| BackgroundNosocomial infection will exist while hospital exist.The sufferers of nosocomial infection include not only inpatients,but also medical staff,outpatients,escorts and visitors,etc.Nosocomial infection exists in every link of medical activities and causes many losses,such as endangering medical safety,wasting of security resources,destroying the reputation of the hospital,and so on.In the recent years,nosocomial infection control becomes more and more difficult with the development of medical technology and the emergence of new pathogens and drug-resistant bacteria.It is deserved to consider that how we can prevent and control nosocomial infection effectively.Nosocomial infection and the strategies of prevention and control have become important research topics in clinical and preventive medicine.ObjectivesThis study collected the information of inpatients undergoing surgery of a general hospital in Jining from 2012 to 2016.Data were analyzed retrospectively to investigate the morbidity,site,pathogenic bacteria of nosocomial infection,especially in the cases of surgical site infection,in order to find out the relevant factors and provide basis for prevention and control of nosocomial infection of inpatients undergoing surgery,so that to reduce the incidence of nosocomial infections of inpatients undergoing surgery ultimately.Materials and methods(1)The subjects of this study were inpatients undergoing surgery of a general hospital in Jining from 2012 to 2016.(2)Based on'Diagnostic criteria for nosocomial infection(tentative standard)',the information of the subjects was collected and organized by using electronic medical record system.(3)EXCEL software was used to input the data and establish a database.SPSS20.0 software was used for statistical analysis.The incidence of nosocomial infection,nosocomial infection sites constituent proportion,bacteria examination rate,detection rate of multidrug-resistant bacteria and other indicators were used for statistical description.Univariate analysis was performed by chi-square test or t-test.Multivariate analysis was performed by Logistic regression.P<0.05 was considered statistically significant.Results(1)During the period of monitoring,the incidence of nosocomial infection of inpatients undergoing surgery was 1.21%.The main sites for nosocomial infection were surgical site(constituent proportion 37.74%),lower respiratory tract(constituent proportion 20.89%)and upper respiratory tract(constituent proportion 12.93%).The top three departments for the incidence of nosocomial infection were neurosurgery department(5.42%),burn and plastic surgery department(4.40%)and cardiothoracic surgery department(3.13%).(2)During the period of monitoring,the incidence of surgical site infection was 0.46%.Clean surgical incision infection rate was 0.37%,clean-contaminated incision infection rate was 0.50%,contaminated incision infection rate was 1.05%.The top three departments for the incidence of surgical site infections were neurosurgery department(1.52%),cardiothoracic surgery department(1.08%)and orthopedic trauma department(0.97%).(3)Among the 1733 nosocomial infection cases investigated in this study,a total of 5983 pathogenic specimens were sent for examination,among which 1745 were positive specimens.Bacteria examination rate of nosocomial infection was 70.80%,positive rate of pathogenic specimens was 29.17%(1745/5983).A total of 698 positive specimens were isolated from the same patient after repeated isolation,the majority of them was Gram-positive bacteria(506,72.49%).The top five pathogenic bacteria were escherichia coli(175,25.07%),staphylococcus aureus(113,16.19%),pseudomonas aeruginosa(110,15.76%),acinetobacter baumannii(58,8.31%)and enterobacter cloacae(53,7.59%).(4)Among the 698 cases of pathogenic bacteria,there were 202 multidrug-resistant bacteria,and the detection rate of multidrug-resistant bacteria was 28.94%.The strains with the highest detection rate of multidrug-resistant bacteria were staphylococcus aureus(55.75%),acinetobacter baumannii(51.72%)and escherichia coli(44.57%).(5)The results of Logistic regression model showed that male,children,diabetes,long hospital stay,department(neurosurgery department,pediatric surgery department,burn and plastic surgery department)were independent relevant factors for nosocomial infection in inpatients undergoing surgery.(6)The results of Logistic regression analysis showed that male,old people,diabetes,emergency operation,long preoperative hospitliztion were independent relevant factors for surgical site infections in inpatients undergoing surgery.Conclusions and suggestionsConclusions(1)From 2012 to 2016,the incidence of nosocomial infection in inpatients undergoing surgery was lower than that reported by other studies.(2)The most common sites of infections were the surgical sites and the lower respiratory tract.The constituent proportion of upper respiratory tract infections and urinary tract infections was not much different.(3)The main sources of specimens were surgical incision secretions,urine and lower respiratory tract secretions.The first five pathogenic bacteria were escherichia coli,staphylococcus aureus,pseudomonas aeruginosa,acinetobacter baumannii and enterobacter cloacae.The strains with the highest detection rate of multidrug-resistant bacteria were staphylococcus aureus,acinetobacter baumannii and escherichia coli.The conclusions above can provide evidence for the empirical use of antimicrobial agents(4)Neurosurgery department,burn plastic surgery department,cardiothoracic surgery department,orthopedic trauma department,pediatric surgery department were the top five department in terms of nosocomial infection incidence,they could be the focus of nosocomial infection prevention and control in the future.Age,diabetes,and long hospital stay were relevant factors for nosocomial infection,and infection prevention and control can be strengthened.(5)The top three departments for the incidence of surgical site infections were neurosurgery department,cardiothoracic surgery department and orthopedic trauma department.The incidence of surgical site infections was related to factors such as gender,age,diabetes,emergency surgery and preoperative hospital stay,etc.The occurrence of nosocomial infection could be further controlled from the aspects above.SuggestionsThe prevention and control measures were put forward according to the relevant departments,high incidence sites and main relevant factors of nosocomial infection,including the establishment of systems,personnel training,aseptic operation,environmental hygiene,antibacterial drug application,hospital infection monitoring and so on. |
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