A Cross-sectional Study On Nosocomial Infection In Guizhou Province In2010

ObjectiveA cross-sectional survey on nosocomial infection of hospitals of different levels inGuizhou Province was conducted in accordance with requirements made by the nationaltraining base for nosocomial infection monitoring and management and Guizhou HealthBureau. The study objectives are: to understand the intensity and distribution of nosocomialinfection， and the usage of antibiotics in Guizhou’s hospitals; and to do evidence-basedevaluation on the quality of nosocomial infection control for providing reliable references forhealth authorities to make policies on nosocomial infection prevention and control.MethodsThe cross-sectional survey was adopted to collect data from all inpatients who weretreated in hospital between0:00and24:00on August30，2010in Guizhou. The hospitalsurveyed include all comprehensive hospitals of secondary level or above; the specializedhospitals invited to participate in the study; and the specialized hospitals which voluntarilyparticipated in the study. The diagnostic standards for nosocomial infection used in thestudy are the same as those in "Diagnostic Standards of Nosocomial Infection (tentative)"issued by the Ministry of Health in January2001. The survey contents include the number ofnosocomial infection cases， the distribution of departments with nosocomial infection， thedistribution of parts infected， the types of pathogens， the antibiotic usage， and so on. Thedata were sorted and analyzed by using epidemiological and statistical methods.Results1. General findingds: There were108hospitals which were involved in the study andreport data， including15tertiary hospitals and93secondary ones. The average actual surveyrate in each hospital surveyed was more than96%.29834inpatients should have beeninvestigated， and29358people were surveyed actually with the actual survey rate98.40%. Totally1025inpatients，1063cases with nosocomial infection were reported. The prevalencerate was3.49%， and case prevalence rate3.62%.2. Distribution of nosocomial infection: The comprehensive intensive care unit had thehighest prevalence rate of nosocomial infection (41.03%); The burn surgery unit topped thenosocomial infection prevalence rate in surgical medicine department (11.6%) while thehematology unit in internal medicine department (6.85%). The prevalence rates for secondaryand tertiary hospitals were respectively2.86%and4.41%. The latter was obviously higherthan the former. The lower respiratory tract was the part which was dominantly hit bynosocomial infection， with the infection rate of35.09%.3. Characteristics of pathogens:410strains of pathogens were separated in thenosocomial infection cases， with the isolation rate of38.57%. The pathogens belongedlargely to Gram-negative aerobic bacilli. The top three pathogens isolated were Escherichiacoli， Pseudomonas aeruginosa， Acinetobacter baumannii. The major source of thepathogens was the lower respiratory tract， followed by urinary tract and shallow cut.4. Community infection:7885patients and8188cases were infected with the respectiveinfection rates of26.86%and27.89%. Among the community infection rates， the highestwas in the respiratory group (74.46%)， followed by the non neonatal pediatric group and(71.33%) and infectious disease group (64.84%). The infection rates for secondary andtertiary hospitals were26.91%and26.79%respectively， which were very close. Similarly，the lower respiratory tract was the most infected part among all community infection parts(39.00%).763strains of pathogens were separated in the community infection cases， withthe isolation rate of9.32%. Among the pathogens， the top three were Mycobacteria，Escherichia coli， and Klebsiella. The main source of the pathogens was the lower respiratorytract.5. Antibiotic usage: the total use rate of antibiotics was55.52%. The rate was the highestin the non neonatal pediatric group (86.15%). Most of antibiotics were used for treatmentwhich accounted for51.58%. Only one antibiotic was used， making up60.87%of allantibiotic usage.13.84%of pathogenic samples after antibiotic use were sent for cultivation.67.92%of the samples sent for cultivation were from the comprehensive ICU， higher thanother sources. The antibiotic use rate for secondary hospitals was higher than that for tertiary ones. The cultivation rate of pathogenic samples sent for secondary hospitals was obviouslylower than that for tertiary ones.Conclusions1. The prevalence rate of nosocomial infection in Guizhou province was basically closeto those reported in other places in China. The epidemic intensity differed by hospital level，type of department，and parts where the infection occurred，which suggests that the focus ofnosocomial infection control should be on places with higher infection rates， such as tertiaryhospitals， comprehensive ICU， burn surgery and hematology unit. The special attentionshould be given to the monitoring and control of lower respiratory tract infection.2. The Gram-negative aerobic bacilli were the major pathogens which causednosocomial infection， which implies that hospitals of all levels should build qualifiedlaboratories with corresponding equipment and skills.3. The community hospitals were still faced with a lot of problems of nosocomialinfection， such as the misuse of antibiotics， lack of pathogenic cultivation and communityinfection. Thus， there is need to do further research in order to find problems and makeeffective intervention.