Analysis On The Epidemic Characteristics And Trend Of Nosocomial Infection In A Children’s Hospital From Zhejiang Province During The Years2003-2012

Objective:In this study, nosocomial infection during the past decade in a children’s hospital from Zhejiang Province were retrospectively investigated. The dynamic changes of nosocomial infections in the children’s hospital were systematically studied. The incidence of nosocomial infections、the infection site and pathogen distribution aspects were described. And nosocomial infection high-risk season, high-risk population, high-risk department and high incidence of pathogenic microorganisms were analyzed. So as to provide reference and basis for the development of prevention and control measures to nosocomial infections in children’s hospital.Methods:Clinical charts of nosocomial infection cases with in inpatient children’s hospital from Zhejiang Province were retrospectively reviewed during the years2003-2012. Nosocomial infection cases were diagnosed based on2001version of Nosocomial Infection Diagnosis Criteria formulated by the Ministry of Health. Medical staffs in the departments reported the nosocomial infection cases to the Department of Infection Control of the hospital; and staffs of the Department of Infection Control checked the cases in avoiding of missed reporting. Before2008, all the medical charts of discharged cases were checked; after2008, hospital information system, Electronic Medical Record and Laboratory management system were used for surveillance on the suspected nosocomial infection cases. The incidence of nosocomial infection=Infection episodes/discharged patients (corresponding period)×100%.Results:Totally320,828cases were surveyed during the ten-year period. In total,14621episodes of nosocomial infection with in inpatient children’s hospital from Zhejiang Province were retrospectively reviewed during the years2003-2012. An average infection incidence was4.55%.In the past10years, nosocomial infection incidence overall down, the incidence in2012declined significantly compared to that in2003, decreased by as much as47.89%; the nosocomial infection incidence in winter is highest as4.81%, followed by autumn, summer, spring. The incidence of nosocomial infections in autumn and winter are significantly higher than those in spring and summer(P<0.05).The nosocomial infection incidence in different departments of the Children’s Hospital are different, followed by neonatal (5.6%), intensive care unit (4.95%), internal pediatrics (4.85%), pediatric surgery (1.94%).The infection incidence varied in different settings. The Hematology Department (21%), NICU (9.74%), Gastroenterology Department (6.02%), SICU (5.98%) and Newborns Unit (4.75%) were the top five units with high incidence of NI. The General Surgery Department (1.42%), Urology Surgery Department (2.11%) and Endocrinology Department (2.17%) were the units with low incidence of NI. The incidence of NI in the five high incidence departments in2010-2012were compared with those in2003-2005, the Hematology Department had a remarkable decrease (56.73%);53.87%decline in Gastroenterology Department; the incidence of NI in other three departments remained varying degrees of growth, NICU growth margin147.58%, neonatal ward growth rate138.85%, the growth rate of60.25%of SICU.Regarding the main constituent ratio of infection sites, upper respiratory infection accounted for40.05%, gastrointestinal tract infection22.96%, lower respiratory infection18.68%, septicemia12.57%.From the full-house development trend, upper respiratory tract infections constitute decreased year by year, from47.03%in2003down to25.47%in2012; lower respiratory tract infection constituent ratio increased from16.71%in2003to29.04%in2012; sepsis constituent ratio increased from4.29%in2003to17.24%in2012; gastrointestinal infections constituent ratio remained high volatility.The constituent ratio of infection sites in different departments are different, the main infection site in department of neonatology was digestive tract, accounting for48.66%, the main infection site in department of internal pediatrics and pediatric surgery was upper respiratory tract, accounting for49.61%and48.36%respectively. The main infection site in department of intensive care unit infections was lower respiratory tract, accounting for76.87%. The most common infection in the department of Hematology was sepsis, accounting for57.01%; the most common infection in the department of neonatal ward was digestive tract, accounting for64.73%; the most common infection in the department of cardiothoracic Surgery was lower respiratory tract infections, accounting for51.53%; the lower respiratory tract infections were the main infection in the department of NICU, SICU, PICU.Pathogens involved NI including viruses (52.42%), Gram negative bacteria (31.72%), Gram positive bacteria (11.8%) and fungi (3.69%). We observed no remarkable changes during the ten years. Concerning the top five detected pathogens every year, rotavirus took the first lead; syncytial virus and parainfluenza virus appeared in several years. For Gram-negative bacteria, Klebsiella pneumoniae (KPN) took the fist lead in2004and Acinetobacter baumannii (AB) in2007; these two pathogens were checked to be the top2or3thereafter. Escherichia coli(E.coil), Pseudomonas aeruginosa, Enterobacter cloacae and Burkholderia cepaciat were in the top five in individual years. Gram positive bacteria such as Enterococcus faecalis and staphylococcus epidermidis were detected, and Candida albicans revolved.The detection rate of multi-resistant bacteria:MRSA detection rate from2003to2012increased by13.64%to39.63%, an increase of190.54%; ESBLs-producing Klebsiella pneumoniae detection rate was61.3%in2003, to66.56%in2012. In2010, carbapenem-resistant Klebsiella pneumoniae antimicrobial drugs (CR-KPN) was found in NICU, in2012CR-KPN detection rate rose to14.14%; ESBLs detection of Escherichia coli rate was33.76%in2003, rose to67.44%in2012, an increase of99.76%; pan-resistant Acinetobacter baumannii resistant to impenem rate increased year by year,11.11%from2005to2012reached66.14%, an increase of nearly five times.Conclusions:An average incidence of NI in children hospital was4.55%with a decreasing trend in recent years; the incidence was higher in autumn and winter seasons than in spring and summer seasons.The NI incidence varied in different departments. The incidence of nosocomial infections in neonatal, intensive care unit and internal pediatrics are significantly higher than pediatric surgery. The Hematology Department, NICU, Department of Gastroenterology, SICU and Neonate Unit were the high infected settings. The last ten years, the Hematology Department and Gastroenterology Department with a decreasing trend decrease; the incidence of NI in SICU, NICU and neonatal ward remained varying degrees of growth.Regarding the main constituent ratio of infection sites, upper respiratory infection accounted for40.05%, gastrointestinal tract infection22.96%, lower respiratory infection18.68%, septicemia12.57%. From the full-house development trend, upper respiratory tract infections constitute decreased year by year; lower respiratory tract infection and sepsis constituent ratio increased; gastrointestinal infections constituent ratio remained high volatility. Septicemia in the Hematology Department, gastricenterologic tract infection in Neonate Unit, and low respiratory infections in NICU and SICU should be warned.Pathogens involved NI including viruses (52.42%), Gram negative bacteria (31.72%), Gram positive bacteria (11.8%) and fungi (3.69%). We observed no remarkable changes during the ten years. Rotavirus was the most common pathogen causing NI, followed by KPN and AB.MDR pathogens were detected with an increasing rate, and Carbapenems resistant KPN were detected in NICU. We should attach more importance on common NI pathogens which are resistant to various antibiotics used in pediatric clinics.