| OBJECTIVES To know the incidence and distribution of nosocomial infections in inpatients with viral hepatitis,to analysis the main risk factors and provide scientific basis for measures decreasing the occurrence of nosocomial infections.METHODS There were 6 hospitals with viral hepatitis inpatient department which affiliated the Health Bureau in Jinan.The 6 hospitals included five general hospitals and one special hospital.Using the simple random sampling method,we selected three hospital collecting the nosocomial infection information in 2004-2006.From January 2004 to December 2006,there were 493 cases occurring with nosocomial infection among 14272 inpatients with viral hepatitis.By the cross-sectional investigation method,the inpatients' data were collected and statistically analyzed.The collected clinical data are three aspects including the Nosocomial Infection Case Form reported by the doctors,the investigating of the nosocomial infection control managers and the inpatients' clinical case history records.The descriptive epidemiologic methods were used to explore the characteristics and the risk factors of nosocomial infection.RESULTS1.The analysis of nosocomial infection incidence rate in the past three years(from 2004 to 2006).There were 493 cases who have occurred nosocomial infection in the 14272 inpatients with viral hepatitis.The total incidence rate was 3.36%.The infection rates per year ranged from 2.86%to 3.70%,which had dropped year by year. 2.The analysis of nosocomial infection incidence rate among different hospitals.The incidence rate of nosocomial infection ranged from 3%to 4%among different hospitals, and there were no statistical significant among them.3.The distribution of age and sex in inpatients occurring nosocomial infection.The 14272 inpatients were divided into 5 groups,that were less than 1 year old,1-9 years old, 10-29 years old,30-49 years old,and above 50 years old.The nosocomial infection incidence rate was calculated separately and tested by x~2-test.The result showed that there is a significant difference among 5 groups' incidence rates.The rates of less than 1 year and above 50 age-group were higher(6.72%and 4.90%) than others.The difference between male and female inpatients' incidence rate was not significant by x~2-test.4.The analysis of organs attacked by nosocomial infection.The organ easiest to be attacked with nosocomial infection was the upper respiratory tract(24.44%),other major sites of the infection were the abdominal cavity(22.63%),the mouth cavity(9.9%),the skin and soft tissue(5.05),the urogenital system(4.44%),the thoracic cavity(2.22%) and the hematological system(1.21%).5.The incidence rate of nosocomial infection in different season.The highest is in the spring(3.74%) and the lowest is in the winter(2.32%).The difference is significant with x~2-test.The reason was perhaps that the organs easyly to be attacked with nosocomial infection in inpatients with viral hepatitis were mainly respiratory tract and abdominal cavity.The infections in respiratory tract took place easyly in winter and spring.6.The analysis of pathogenic bacteria in nosocomial infection cases.There were 265 nosocomial infection cases' samples were examined among 493 cases.145 samples were positive.Similar with the domestic literature.The major bacteria were Gram-negative bacilli(51%).The most commonly identified pathogens were candida albcans(24.13%), Pseudomonas aeruginosa(19.31%),Escherichia coli(11.72%),Staphylococcus aureus (9.66%) and Klebsiella pheumoniae(6.90%).7.The sensitivity of main bacteria to various antibacterial agents.Clinical specimens were isolated and cultured according to National Guide To Clinical Laboratory Procedures. Antimicrobial susceptibility testing was performed by Kirby-Bauer diffusion method. Gram-positive bacteria and Gram-negative bacteria were compared for their antibiotic resistance.Staphylococcus aureus,Staphylococcus epidermidis and hemolytic Staphylococcus were all sensitive to vancomycin,no resistant strains;but their resistance rate to imipenem is over 32%;their resistance rate to penicillin,ampicillin oxacillin, cefazolin,chloramphenicol,tetracycline and erythromycin was up to 64%-95%. Resistance rate of gram-negative bacili to picillin,piperacillin and the first-generation cephalosporin was generally high,and their resistance rate to the third-generation cephalosporin was over 2/3.8.The comparison of sterilization effects.The bacteriology detection data of the samples which collected from objects' surfaces in using,enviroment and polluted water, were statisticed and analyzed finding that in three years the qualification rate of sterilization effect of facilities,object's surface and the air in the diagnose-treatment room was separately 99.66%,99.61%and 90.74%.9.Study of risk factors of acquiring nosocomial infection in severe viral hepatitis. There were 115 severe hepatitis cases in the 493 inpatients with viral hepatitis.The likely ten risk factors were studied with univariate and multivariate analysis(logistic regression analysis),showing that the main risk factors remained significant were long term of hospitalization,receiving invasive therapy,more kinds of antimicrobial used before nosocomial infection,having complication of severe hepatitis.CONCLUSIONS1.From 2004 to 2006,the incidence rate of nosocomial infection in inpatients with viral hepatitis had dropped year by year,because of the reconstruction of nosocomial infection controlling and the department construction,the enlarge of the observing range and the enhance ofnosocomial infection management.2.There is no significant difference in the incidence rate of nosocomial infections in different hospitals and department.Hospitals generally addressed the nosocomial infection knowledge training among doctors,nurses and cleaners,take measures for the control and prevention of nosocomial infection.At the same time,they enhance the management of sterilization and monitoring.Infection diseases departments and digest medical department are constructed well than before,having better equipment and reasonable disposition.3.The pathogenic bacteria of nosocomial infection are mainly Gram-negative aerobic bacilli,next include Gram-positive bacteria and mycetes.The common bacteria that cause nosocomial infections in inpatients with viral hepatitis are Candida albicans,Pseudomonas aeruginosa,Escherichia coli,Staphylococus aureus,Klebsiella pheunoniae, Staphylococcus epidermids,Enterococci,Salmonella and Enterobacter aerogenes.The isolated strains have generally high resistance rate to antibiotics.4.The sterilization is an effective measure to cut offthe route of transmission.That is very important to prevent the incidence of nosocomial infection.In this investigation,the sterilization effects is satisfactory.The sterilization qualification rates are higher than report in recent literature.5.Significant risk factors of acquiring nosocomial infection in severe hepatitis include years old,season,term of hospitalization,receiving invasave operation,utilization of hormone or/and immunosupressant treatment.SUGGESTIONIt's important to take measure for improving the control of nosocomial infection,such as professional knowledge training together with continuing education,strengthen control of the risk factors,strict the operation of bioclean rules,reasonable utilization of antibiotic, prompt and accurate pathogenic detection,emphasis control,ordered arrangement of person and object stream. |
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