| Background:Hospital infection is a major problem faced by the medical field. The disease and the economic burden of the patients were increased by the hospital infection, even the patients died. A WHO survey result in2005showed that the patients with hospital infection were more than14million at any time in world. Hospital infection rate is currently an indicator which is strictly monitored in the tertiary hospitals by China’s Ministry of Health, thence deep-level analysis to the situation and predisposing factors of hospital infection would provide important data for control of hospital infection. In addition, Ministry of Health requires which average length of stay for the National Quality Hospital is seven days at present, therefore the hospital must shorten the average length of stay. In this context, Research of hospital infection also has a positive significance on the average length of stay.Objectives:To analyze the feature and risk factors of hospital infection, and the impact on the average length of stay by a retrospective study, in order to provide the appropriate basis for decision making for preventing and controlling hospital infection, and reducing economic losses for the patient. Object of study:The discharged patients in a hospital from January1,2007to December31,2011were as object of study.281,490discharged cases were collected in the five years.6588cases (7324times) occurred hospital infection. Excluding the200cases of hospital examination, the remaining274,702patients did not occur hospital infection. The patients with hospital infection were as a case group, the patients with non-hospital infection were as a control group. On the patients with non-hospital infection, to discharged year and discharged from hospital departments as a dual variable, by using stratified random sampling method,10%of the discharged patients for all the various departments each year were extracted as a control group. The number of cases was27,179cases.Methods:Data extraction:Cases of hospital infection were screened preliminarily according to the first page of the medical record by the HIS system. Then the information for cases was extracted by reading, then read the information of the case excerpt, the variables of extract:the patient’s ID, name, gender, age, number of admissions, admission date, discharge date, discharge department, work status, marital status, the first diagnosis for discharge, underlying diseases, hospitalization way, the admission condition, discharge way, the date of hospital infection, the name of infection, the ultimate outcome for infection, invasive operation, etc. Statistical analysis:SPSS17.0software was used for data analysis. The complex sampling was performed by Complex Samples, a random sample of10%was performed according to the department and discharged year, the number of random seed was50million. The x2test was used for hospital infection rates and pathogen indicators. The stepwise logistic regression (Forward LR) method was used for analyzing the impact factors of hospital infection., The non-parametric Mann-Whitney test of two independent samples was used for the average length of stay in different departments, because they do not follow a normal distribution. The method of stepwise regression (Stepwise) of multiple linear regression method was used for the impact factors of the average length of stay. Two-sided test was used, inspection standards for α=0.05.Results1The feature of hospital infection1) The overall situation:6588cases (7324times) occurred hospital infection from2007to2011,3970men and2618women, the overall hospital infection rate was2.3%for the5years, there was significant difference among the different years (χ2=35.595, P<0.001). The hospital infection rate was significant difference between the gender (χ2=80.571,P<0.001), higher in men than in women by0.5percentage points. The hospital infection rate for males and females in the5years showed a gradual decline over time (P<0.004).2) Mortality rate of hospital infection:1756cases died in the5years. Of them,268cases died to hospital infection, accounting for15.3%of overall patients had died. There were no significant difference for the infection mortality among the different years (χ2=6.548, P=0.162) and between the gender (P≥0.180).3) Departments of hospital infection:The first department for hospital infection was the Department of the Hematology, followed by the Department of the Rehabilitation, ranked third for Department of the Pediatrician. The infection rate was0for Department of the Psychologist. The last five departments with lower prevalence were the Department of the Breast Center, Department of the Intervention, Department of the Ophthalmology, Department of the Joint and Bone Surgery and Department of the ENT. Of the268cases who died to hospital infection, the top five departments for the hospital infection mortality were the Department of the Surgical ICU(28.3%), Department of the Burn Unit(25.0%), Department of the Infectious Diseases(10.1), Department of the Thoracic Surgery(10.1%) and Vascular Surgery(10.0).4) Ages of hospital infection:Of the patients with hospital infection, the hospital infection rate in gender was significant difference among ages(χ2=41.193, P<0.001), males with age for40to50years and females with age for50to60years had the highest hospital infection rate. The hospital infection rate in different years was significant difference among ages(χ2=41.193, P<0.001), the main ages of patients with hospital infection were30to40years in2007,50to60years in2008and2009,40to50years in2010and2011. The hospital infection rate in different years was no significant difference between the gender (χ2=3.524, P=0.474).5) The site of hospital infection:The top five infection sites were respectively respiratory tract (55.7%), gastrointestinal (8.6%), blood (8.5%), oral cavity (4.7%) and cerebral (4.4%). The respiratory tract infections ranked first hospital infection in different years, the infection rate was53.5%to58.9%. Lung infection was the main manifestation. The respiratory tract infections account for first place in whether it was male or female. The proportion of blood infection was equivalent between gender. The proportion of gastrointestinal infection, urinary tract infection, and oral infection in females was higher than in males. The site of infection was significant difference between the gender(χ2=37.685, P<0.001).6) The distribution of hospital infection site in different ages:The top three hospital infection sites were the respiratory tract, blood and gastrointestinal tract in<1year old infants. The top three hospital infection sites were the respiratory tract, oral cavity and blood in children with1to10years. The top three hospital infection sites were the respiratory tract, blood and Cerebral in patients with10to20years. The top three hospital infection sites were the respiratory tract, blood and gastrointestinal tract in patients with20to30years. The top three hospital infection sites were the respiratory tract, gastrointestinal tract and blood in patients with30to60years. The top three hospital infection sites were the respiratory tract, gastrointestinal tract and urinary tract in patients with>60years. The distribution of hospital infection site was significant difference among different ages(χ2=928.190, P<0.001).7) The hospital infection mortality in different ages:The hospital infection mortality showed a gradual upward trend with increasing age, there was significant difference among different ages(χ2=41.534, P<0.001).8) The distribution of infected season:The first four months of hospital infection were from high to low in July, August, June and October. The lowest month for hospital infection was in February. The distribution of hospital infection in different months was no significant difference between gender (χ2=7.015,P=0.798). The distribution of hospital infection in different seasons was no significant difference between gender (χ2=2.254, P=0.521).2Bacteriological situation1) The situation of submission specimens:The numbers of submission specimens were6780times from2007to2011. The first place in specimens was sputum, followed by wound secretions, ranked third in the urine.2) The situation of pathogens which were detected:G+bacteria accounted for33.5%, G-bacteria53.3%, fungi13.2%. Of them, Staphylococcus aureus accounted for the first place in the G+bacteria, Escherichia coli in G-bacteria, Candida albicans in fungi. The detection rate was significant difference among different submission specimens (χ2=4275.675, P<0.001). The number of Escherichia coli (92) was most in pathogenic bacteria puncture fluid, Candida albicans (49) and Enterococcus faecium (48) in stool, Escherichia coli (162) in venous blood, Staphylococcus epidermidis (17) in equipment, Staphylococcus aureus(141) in wound secretions, Bowman bacilli(351) in sputum, Pseudomonas and Enterococcus faecalis (both15) in throat swab, Escherichia coli(316) in urine. 3) The pathogen detection of departments:The pathogen were different in different departments(χ2=552.499, P<0.001). G+bacteria were detected mainly in the Department of the Breast Center, Department of the Ophthalmology, Department of the Oral and Maxillofacial Surgery, Department of the Neonatal and Department of the Plastic Surgery. G" bacteria were detected mainly in the19departments, as Department of the Urology, Department of the Neurosurgery, Department of the Rehabilitation, Department of the Physiotherapy, and Department of the Spine Surgery.3Analysis of the influencing factors of hospital infectionBinary Logistic regression analysis was used for analyzing the risk factors of hospital infection,33,767cases were analyzed, considering the30covariates. Stepwise logistic regression (Forward LR) analysis showed that there were21factors into the model. The total correct determine rate was91.7%. The determined coefficient (R2) for Cox and Snell, and Nagelkerke were0.420and0.670, respectively. Model χ2=18403.114, P<0.001, the equation was meaningful, P0.001.The OR values of year (compared with the reference category) were less than0.56. Compared to2007, hospital infection rates decreased from2008to2011. Month: Compared to January (the reference category), the OR values of September, October, November and December were less than0.806. They were the protective factors.The OR values of the "1～" and "10～" two age groups (compared with the reference category "<1-year-old group", OR>1.72, P>0.03), Female(compared with the reference category "male", OR=1.095, P=0.044), underlying disease category(OR=1.478,P>0.001), discharge way for death(compared with the reference category "normal", OR=11.920, P>0.001), admission condition for general (compared with the reference category "critical condition", OR=2.188, P=0.022), invasive operation(compared with the reference category "no", OR=99.021, P>0.001), the number of rescue(OR=1.218, P=0.013), days for the first care(OR=1.028, P>0.001), days for the second care(OR=1.025, P>0.001), days for the tertiary care(OR=1.028, P>0.001), the number of transfusions(OR=1.047, P>0.001), surgery(compared with the reference category "no", OR=1.419, P>0.001) were greater than1, they can be seen as risk factors of the hospital infection.4Affect of the average length of stay caused by hospital infectionMann-Whitney U test (Non-parametric two independent samples) was used. The median average length of stay was28.0days in case group,8.0days in control group, there was significant difference between2groups(Z=92.209, P<0.001). The median average length of stay in case group was longer20.0days than in control group.In the Department of Orthopaedic and Trauma, the average length of stay was10.0days in control group and45.0days in case group, the average length stay in infected patients were more than35.0days in without infected patients. The infected patients in the Department of the Rheumatology Division, Department of the Joint and Bone Surgery and Department of the Breast Center were only two cases, test was not made. The average length of stay in the Department of the Oral and Maxillofacial Surgery was no significant difference between case group and control group (P=0.193). The average length of stay in the other departments was significantly higher for case group than for control group (P<0.017).The hospital infection was one of the influencing factors for extending the average length of stay by using multiple linear regression (stepwise regression)(P <0.001). In the13variables which were selected for the model, the hospital infection ranked8. Conclusions The overall hospital infection rate was2.3%in the5years. The hospital infection rate showed a gradual decline over time (P<0.004). The top five hospital infection sites were respiratory tract, gastrointestinal tract, blood, oral cavity, and cerebral. The hospital infection mortality showed a gradual upward trend with increasing age. The risk of hospital infection was higher in "1～" and "10～" two age groups than in the<1-year-old group. There was susceptible to hospital infections in women than in men. The risk of hospital infection was higher in patients with more underlying disease category than in patients with less underlying disease category, patients with invasive operation than patients with no invasive operation, patients with more numbers of rescue than patients with less numbers of rescue. There was susceptible to hospital infections in patients with longer days for the first care, days for the second care, days for the tertiary care than patients with shorter days. The risk of hospital infection was higher in patients with more numbers of transfusions than in patients with less numbers. The surgical patients were susceptible to hospital infections. The median average length of stay in case group was longer20.0days than in control group. The hospital infection was one of the influencing factors for extending the average length of stay by using multiple linear regression. To reduce hospital infections, many measures were adopted in the hospital. These mearsures included strengthen the propaganda and education work of hospital infection,establishing a department infection control team, requiring the doctor to report promptly cases of infection, reduce the rate of missing report, strengthen in high-risk departments, high-risk patient monitoring, improving the aseptic practices of health care workers, attach importance to the medical equipment and apparatus for the disinfection of disposal, a less invasive operation and shorten the time, reasonable use of antibiotics,isolating cases of infection, regulating accompanying persons, improving the ward environment, monitoring the medical waste, et al. There by the management of hospital infection was strengthened and the hospital infection rate was reduced. |
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