Study On Nosocomial Infection Risk Among Inpatients In Hematology Department

Central venous catheterization is widely used in clinical puncture technology.It has advantages of small wound,to avoid repeated puncture of the peripheral vein,can be visualized in the ultrasound-guided catheter,the catheter can reach the end vena cava,lumen blood flow,the drug infusion after rapid dilution and reduce the stimulation of blood vessels,etc.Therefore Central venous catheterization are the most commonly used intravenous infusion in the treatment of hematologic inpatients requiring long-term high-dose intravenous chemotherapy,intravenous nutrition support,hematopoietic stem cell fluid transfusion,blood product infusion,and anti-rejection drug infusion way.Due to chemotherapy,hematopoietic stem cell transplantation,the hospital patients in hematology department are often in the situation of hematopoietic and immune dysfunction,the higher the risk of hospital infection.So they are the focus of hospital infection surveillance crowd.In recent years,the study on the risk factors of nosocomial infection in hematological patients has been increasing.Among the risk factors,Central venous catheterization is invasive operation,damage to the integrity of the skin may make the environment in the ward pathogenic microorganisms through the catheter port into the body lead to increased opportunities for hospital infection.Therefore,it is very important to know whether nosocomial infection is related to central venous catheterization and related catheterization.Therefore,clear Department of Hematology nosocomial infection risk factors of central venous catheter related operation and hospital infection related degree is very important: the theoretical basis,as a clinical screening of high-risk groups,to provide the guide to management of hospital infection,to provide reference value for effective management measures of hospital infection two,for the guidance of the nursing staff;clinical nursing methods of continuous improvement on key links to reduce infection,the incidence of hospital infection as soon as possible.ObjectiveThrough the collection of 2013.01-2014.12 during the blood disease center of a large hospital,all hospital clinical nursing operation and hospital infection in patients with relevant information,and understand the characteristics of nosocomial infection in the Department of Hematology of our hospital hospital related risk factors;risk of further admitted to the Department of Hematology and central venous catheter and related operation association analysis of patients with nosocomial infection,and to investigate the effect of other related hospital sense of risk factors on the results.MethodsThe research object is the total of 7381 patients who were hospitalized for more than 48 hours in the blood disease center of a large third grade hospital during the period of 2013.01-2014.12.According to the hospital records,the central venous catheter care records and hospital infection registration system to collect the relevant clinical data of patients,catheter operation and hospital infection related information.According to the Ministry of Health issued the 2001 "hospital infection diagnosis standard(Trial)" were divided into the infection group and the control group of 12 hospitals were included in the analysis of infection related factors(gender,age,duration of hospitalization,peripheral white blood cell value,absolute value of neutrophils,whether in heart vein catheter,type and the catheter puncture site,whether hematologic malignancies,chemotherapy,corticosteroids or immunosuppressive agents)were analyzed in the distribution difference between the infection group and control group,the difference was statistically significant(P<0.05)variables into the logistic regression model,the risk analysis and hospital infection single factor and multiple factors on the risk factors of nosocomial infections and central venous.Results1 Hospital infection of inpatients in Department of Hematology1.1 Incidence rate of hospital infectionThere were 771 cases(821 cases),and the infection rate was 10.45%(11.12% cases).There were 6026 cases of blood tumor in 7381 cases,721 cases of nosocomial infection(771 cases),the infection rate was 11.96%(the infection rate was 12.77%).1.2 Disease distribution of hospital infectionIn the distribution of disease,771 cases of hospital infection in patients with 721 cases of hematological malignant diseases,including acute leukemia patients with a total of 446 cases(57.85%),the infection rate was 15.84%,among which acute myeloid leukemia infection,283 cases(36.71%),the infection rate was 15.54%;174 cases of patients with lymphoma(22.57%),the infection rate was 9.41%.The infection of non Hodgkin's lymphoma,a total of 159 cases(20.62%),the infection rate was 9.55%;only 53 cases(6.87%)for non cancer patients,the infection rate was 4.60%.1.3 Site distribution of hospital infectionThe main pathogenesis of 2013.01-2014.12 infection in the Department of Hematology,comprehensive hospital,ranks first in a prone position than in the respiratory tract infection(312 cases,38.01%);followed by neutropenia and infection(228 cases,27.77%);185 cases of blood system infection,22.53%(93 cases,11.33% in 75 blood bacteria;septicemia 9.14% cases of catheter-related bloodstream infection;17 cases,2.07%);urinary and reproductive tract infections(28 cases,3.41%);oral infection(22 cases,2.68%);skin and soft tissue infections(16 cases,1.95%);gastrointestinal tract infection(14 cases,1.71%);perianal infection(6 cases,0.73%)other;infection(10 cases,1.22%).1.4 Distribution of pathogens in hospital infection2013.01-2014.12 patients hospitalized in Department of Hematology from various specimens among 226 strains of pathogens,pathogen infection of bacteria,including 126 strains of gram negative bacteria(55.75%),the top 3 are 54 strains of Escherichia coli(23.89%),Klebsiella pneumoniae(12.83%)and 29 strains of Pseudomonas aeruginosa 20 strains(8.85%);53 strains of gram positive bacteria(23.45%),including 18 strains of Staphylococcus epidermidis(7.96%),7 strains of Staphylococcus aureus(3.1%);38 strains of fungi(16.81%),were Candida;virus strain 8(3.54%),with EB virus and cytomegalovirus infection.2 Analysis of the distribution of hospital infection related factors in the infection group and the control groupAnalysis of the factors related to the infection of 12 hospitals were included between groups analysis results show that: in addition to gender has no significant difference(P=0.73),two patients in age,hospitalization days,peripheral blood white blood cell count(WBC),absolute neutrophil count(ANC),pipe,type,tube position whether the blood and catheter system malignant tumor,chemotherapy,corticosteroids or immunosuppressants were statistically significant in central venous catheter(P<0.05).3 Analysis on risk factors of nosocomial infection in patients in Department of HematologyThe risk factors of 7381 patients,7108 patients diagnosed as hematological diseases,6026 patients with hematologic malignancies and 1082 patients with non hematologic malignancies were generally consistent.Univariate analysis showed that age,long hospital stay,the number of white blood cell,neutropenia,use of immunosuppressive agents,corticosteroids,hematological malignancies,chemotherapy and central venous catheter and hospital infection were significantly associated with increased risk.After multiple factor correction,there was a significant association between increased hospital stay and increased hospital stay,low WBC count,granulocyte deficiency,and use of glucocorticoids.4 The influence of central venous catheter and related operation on hospital infectionAll hospitalized patients,diagnosed patients with hematological diseases,blood tumor and non tumor patients and hospital stay less than 28 days in patients with central venous catheter and related operation and hospital infection associated increased risk analysis showed that in the Department of Hematology,only by single factor analysis,accept the central venous catheter for the risk of nosocomial infection was significantly higher than that of non-Manager(P<0.05),but was associated with patient status and treatment and the single factor analysis in the same hospital and other factors were associated with the sense of risk adjusted Association of central venous catheter and hospital infection risk was not significant(P>0.05);with PICC catheter and through basilic vein catheterization at although still with hospital infection were associated with increased risk,but the risk increased significantly.Only in the hospital for more than 28 days of patients results: central venous catheter and hospital infection risk after multivariate correction was significantly increased(OR=1.60,95%CI: 1.04-2.46 Association);the tube type is PICC when the hospital risk is 1.7 times the catheter(OR=1.72,95%CI:,1.07-2.76)tube the basilic vein puncture site for the hospital infection risk was 2.7 times(OR=2.69,95%CI: 1.45-5.02).ConclusionsThe high infection rate of hospitalized patients in Department of Hematology of hospital,there are many risk factors for infection caused by the results of this study indicated that the large hospital department of Hematology hospital main risk factors of nosocomial infection: increased duration of hospitalization,low white blood cell count(WBC<4×109/L),granulocyte deficiency(ANC<0.5×109/L)andglucocorticoid.On the whole,receiving operation of central venous catheterization can cause rising risk of nosocomial infection,but the effect is not as strong as other risk factors.However,for patients with comparatively longer LOS,central venous catheterization may be an independent risk factor of nosocomial infection.