| Objectives To evaluate the effects of the evidence-based quality improvement program on reducing the incidence of nosocomial infection(NI)in preterm infants with gestational age <34 weeks of neonatal intensive care unit(NICU)and investigate the risk factors for nosocomial infection so as to provide evidence-based guidance for prevention and control of nosocomial infection.Methods Preterm infants with gestational age <34 weeks discharged from the NICU from May 2015 to April 2018 are prospectively selected as subjects.Clinical information related to nosocomial infection of those enrolled infants was collected through a standarized database.The baseline data collection period,from May 2015 to April 2016,is defined as the first year.The implementation period of the quality improvement program,from May 2016 to April 2017 and from May 2017 to April 2018,is defined as the second year and the third year.The program includes strengthen hand hygiene,ventilator management,central venous catheter care,and strictly control antibiotic utilization.According to the presence or absence of nosocomial infection during the hospital stay,the recrutied infants were divided into NI group and non-NI group.According to the study year,the NI rate,the type of infection,pathogen distribution and drug resisitant,clinical outcome,the antibiotic utilization and other date were comparatively analyzed in the study.Univariate analysis and binary logistic regression analysis were used to investigate the risk factors of nosocomial infection.Results 1.A total of 1 193 preterm infants with gestational age <34 weeks were included in the study,including 387 in the first year,372 in the second year,and 434 in the third year.There were 185 cases in the NI group and 1008 cases in the non-NI group.There were 208 episodes of nosocomial infection in 185 infants.The overall incidence of NI was 17.44%(208/1 193),and The incidence density was 7.30 per 1 000 patient days(208/28 518).During the three-year study period,the incidence of NI decreased gradually each year(24.29% vs 18.28% vs 10.60%),and the difference was statistically significant(P =0.000).The NI rates per month showed a downward trend.The mean NI rates per month in the three years was statistically significant(P=0.000).There was a statistically significant difference in the NI rates between different gestational age groups and different birth weight groups(P=0.000).2.The most common types of NI during the study were clinical sepsis(28.8%,60/208),pneumonia(27.4%,57/208),and laboratory confirmed sepsis(22.1%,46/208).There was no significant difference in the proportion of NI types in the 3 years(P>0.05).The incidence of ventilator-associated pneumonia was 16.75/1 000 mechanical ventilation days,and the incidence of catheter-related bloodstream infection was 0.82 per 1 000 central venous catheterization days.Totally 98 strains of pathogen were isolated from the pramature infants with NI,of which 62.28%(63 strains)were Gram-negative bacteria,31 strains,accounting for 31.63%,were Gram-positive bacteria and 4.08%(4 strains)were fungi.Klebsiella pneumoniae is the most common pathogen(48.98%,48/98).The proportion of Kp strains per year showed a downward trend,and the difference was statistically significant(P=0.006).The drug sensitivity test of Kp showed that the resistance rate to β-lactam antibiotics was over 95%,the resistance rate to imipenem and meropenem was 60.4%,and the sensitivity rate to aminoglycosides and quinolones was over 50.0%,absolutely sensitive to minocycline and tigecycline.3.The cure rate of NI group was 79.5%(147/185).The poor prognostic rate of NI group was 16.2%,with significant difference in comparison with the non-NI group(4.8%,P=0.000).The hospital stay of the NI group was longer than that of the non-NI group [37(27,27)d vs 18(12,27)d],the difference was statistically significant(P=0.000).The proportion of premature infants with NI who were cured or improved was increased year by year,and the proportion of infants with death was gradually reduced.There was no significant difference in all types of outcomes(P>0.05).4.The proportions of male gender,gestational age ≤31W,birth weight ≤1 500 g,small for gestational age,cesarean section,birth asphyxia,gestational hypertension,application of mechanical ventilation before infection,the use of peripherally inserted central venous catheters and being exposed to antibiotics bofore onset in the NI group were higher than those in the non-NI group and the differences were statistically significant(P<0.05).In multivariate logistic regression analysis,it showed that male gender(OR=1.843,95% CI 1.281~2.653),gestational age ≤31W(OR=1.923,95% CI 1.242~2.976),birth weight ≤1500g(OR=2.477,95% CI 1.520)~4.037),small for gestational age(OR=1.597,95% CI 1.018~2.506),birth asphyxia(OR=1.965,95% CI 1.355~2.850)and gestational hypertension(OR=1.596,95% CI 1.046 ~2.433)were independent risk factors for nosocomial infection in preterm infants with gestational age <34 weeks(P<0.05).5.The antibiotic utilization(days of antibiotic therapy per 1 000 patient days)per month showed a downward trend in the whole three years,and the mean difference was statistically significant(P=0.023).Conclusions The evidence-based quality improvement program have positive effects on reducing the incidence of nosocomial infection in infants with gestational age <34W in NICU.Further apply and investigations on current quality improvement practices are needed to improve the quality of treatment of preterm infants.Male gender,gestational age ≤31W,birth weight ≤1500g,small for gestational age,birth asphyxia and gestational hypertension were independent risk factors of nosocomial infection. |
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