Current Status Of Device-Associated Infection In Comprehensive ICU Of A District Of Shanghai In 2015-2017

Objectives:1 To investigate the incidence of nosocomial infection in comprehensive ICU in a district of Shanghai,to clarify the key points of nosocomial infection prevention and control,so as to put forward the targeted prevention and control measures.2 To analyze the incidence of device-associated infections,the distribution of pathogens in comprehensive ICUs in a district of Shanghai,and to screen the influencing factors of device-associated infections.Methods:By means of retrospective survey,the date of targeted surveillance of nosocomial infections were collected from comprehensive ICUs of 5 hospitals from 2015 to 2017,the statistical analysis was performed by using SPSS 21.0 software,and the incidence of nosocomial infection and device-associated infections in the ICU patients was analyzed.Results:1 Totally 4788 patients in 2015-2017 were enrolled in the study,with the total hospitalization duration 50418 days;434(510 case-times)patients had nosocomial infections,the incidence rate of nosocomial infection was 9.06%,the daily infection rate was 10.12‰.The incidence of nosocomial infection in patients with hospitalization days>14 days was higher than that in patients with hospitalization days?14 days(?~2=547.68,P<0.000).2 Lower respiratory tract,VAP and CAUTI were the main nosocomial infection sites in ICU,accounting for 41.37%,26.08%and 13.73%respectively.Gram-negative bacteria was dominant among the total pathogens were isolated from the patients with nosocomial infection,accounting for 67.16%,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae were the predominant species of pathogens.3 Totally 221 case-times of patients had device-associated infection,accounting for 43.33%among the patients with nosocomial infection,and the percentage showed downward trend in the 3 consecutive years(?~2=24.44,P<0.001).The total utilization rates of ventilator,catheter and central catheter in the 3 consecutive years were43.91%,71.97%and 52.78%,respectively.During the three years,the utilization rates of ventilator and central catheter increased in the 3 consecutive years(?~2=81.94,?~2=16.50,P<0.001).4 There were 133 cases of VAP in 1567 patients with mechanical ventilation,the incidence was 8.49%,the daily incidence was 6.01‰,and the incidence of VAP decreased year by year from 2015 to 2017(?~2=11.46,P<0.001).The mortality rate of VAP patients was 12.78%,the mortality of non-VAP patients was 7.25%,and the mortality rate of VAP group was higher than that of non-VAP group(?~2=5.22,P<0.05).Gram-negative bacteria was dominant among the total pathogens were isolated from the patients with VAP,accounting for 75.37%,Pseudomonas aeruginosa was the predominant species of pathogens.Multivariate Logistic regression analysis found that women,APACHE II score>15,the days of ICU hospitalization>14,the number of days of mechanical ventilation>7 were independent risk factors of VAP.5 There were 70 cases of CAUTI in 3204 patients with catheter,the incidence was 2.18%,the daily incidence was 1.93‰.The mortality rate of CAUTI patients was15.71%,the mortality of non-CAUTI patients was 9.48%.Gram-negative bacteria was dominant among the total pathogens were isolated from the patients with CAUTI,accounting for 50.00%,Escherichia coli was the predominant species of pathogens.Multivariate Logistic regression analysis found that age>60 years,APACHE II score>15,the days of ICU hospitalization>14,the number of days of indwelling catheter>7 were independent risk factors of CAUTI.6 There were 18 cases of CLABSI in 2223 patients with central line,the incidence was 0.81%,the daily incidence was 0.68‰.The mortality rate of CLABSI patients was 11.11%,the mortality of non-CLABSI patients was 9.93%.Gram-negative bacteria was dominant among the total pathogens were isolated from the patients with CLABSI,accounting for 75.00%,Klebsiella pneumoniae was the predominant species of pathogens.The single factor analysis showed that gender,the number of days of ICU hospitalization were the influencing factors of CLABSI(?~2=5.69,9.27,P<0.05).Conclusions:1 The incidence of nosocomial infection and the utilization rate of catheters in the comprehensive ICU in this district are at a high level,and the patients with device-associated infection are the focus of the patients with nosocomial infections in comprehensive ICU.The hospital stay in ICU should be reduced as much as possible,and the application and management of catheters should be strengthened to reduce the utilization rate of catheters.It is necessary to continuously carry out targeted surveillance of nosocomial infection in ICUs,enhance the informatization construction of nosocomial infection,promote the standardized management of data of nosocomial infection.2 The lower respiratory tract,VAP and CAUTI infection sites should be listed as the key points in the prevention and control of nosocomial infection in comprehensive ICU.The surveillance of high-incidence infection sites should be strengthened in clinical practice.3 VAP caused by mechanical ventilation is preventable and controllable in the comprehensive ICU.The patients with mechanical ventilation should be actively treated the primary disease,shortening the time of ICU hospitalization,strengthening airway management,strictly controlling the indication of withdrawal,reducing the time of mechanical ventilation,so as to reduce the occurrence of VAP.4 The incidence of CAUTI in patients with indwelling catheter in ICU was low.The older the patients are,the higher the APACHE II score,the longer the ICU hospitalization and the longer the catheter indwelling,the more likely patients with indwelling catheter are to develop CAUTI.5 The incidence of CLABSI in patients with central line in this area is at a low level.Gender and ICU hospitalization are the influencing factors of CLABSI in patients with central line.The key to prevent CLABSI is to rationally arrange patients,shorten the time of ICU hospitalization.