| BackgroundNosocomial infection is one of the most difficult problems in hospital management nowadays, which affects the medical quality. With the development of modern medical technologies, extensive application of immunosuppressive agent, more device utilization, unreasonal use of antibiotics and the aging of society,which brought on nosocomial infection increasing gradually. Now there is enough material that can prove that nosocomial infection is the main reason that lead to Americans' death, it will be listed the 8th main reason that cause death. Our country is alike. The annual direct economic loss in our country is 10 to 15 billion yuan. The number cannot be estimated, if indirect economic loss were included. Therefore, nosocomial infection has been a big problem of public health at present, and caused scholar and the high value of society.The surveillance of nosocomial infection is to study the secular trends of incidence, distribution, and risk factors of infection in patients, longitudinally, systematically, designedly, and initiatively. The surveillance process includes data collection and analysis periodically. Based on the date, the surveillance efficiency could be assessed to decrease the nosocomial infection. Nosocomial infection depend on the relationship among the host, the pathogen and the environment. Pathogen in the surroundings may spread to patient through one or other ways, such as: air spreading, intermediate spreading, or arthropod with bacterium spreading. As a result, it seems very important to make surveillance of the hospital environment. AimTo evaluate the surveillance of nosocomial infection, also to decrease the occurrence of nosocomial infection and perfect the NNIS system with investigating the nosocomial infection, environment surveillance and the relationship between each other in one provincial class3, rank1 hospital between 1993 and 2006.Material and methods1. The patients, who were hospitalized more than 48 hours, were monitored by prospective investigation from 1993 to 2006 in class3, rankl hospital in Henan. The diagnosis standard was the nosocomial infection criterions formulated by the nosocomial infection surveillance and control cooperative group, the health ministry, the People's Republic of China.2. The surveillance and intervening methods of nosocomial infection: By the prospective investigation way, each inpatient was registered and supervised as surveillance object, date from clinician and specific duty. Survey sheet for prospective survey of nosocomial infection was instituted, then the full-time personnal registered case who was detected the bacterium in blood from biological assay, and checked out the case who was infected by bacterium and fever, at the same time, urged the clinician to fill in the table which is registed the infection case and input the computer. They collect the result every month and every quarter respectively and summarize yearly. Every 50 patients was investigated by a clinical worker who was trained by the ICPs (infection control practicer). According to the uniform investigation methods (combining the investigation by sick bed with the investigation of consulting the case history) from Chinese NNIS(National Nosocomial Infection Surveillance) System, they filled every case's investigation table and collected the nosocomial infection cases prospectively. The incidence of nosocomial infection of the patients who left hospital was respectively calculated every month in terms of department, infected site and risk factors. At the same time, the relevant information of nosocomial infection was released and communicated in time.3. Environmental monitoring of the hospital: Sterilization result was monitored by sterility test and limulus test, relyed on 'technological specification of the sterilization(3rd edition)' , 'Hospital disinfection hygiene standard (GB15982～1995)' and 'People's Republic of China pharmacopoeia'. Colony count including of the air, body surface, hand; Germ quantity examination and active component examination including of antiseptics and sterilizing agent; Sterility test and limulus test aimed at medical equipment and disposable medical thing sterilizated; Bioindicator and chemical tracer detection aimed at pressuresteam sterilization.4.Statistical methods: The data were analyzed by software SAS9.13, the incidence rates of nosocomial infection were tested by chisquare test ; Nonparametric Tests were used to make classified relating statistical analysis; Tendency test were used to study qualification rates of environment factors with the time-distribution. Correlation test were used to study the relationships between environment qualification rate and nosocomial infection.Results1 Prospective investigating methods were used to make survey of every environment factors from 1993 to 2006 in this research. Results show that the qualification rates of environment factors increases year by year.2. It also indicates that the total qualification rates of environment increases year by year. In particual from 1999 to 2003,the qualification rates (78.9%,81.4%,90.8%,79.3%,89.4%) was relatively higher and higher.3. Among the environment factors, the qualification rate of disinfector was higher up to 99.61%, however the qualification rates of hand and the surface of matter were, relatively lower, only 60.71%.4. With the prospective survey and investigation, we conclude that the nosocomial infection rates(7.89%,6.16%,4.97%,4.51%,3.57%,2.85%,2.95%,1.24%,1.32%)in the past 13 years was descending year by year.5. The data of 2000-2003 showed that the infection rates in hospital differs in the rate of case-times and the rate of constitute, with chisquare test P<0.05, the difference was significant. So, to enforce the surveillance and nurse of the high risky sites was the effective way to decrease the rate of nosocomial infection.6. The surveillance of the nosocomial infection rates of medicine and surgery between 2000 and 2003 showed that it differed between each other, P<0.05, the difference was significant. The total infection rate of medicine is 2.4%, which was larger than 1.12% which was the total infection of surgical department, maybe because the patients in the medicine department were larger, longer hospitalized and always have some fundamental disease. Infection rate is different with different operative incisions. There was no difference significantly between the absence of surgery and the depuratory incision.7. After the continuous surveillance of nosocomial infection pathogen, the descriptive statistics showed there was differences among the main infection site, the major pathogen and the distribution of pathogen in infection site, in November, 2002 in October, 2003.8. There is no relationship between the operative incision infection rate and the fraction defective of air, operating room and hand sterilized(P: 0.9265, 0.4210, 0.5522).9.Further analyst of two main risk factor of nosocomial infection: air way and operative incision, respectively study the double-variate relationships between the risk factors and the disinfection qualified rate of the environment factors: air, object, hand, surgery room, there was no statistical significance in their relationship.10. There was not correlation between nosocomial infection rate and environment qualified rate in 2002-2003,( P>0.05).Conclusions1. With the prospective surveillance and investigation of one hospital in Henan between 1993 and 2006, the qualified rate of the air, object and hand in one hospital in Henan increased year by year.2. Between 1993 and 2006,nosocomial infection rate in past 13 years is decreasing.3.There was no relationship between the not qualified rates of environment (air; the surface of matter; hand; disinfectant) disinfection and nosocomial infection,the improvement of qualified rate of the hospital environment is not the main factor to the descending of the nosocomial infection rate.
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