,the top three were lower respiratory tract,other sites and upper respiratory tract.Lower respiratory tract was the top HCAs site in 5 years,and showed a downward trend,upper respiratory tract showed a upward trend.3.The total number of HCAs pathogens of 2013-2017 in first-level medical institutions was 8,second-level 165,third-level 165,Each level medical institutions’main pathogen was Gram-negative bacteria.Gram-negative bacteria was the top HCAs pathogen in 5 years,and showed a downward trend,Gram-positive bacteria showed a upward trend,fungus showed a downward trend.4.The prevalence rates of HCAs of 2013-2017 among department of medicine,surgical department,obstetrics and gynecology,pediatrics,comprehensive ICU,facial features and other departments were 2.30%,2.36%,0.16%,0.00%,17.14%,0.00%,2.67%,respectively.The prevalence rates of HCAs of department of medicine showed a upward trend,surgical department,other departments showed a downward trend.5.The utilization rates of antibiotics of 2013-2017 in first-level medical institutions were 7.57%,5.30%,5.38%,6.96%,7.88%(χ~2=6.121,P=0.190)respectively,second-level 19.78%,30.90%,32.56%,31.49%,34.41%(χ~2=200.612,P=0.000),third-level 38.50%,37.23%,43.63%,43.60%,44.12%(χ~2=34.690,P=0.000).The higher the level of medical institution,the higher the utilization rates of antibiotics(χ~2=1447.583,P=0.000).The top constituent ratios were therapeutic use and single usage.Percentages of specimens sending of first-level,second-level,third-level medical institutions were 7.25%,56.31%,80.09%respectively(χ~2=706.161,P=0.000).The prevalence rate of HCAs was negatively correlated with the utilization rates of antibiotics and percentages of specimens sending respectively(r_s=-0.829,P=0.000;r_s=-0.842,P=0.000).Conclusions:1.The overall prevalence rates of HCAs in this district in 2013-2017 didn’t change,which means this area did a good job in control and prevention of HCAs.The higher the level of medical institution,the lower the prevalence rates of HCAs.2.Medical institutions of each level should intensively monitor the lower respiratory tract,urinary tract and the upper respiratory tract.3.Strengthening rational usage of antimicrobial can reduce the incidence of HCAs.