Investigation Of The Risk Factors Of Nosocomial Infection In High-risk Gravidas And Parturients

[Obective]: Maternal Mortality Rate(MMR), a sensitive indicator to envaluate one country's health care system,are increasingly concerned .Now it's our important target to decrease the MMR and make sure the delivery safety. Nosocomial Infection is one of the important causes that lead to the maternal mortality ,specifically the high-risk maternal mortality。So it's necessary to find out how to decrease the high-risk maternal's nosocomial infection. This study was performed to investgate the state of nosocomial infection in high-risk gravidas and parturients and find out the risk factors in order to provide scientific evidences to its prevention and make out the countermeasures.[Methods]: 212 cases of nosocomial infection in 6454 high-risk gravidas and parturients from Jan 2004 to Dec 2007 were retrospetively analyzed, finding out what cause the nosocomial infections.[Results]: From Jan 2004 to Dec 2007, there were 9251 obstetric inpatients,in which high-risk patients were accounted for 69.77%(6454 cases). Over 90% high-risk patients were patients with pregnancy complication and complicating pregnancy. 212 high-risk patients were diagnosed as nosocomial infection(morbidity:3.84%) ; at the same time,only 29 normal pregnant women were diagnosed as nosocomial infection (morbidity:1.04%). The nosocomial infection morbidity of high-risk patients was significantly higher than the morbidity of the normal groups (P<0.05). But there was no significant difference between the morbidity of patients with pregnancy complications and patients with complicating pregnancy(P>0.05)(morbidity were 3.41%,3.68%, respectively). Amomg the high-risk patients,there was the statistics difference between the nosocomial infection morbidity in the transient population (morbidity:4.46%)and the nosocomial infection morbidity in the local residences(morbidity:2.23%) (P<0.05). The nosocomial infection's morbidity of vinginal delivery,vinginal midwifery( forceps delivery and vacuum extraction) and cesarean section were 1.88%,7.36%,4.13%,respectively. The patients who were vinginal delivery had less chance of nosocomial infection than the other two groups (P<0.05).But there was no statistics difference between the morbidity of the vinginal midwifery and the cesarean section(P>0.05). According to the constituent ratio of the infection sites, respiratory tract infection(48.58%)was on the top of the list,fellowed by gential tract infection(28.77%),skin and wound infection(15.09%),urinary tract infection(4.71%)and gastrointestinal infection(2.83%). The Pathogens included the G+bacteria(43.07%),the G-bacteria(38.46%) and the fungi(18.47%). 83.96% cases took place in 2-7days after delivery. When patients had nosocomial infection, length of staying in the hospital was significantlly longer. (P<0.05). But no statistcs difference was found in the nosocomial infection's morbidity regardless patients used a single antibiotic or used several antibiotics jointly (P>0.05).Their infection morbidity were2.80%,3.67%,respectively[Conclusion]:The high-risk gravida and parturient's morbidity of nosocomial infection was higher than that of normal pregnant women. Pegnancy complication and complicating pregnancy were the major courses which result in the high-rish pregancy. There was no statistical difference between their nosocomial infection morbidity.But among the high-risk patients,the transient population's nosocomial infection morbidity was higher than the local residence's nosocomial infection morbidity.The major infection sites were respiratory tract and gential tract. The predominant bacteria was the G+bacteria. Most cases took place in 2-7days after delivery. Operative delivery was one of the important courses that resulted in high-risk patients'nosocomial infection. Combination apply of antibiotics could not decrease the nosocomial infection's morbidity of high-risk patients.In order to prevent the nosocomial infection;fristly,Strengthen the high-risk gravides'antenatal examination,especially the non-resident high-risk patients'antenatal examination. Secondly,avoid any unnecessary incuesive check-ups and operative precedures.Thirdly, shorten the length of staying in the hospital. At last,Rationally use the antibiotics .