Study On The Risk Factors Of Nosocomial Infection In Senile Orthopaedic Patients

OBJECTIVETo investigate the characteristics of nosocomial infections in senile orthopaedic hospitalized patients and to analyse the related risk factors of hospital infection, so as to identify the high-risk group and provide basis for clinical staffs to prevent and control hospital infection effectively.METHODSThe clinical data of hospitalized orthopaedic medicine senile patients who were complicated with nosocomial infection were retrospectively analyzed. From January2010to December2011,1044elderly cases (≥60years) were chosen among1157out-patient cases in the senile orthopaedic medicine. Data were extracted and classified from the records. Chi square test (including calibration for Chi square test) or Fisher’s exact probability were used to compare the incidence of various influencing factors of different levels. Logistic regression analysis was performed to explore the risk factors of nosocomial infection.RESULTSAmong the1044senile orthopaedic hospitalized patients,117cases occurred (125case-times in total) infection and the infection rate was11.21%(case-times infection rate was11.97%). The main sites of nosocomial infections were lower respiratory tract, urinary tract and bone traction sites, respectively accounting for71.20%,13.60%and12.80%. The lower respiratory tract was the main infection site, at which the infection was significantly higher than other sites (P<0.05). Nosocomial infection in elderly inpatients occured substantially higher in the first quarter than the others (P=0.000<0.05) in the Department of orthopedics. A total of142strains of pathogens were isolated, including96strains of gram-negative bacteria (accounted for67.61%, with Klebsiella pneumonia and Acinetobacter baumannii dominantly accounting for19.72%and14.79%respectively),31stains of gram-positive bacteria (accounted for21.83%, with Staphylococcus aureus and Hemolytic Staphylococcus dominantly accounting for9.15%and4.93%respectively) and15stains of fungi (accounted for10.56%, with Candida albicans dominantly accounting for9.86%).Nosocomial infection in elderly inpatients had close correlation with15factors, i.e. gender, age, hospitalization time, fracture, operation, bone traction, catheter indwelling days, urinary catheter intubation times, other catheters, underlying diseases (including coronary heart disease, osteoporosis, hypoproteinemia, anemia, cerebral atrophy) and number of underlying diseases. Besides, indwelling catheter had no direct correlation with the overall infection rate, but related to urinary tract infection.Conditional logistic regression analysis indicated that the following8factors were potential independent risk factors for nosocomial infections in senile orthopaedic hospitalized patients, which were gender (OR=0.570,95.0%CI0.332-0.980), hospitalization days (OR=2.626,95.0%CI1.795-3.842), bone traction (OR=3.255,95.0%CI1.692-6.261), urinary catheterization times (OR=3.573,95.0%CI2.482-5.144), orther catheterization (OR=0.461,95.0%CI0.241-0.883), coronary heart disease (OR=2.917,95.0%CI1.526-5.576), osteoporosis (OR=2.472,95.0%CI1.401-4.361) and hypoproteinemia (OR=7.590,95.0%CI4.132-13.942).CONCLUSIONS1. The nosocomial infection rate in senile orthopaedic hospitalized patients is high, to which the medical workers should pay more attention and strengthen professional training and relevant knowledge studying. Besides, specific preventive strategies should be taken to reduce the incidence of nosocomial infection.2. Due to combined diseases, hospilized, long time in bed, facture injury, surgical trauma and invasive operation in elderly patients with orthopaedic disease, the incidence of inpatient nosocomial infection is high in geriatric orthopaedic department.3. The risk factors of nosocomial infections are in varied forms in senile orthopaedic hospitalized patients. Eight factors (i.e. gender, age, hospitalization time, fracture, operation, bone traction, catheter indwelling days, urinary catheter intubation times, other catheters, underlying diseases and number of underlying diseases) are seen as main risk factors of nosocomial infections in senile orthopaedic hospitalized patients.4. Nosocomial infection incidence in senile orthopaedic patients is caused by multiple factors. Medical staff should attach great importance to protect patients of high-risk group and treat the primary affection and basic diseases in time. At the same time actively targeted measures should be taken to prevent nosocomial infection, including strengthening the monitoring and infection intervention, strictly following the indications to traumatic examination and invasive treatment, strengthening disinfection and isolation and basic nursing (strict aseptic manipulation and hand hygiene) so as to reduce the rate of hospital infection.