Study For The Incidence And Risk Factors Of Nosocomial Infection About The Patients In The Department Of Neurology In A General Hospital

【Objective】The aim of this study was to evaluate the risk factors of nosocomial infection (NI)in the department of neurology and to determine the incidence of NI, microbiologicprofile and bacterial resistance.【Methods】By the means of prospective monitoring, the clinical data of the hospitalizedpatients whose length of stay in the department of neurology above48hours during10months(1March,2012through31December,2012) was analyzed and summarized. Wecollected clinic data in the form of accessing medical records and nursing records,visiting patients by the bed, and communicating with medical staff, in order tounderstand the patient’s condition, treatment situation and the status of hospital infection.The questionnaire was developed by aspects of the baseline of patients, usage of drugs,invasive operation and the status of hospital infection. After the completion of datacollection, the incidence was calculated. Chi square test (including calibration for Chisquare test) or Fisher’s exact probability were used to compare the incidence of variousinfluencing factors of different levels, the RR and95%CI for RR were calculated at thesame time. And then, statistical comparisons for multiple factors were performed usinglogistic regression analysis. The drug-resistance of bacteria was analyzed according tothe results of drug sensitive test.【Results】1.The incidences of nosocomial infectionOf the2103patients who were investigated,159developed NI. The incidence ofNI was7.60%and the rate of infections was8.37%. A total of75patients (7.10%)developed NI in1063patients came from the department of internal neurology with therate of infections was7.81%.A total of84patients (8.10%) developed NI in1040patients came from the department of neurosurgery with the rate of infections was 8.94%. The incidence of NI in the internal neurology patients compared withneurosurgery patients has no statistically significant difference (2=0.79, P＞0.05).2.The situation of pathogen detection46strains of pathogens were detected in the patients who developed NI in thedepartment of internal neurology,including28strains of gram-negativebacteria(60.87%),6strains of gram-positive bacterium(13.04%) and12strains offungus,(26.09%).82strains of pathogens were detected in the patients who developedNI in the department of neurosurgery,including47strains of gram-negativebacteria(57.32%),20strains of gram-positive bacterium(24.39%) and15strains offungus(18.29%). Multi-resistant bacteria (36.96%) were separated from46strains ofneurological patients, among them6strains of E. coli,4strains of klebsiellapneumoniae; Multi-resistant bacteria (41.46%) were separated from82strains ofneurosurgical patients, among them12strains of acinetobacter baumannii,7strains of E.coli and7strains of staphylococcus aureus.3.The risk factors of nosocomial infectionsThe independent risk factors for NI in the department of internal neurology aresuffering from malignant tumor (OR=5.73,95%CI1.56~21.06), no activity underbed (OR=6.37,95%CI2.9513.76) and detaining urethral catheter (OR=3.52,95%CI1.996.21). The independent risk factors for NI in the department of neurosurgery arethe patients aged more than65years (OR=2.01,95%CI1.133.58), no activity under bed(OR=16.99，95%CI5.0856.87), enteral nutrition via nasogastric tube (OR=4.86，95%CI2.828.38) and protonpumpinhibitors (OR=4.29，95%CI1.6511.16).【Conclusion】1.The incidence of NI in the neurological department was7.60%, infection rate ofcases was8.37%.Patients in the department of neurology are at high-risk with NI.Theincidence of NI in the internal neurological patients compared with neurosurgicalpatients has no statistically significant difference.2.The proportion of multi-resistant bacteria was quite high in the separated bacteria,mainly including E.coli, acinetobacter baumannii and staphylococcus aureus, klebsiellapneumoniae.3.The independent risk factors for NI in the department of internal neurology aresuffering from malignant tumor, no activity under bed and enteral nutrition vianasogastric tube.The independent risk factors for NI in the department of neurosurgery are the patients aged more than65years, no activity under bed, enteral nutrition vianasogastric tube and protonpumpinhibitors.4.The patients aged more than65years, suffering from malignant tumor, or noactivities under the bed are at high risk with NI in the department of neurology. Theyshould be treated as the focus objects of the hospital infection prevention and control.Physicians should strictly abide by the principle of operations when implementingurethral catheterization or indwelling gastric tube, and then assess the time of urine tubeindwelling, in order to pull urine tube as soon as possible. For patients with enteralnutrition via nasogastric, we should pay attention to the amount of intake, in order toprevent gastroesophageal reflux, and encourage patients to do some activities out of bedif their status allows as far as possible.