Analysis On Nosocomial Infections Of General ICU In A County-level Hospital

Background and purposeWith the development of medical technology， the route of transmission，susceptiblepopulation and source of nosocomial infections in ICU had taken place.So a long-termwork has been waged for the monitoring，prevention and treatment of ICU nosocomialinfections to understand accurately the change trend，infection site distribution，pathogenic bacteria distribution and drug susceptibility of NI in ICU，so that effectivemeasures could be taken to prevent and control the infections， and finally achieved thepurpose of improving the quality of medical care. The objective of this research was acomprehensive second-level first-class hospital.The characteristics of which is that thereare more elderly patients and less severe and complicated cases compared with the otherbigger hospitals.By looking through all the inpatient cases during January2012toDecember2012， I researched and analysised the nosocomial infection monitoringindicators and results， pathogenic bacteria distribution and antimicrobial spectrum for thepurpose of getting a comprehensive understanding of ICU nosocomial infections.Methods1. Collection of information:I searched and consulted all the ICU inpatient casesduring January2012to December2012in a local hospital，with the collection of patients’basic information (age， gender， etc.)， operation or not， use of medicine， length ofhospital stay，discharge time，hospital acquired infections，pathogenic bacteria and drugsensitivity， etc.2. statistical analysis：Information was collected and typed into the EXCEL2003，and was analyzed by using SPSS19.0software. 3. Separation and identification of pathogenic bacteria:According to MicrobialLaboratory Procedures，the clinical samples were cultured by automatic microbiologicalassay/drug sensitive test system which was produced by French Biological MerryAngstrom Company. The results were judged according to CLSI Standard，by using drugsensitive paper and board u produced by the UK OX Company. And used standard strainfor quality control at the same time. Quality control strains were pseudomonasaeruginosa ATCC27853， escherichia coliATCC25922and staphylococcus aureusATCC25913.Results1. Incidence of nosocomial infections: After analysising all the1892ICU inpatientscases during January2012to December2012by using the method of targeted monitoring，the results was that，the incidence of ICU nosocomial infections was2.59%， total days ofICU hospitalizaiton was8103days and daily infection rate was1.66‰， with the averageseverity of3.65.2. Constituent ratio of NI site: The major site was urinary tract，accounted for55.55%，followed by lower respiratory tract (15.87%).3. Different diseases had different incidence of NI: The cerebrovascular diseaseshad the highest infection rate，accounted for (20.89%)，followed by lung diseases (15.02%)and the respiratory diseases(13.24%).4. Influencing factors:The ICU nosocomial infection rate was affected by gender，lenth of stay in hospital，disease condition and invasive operation， and the difference ofage had statistical significance.5. The targeted monitoring results of invasive operation related nosocomialinfections:Catheter utilization rate was74.55%， catheter related urinary tract infectionrate was5.79‰； Central venous cannula utilization rate24.46%， central venouscorrelation blood infection rate was1.01‰；Breathing machine utilization rate was11.48%， breathing machine correlation pneumonia was4.30‰.6. Pathogenic bacteria distribution: A total of126strains of pathogenic bacteriawere isolated，including46strains of gram-positive bacteria，68strains of Gram negativebacteria and12strains of fungi. The detection rate of gram-negative aerobic bacteria was53.5%， that of gram positive aerobic bacteria was36.5%and the rate of fungi was10%.In gram-negative bacilli，escherichia coli bacteria detection rate was the highest (35.41%)， followed by acinetobacter baumannii， pseudomonas aeruginosa， haemophilusinfluenzae and klebsiella pneumoniae， respectively accounted for15.08%，15.08%，10.82%，6.72%.In garm-positive coccus， Staphylococcus aureus isolation rate was thehighest（37.99%），followed by the epidermis staphylococcus (15.20%)， streptococcuspneumoniae (12.75%)，enterococcus faecium (6.86%).7. Medicine sensitive situation: In1892cases of hospitalized patients，there were850cases of using antibiotics，with the rate of44.9%，and219cases were used for thepurpose of prophylaxis，accounted for25.81%，while631cases were used for curingdisease，accounted for74.19%. The number of using levofloxacin is217cases，with thehighest rate of utilization. The results of drug susceptibility showed that the sensitivity rateof gram-negative bacilli to imipenem and piperacillin was more than90%，and that tocephalosporins was about50%.The highest sensitive antibiotics of pseudomonasaeruginosa was piperacillin (100%).In gram-positive cocci， sensitive rate ofstaphylococcus aureus to vancomycin was97.81%，to tigecycline was100%；and that ofstreptococcus pneumoniae to vancomycin and levofloxacin was100%.8. The constitution of Multiple drug-resistant bacteria (MDRO):The isolationnumber of Multi Drug Resistent Organisms(MDRO) was149people，190cases in2012.The G-bacteria was112cases， accounted for59.56%， G+bacteria was78cases，accounted for40.44%.In G-bacillus，there were56cases of escherichia coli (ESBL+)，28cases of klebsiella pneumonia bacteria (ESBL+)，12cases of acinetobacter baumannii(MDR)，7cases of proteus mirabilis (ESBL+) and4cases of pseudomonas aeruginosa(MDR)，etc. As for the G+bacteria， there were32cases of staphylococcus epidermidis(MRS+)，16cases of methicillin resistant staphylococcus aureus (MRSA)，12cases ofaureus hemolysis (MRS+)，10cases of methicillin resistant staphylococcus hominis and8cases of others.Conclusions1. The incidence rate of ICU nosocomial infections was2.59%， total days of ICUhospitalizaiton was8103days and daily infection rate was1.66‰，which was lower thanthe other hospitals.2. The major infection site in ICU was urinary tract and respiratory tract and themajor infection pathogen was gram-negative bacteria.And the patients who had cerebrovascular，lung or respiratory diseases should be monitored as focus.3. Male patients had higher infection rate than the famale(P<0.05).Along with thegrowth of age，the condition of disease and the length of hospital stay， the infectionrate is higher (P<0.05).4. Compared with the data announced by NHSN of US in2009， invasive operationrelated nosocomial infections rate in our ICU was in the middle position.5. Gram-negative aerobic bacteria was the major pathogen of nosocomial infection，next is gram-positive aerobic bacteria. The antibiotic sensitivity of ESBLs，MRSA andMRSCON is generally low.6. The antibiotic use of this hospital was more normative，according to NosocomialInfections Management Standard.