Nosocomial Infection Incidence And The Risk Factors In Surgical Intensive Care Unit: A Prospective Cohort Study

[Objective]To explore the incidence of nosocomial infection in the surgical intensive care unit(SICU) and its risk factors and epidemiological characteristics.[Methods]A prospective cohort study was carried out in SICU from July1,2012to February28,2013in a tertiary general hospital. Through continuous observation, patients’ informationwere collected including demographic data, use of medicine and antibiotics, treatment andother related factors. The outcome was whether nosocomial infection occurred. EpiData3.02software was used to establish a database. SPSS13.0was used for descriptive statistics andapplying logistic regression model for univariate and multivariate analysis.[Results]1. A total of295cases in SICU were monitored for more than48hours, the nosocomialinfections occurred123times in82cases. There were3085days of hospitalization weremonitored (440.71weeks). The overall incidence rate of nosocomial infections was27.80%,the incidence density was18.61/100weeks; the case-time incidence rate was41.69%, thecase incidence density was27.91/100weeks. Nosocomial infections were mainly occurredin the lower respiratory tract (61.79%) and blood (26.01%). A total of110strains of newhospital infection pathogens were cultured, the most frequently isolated species of pathogenscausing nosocomial infections were Acinetobacter baumannii(35.45%), Pseudomonasaeruginosa（15.45%）, Klebsiella pneumoniae(10.91%), Staphylococcus aureus(9.09%).51strains of multidrug-resistant organisms (MDROs) were isolated. The isolation rates ofMDROs, MRSA and MRAB were respectively46.36%,70.00%and64.10%.2. The results of univariate analysis show that many factors were significantly related tonosocomial infection in SICU. The factors included that the major basic disease was cerebralvascular disease, GCS score while admission was12points or less, APACHEⅡ score wasequal or greater than18points, blood glucose was more than10mmol/L, blood bilirubin wasmore than17.1μmol/L, under rescued, suctioning procedure, oral care, the use of bronchoscopy, endotracheal intubation, tracheotomy, use respiratory machine, nasal feedingcare, mechanical expectoration, tranquilizers, gastric acid inhibitors, regulation of intestinalflora drugs, blood products, antibiotics, more than two kinds of antibiotics were used.3. The result of multivariate logistic regression analysis showed that many independentfactors cause nosocomial infections. The risk factors included that APACHEⅡ score weremore than18points (RR=2.17,95%CI=1.10-4.29), tracheostomy (RR=1.89,95%CI=1.00-3.58), ventilator (RR=4.42,95%CI=1.84-10.62), tranquilizers (RR=2.54,95%CI=1.24-5.22), more than two kinds of antibiotics were used (RR=3.15,95%CI=1.58-6.26), bloodglucose was more than10mmol/L (RR=1.81,95%CI=1.04-3.13); machinery expectoration(RR=0.26,95%CI=0.11-0.62) was a protective factor for nosocomial infection SICU.[Conclusions]1. Nosocomial infection incidence rate in SICU of was27.80%, case incidence rate was41.69%. Patients in SICU were at high risk of nosocomial infection.2. Multi-drug resistant bacteria were at high proportion. Most of them wereAcinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae andStaphylococcus aureus.3. The independent risk factor of nosocomial infection were APACHE Ⅱ score≥18points, tracheotomy, ventilator, tranquilizers, types of antibiotics>2kinds and pathoglycemia.Mechanical expectoration is protective factors of nosocomial infection in SICU.4. APACHE Ⅱ score should be considered as an early warning of nosocomial infection.Besides, it is encouraged that to minimize the invasive procedures, rational use of antibioticsand sedative drugs, effective monitor and regulate blood glucose, implement mechanicalexpectoration timely and so on, thus, it will be benificial to prevent and control thenosocomial infection in SICU and ensure patients’ safety.