A Study On Incidence Of Nosocomial Infection Survey And Antimicrobial Use Strategy In A Hospital, Tianjin

Part I Descriptive Study on Nosocomial Infection in Gestrointesitine Units in an Infectious Disease Hospital from 2007.1 to 2008.12Objective To analyze the data of nosocomial infection (NI) in an infectious teaching hospital for 2 years (from 2007.1 to 2008.12) and reveal the distribution and tendency.Methods To investigate prospectively the incidence of nosocomial infection among in-Patients during 2007.1 and 2008.12.Results1. All 4,198 cases were involved during the surveillance,394 of which were aquired NI. And the incidence of NI was 9.39%, the incidence density of NI was 3.030/1000patient days.457 times attacked, the case-times incidence was 10.89%, the case-times incidence density was 3.515/1000patient days.2. The frequent NI sites are peritonitis (23%), blood stream infection (20%), uper respiratory tract infection (20%) and lower respiratory tract infection (17%), which holds 80% of all.3. The nosocomial uper respiratory tract infections most frequently appeare in the first quarter of year. Nosocomial blood stream infections are stable higher. The incidence of nosocomial peritonitis trends down slowly.4. The best cure of nosocomial infections is gastrointesital tract infection. Then uper resperitory tract infection, peritonitis, skin-soft tissu infection are followed. The lower respiratory tract infection and blood stream infection are on the top in motality and renunciative leaf-off rate.5. The NI incidence in A2 unit is the highest by 4.417/1000patient days, most of which are blood stream infection (1.646/1000patient days) and lower respiratory tract infection (1.459/1000patient days). The incidence of nosocomial uper respiratory tract infection is highest in unit A5, a tradetional Chinese medicine unit,1.084/1000patient days.6. The motality of nosocomial infection is the highest in intraperitoneal tissue infection (11%), followed by lower respiratory tract infection (8.70%) and blood stream infection (7.32%).7. The median value of chemotherapy on single lower respiratory infection aquired in hospital is highest among all NI, by 1,635.20 RMB (592.10-2,202.20). The median value of chemotherapy on single blood streamm infection aquired in hospital is 1,030.60 RMB, (592.10-2,202.20). The median value of chemotherapy on single peritonitis aquired in hospital is 1,034.40 RMB, (693.60-2,579.60). The median value of chemotherapy on single urinary tract infection aquired in hospital is 632.00 RMB, (458.92-1,352.60).The median value of chemotherapy on single uper respiratory infection aquired in hospital is 442.40 RMB, (353.40-632.00).Conclusion1. It is iniatial prospective surveillance on nosocomial infection in China with more credible and scientific incidence, with which could be compared in advanced countries.2. The unit A2 with the highest nosocimial blood stream infection and lower respiratory tract infection is the one that fits to be surveyed as a target object.3. The upper respiratory tract infections aquired in hospital are most frequently in the first quarter of year.Part II The Prophylactic Use of Antibiotics Administration in preventing Surgical Site Infection of Cesarean section:A Meta Analysis of randomized controlled trials in ChinaObjective To evaluate the impact on surgical site infection (SSI), postpartum endometritis and/or puerperal morbidity by prophylactic administration of antibiotics in cesarean section.Methods Comprehensive Chinese randomized controlled trials retrieval about preventing postpartum infection related to cesarean section by antibiotics prophylactic uses was performed via searching electronic database, hand searching bibliographies of books and relevant journals.Results Compared with long term antibiotics prophylaxis started after operation, short term antibiotics prophylaxis started at time during 1/2 to 2 hours before operation or started after umbilical cord clamped showed lower surgical site infection (OR=0.34,95%CI0.24-0.48) and puerperal morbidity(OR=0.40,95%CI0.32-0.48) significantly, and lower postpartum endometritis incidence in selective C-section(OR=0.45,95%CI 0.11-1.83) or unselective C-section (OR=0.55,95%CI 0.16-1.96).Conclusion This meta analysis indicated that short term antibiotics prophylaxis started at time during 1/2 to 2 hours before operation or started after umbilical cord clamped is a strategy for improving to prevent SSI and puerperal morbidity.PartⅢThe evaluation of intervention of prophylactic use of first generation of cephalosporins in Cesarean section by single doseObjective The purpose of this history comparison between retrospective and prospective study was to determine the evidence-based hospital-made guideline of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity.Methods The intervention included to provide evidence-based guideline of prophylactic use of antimicrobial for cesarean section, increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. Single-dose of first generation cephalosporins at cord clamping was guided as prophylactic use of antimicrobial for sesarean section. In the pre intervention periods, a retrospective collection of antimicrobial consumption and surgical site infections were measured randomly.Results1. Patients evaluated increased from 0 to 100% and the SSI rates in both periods were 2.17% to 1.89%, respectively. The difference of rates of术后病率between pre and post intervention (3.26% vs 1.89%) has not statistical significance. The endometritis before and after the intervention are not observed.2. The count of white cell in peripheral blood more than 13G/L cases are 3 and 1 respectively. The rate of Neutrophil in peripheral blood WBC more than 80% cases are 26 and 30, respectively.3. There was about 5/6 cost reduction in prophylactic antimicrobial use on average per cesarean section (RMB 221.15±67.53 to RMB 36.70±25.85).4. neonatal weight are 3446±422 g and 3393±408, respectively between before and after intervention, p=0.36. The Apgar scores are 9.62±0.88 and 9.79±0.50, p=0.10. The rates of neonatal Apgar score less than 7 cases are 2.17% and 0.Conclusion1. An ample intervention, including administrative and educational measures, led to high compliance with the first generation of cephalosporins within less than 24 hours after the operation. and saved more except bacterial resistence pressure.2. There was no difference in maternal infectious morbidity whether the duration of cefotazidine given before skin incision were at least 48 hours or single dose of the first generation of cephalosporins at cord clamping.Part IV The trend in antibacterial agents consumption by the appropriate use of antibiotics program at a Infectious Disease HospitalObjective To improve capability of antibiotics reasonable use in hospital.Methods People-centred infection control programmes were implemented over a 3-year period (2006-2008) in an infectious disease hospital, which included acting out antibiotics reasonable use management, strengthening nosocomial control and improving their surveillance capabilities. It was taken to provide pertinent education on reasonable use of antibiotics and formulate antibiotics use guideline to relative infection.Results1. The percentage of antimicrobials in medicine cost in the hospital is decreased from 3.32% to 2.79%.2. The cost of antimicrobials per 100 admitted patients is reduced continuously from RMB 224.20 to 152.04.3. The cost of antimicrobials per 1000 admitted out-clinic patient-times shows decreased trend, RMB 406.00 to 274.70.4. The Defined Daily Doses (DDDs) per 100 patients of antibacterial was on a degressive slope during the intervention. The DDDs per 100 patients of Imidazole derivatives, antimycotics, Fluoroquinolones, Third-generation cephalosporins and Beta-lactam antibacterials and enzyme inhibitors showed decrease marked in use.5. At the same time the component consumption of some antibacterial, such as Macrolides, Beta-lactamase sensitive penicillins, Second-generation cephalosporins, Tetracyclines, Sulfonamides and trimethoprim, and other aminoglycosides excluded streptomycins, were increased markedly.6. The sensibility rate of Staphylococcus aureus rises to oxacillin continuously from 71% to 82%; The one to levofloxacin rises from 63% in 2006 to 88% in 2008.7. Among strains of E.coli, the susceptibility to piperacillin/tazobactam increases from 38% to 62%; This trend is also in the susceptibility to ciprofloxacin/levofloxacin, from 18% to 48%.Conclusion Systematic and active strategy of appropriated use of antibiotics improving access and changing behaviour placed a key role but took time. The successful reduction of the third generation of cephalosporins and increases the susceptibility to E. coli and S. aureus. The longer effect of intervention existed.