Study On The Situation And Risk Factors For Postoperative Nosocomial Infections In Patients With Orthopedics Operation

Background and ObjectiveNosocomial Infection refers to all infection acquired in the hospital.It not only increases the patients' pain,prolongs the patients' hospitalization duration,but also aggravates the workload of medical staff,reduces the turnover rate of beds,and causes significant economic losses to patients and the society.The prevention and control of nosocomial infections in patients with orthopedics operation play an important part in the general hospitals and have been receiving increasing attention from medical professionals.Postoperative nosocomial infection in patients with orthopedics operations refers to nosocomial infections obtained after surgery.Since orthopedics operation often use allogeneic bone,bone cement,steel plates,screws,and artificial joints,the risk of infection is higher,and it is often more difficult to control.The purpose of this study was to explore and analyze the postoperative nosocomial infection status and risk factors in orthopedic patients,and to provide a theoretical basis for the prevention and control of postoperative nosocomial infections in patients of orthopedics department.Subjects and MethodsWe conducted a retrospective case-control study in 13134 patients with orthopedics surgery in a hospital during Jan.2013 to Dec.2015.Using real-time nosocomial infections surveillance system,we selected and retrospectively reviewed the medical record of all patients with postoperative nosocomial infections from Jan.2013 to Dec.2015 at total of 13 134,and the data were verified and registered in the"Postoperative infections Cases for patients with orthopedics operation" The questionnaire was designed to fit the target monitoring survey and research methods,including the general data of patients,surgical-related factors,susceptibility factors,the situation of nosocomial infection,pathogenic examination,and antibiotic use after nosocomial infections.A 1:1 matched case-control study was carried out to explore the risk factors of postoperative infection in orthopedic patients.The case group includes patients with postoperative nosocomial infections,the control group includes patients with the same period of hospitalization,the same department,the same sex,age difference within5 years old,the same main diagnosis but without nosocomial infections.All data were checked for logical error and cleaned up by professional nosocomial infections staff.Epidata 3.0 software real-time dual input was used.Excel 2010 was used to establish the database and SPSS 20.0 was used for statistical analysis.The counted data is expressed as the number of cases or percentages(%),and the balance is compared using x2 test and t test.The influencing factors of postoperative nosocomial infections in patients with orthopedics surgery were analyzed using conditional logistic regression model.Conditional logistic regression model for simple factors was performed for each continuous variable and categorical variable.Then the variables with P<0.20 in the single factor analysis were included in the multivariate conditional logistic regression model to determine the risk factors or protective factors for postoperative nosocomial infections in patients with orthopedics operation.The test level a=0.05.Results1.The epidemiological features of postoperative infection in patients with orthopedics operationAmong 13134 cases of patients with orthopedic operation from Jan.2013 to Dec.2015,91 patients acquired nosocomial infection,and the rate of nosocomial infection was 0.69%.In other words,94 cases acquired postoperative nosocomial infection,and the incidence of nosocomial infections was 0.72%.The major infection areas were superficial incisions,deep incisions,lower respiratory tract,upper respiratory tract,and urinary tract.According to different incision classification,the incidence of nosocomial infection and incision infection showed a gradual increase on type ?,type ?,type ?incision operation.Multiple susceptibility factors existed in 94 nosocomial infection cases,including 92 cases with invasive procedure,90 cases with antibiotics treatment,56 cases with hormonal treatment,41 cases with past history of hypertension,diabetes,etc.,and 15 cases with smoking or drinking habit.There was also one case of postoperative infection with multiple susceptibility factors.Among 94 nosocomial infections cases,73 cases were performed pathogenic organism examination,and the rate of examination was 77.66%.43 cases were positive,and the positive rate was 58.90%.47 strains of pathogens were detected,among which 6 strains were multidrug-resistant organism.Sorted by isolates,the 47 strains of pathogens were followed by Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,and Staphylococcus epidermidis.2.The factors affecting postoperative infection in patients with orthopedics operationThe risk factors for postoperative nosocomial infection in patients with orthopedics operation are those that treated in the ICU(OR=103.128,P=0.033),with a high level of incision contamination(OR=24.097,P=0.027),perioperative use of antibiotics for prophylactic purposes(OR=12.534,P<0.001)and use of hormones before nosocomial infection(OR=6.872,P=0.019).Conclusion1.Orthopedic surgery in this hospital was mainly performed by type I incision surgery(clean surgery),and the postoperative infection rate maintained a low level.2.Patients who have been treated in ICU would have an increased risk of postoperative nosocomial infections in patients with orthopedics operation.With increase of incision contamination,the risk of nosocomial infections in orthopedics patients increased.Patients who had used antibiotics for prophylactic purposes and had used hormones were more prone to acquire postoperative infections.