| Nosocomial infection is an important public health problem.According to the World Health Report issued by WHO in 2013,the total prevalence of nosocomial infections in high-income countries was 7.5%in 1995-2010.The prevention and control of nosocomial infection plays an important role in maintaining the health and safety of patients.However,in recent years,outbreaks of nosocomial infection have occurred frequently,including the spread of SARS in hospitals in 2003.These events have great impact,heavy casualties and profound lessons.On one hand,nosocomial infections pose extra threat on patients and medical staff and increase working load.On the other hand,the treatment of nosocomial infection cases is financially demanding,which will affect the economic revenue of the institutions.In most cases,the control of nosocomial infections is hysteretic,it is conducted after the infection occurs.So it is critical to formulate the diagnostic criteria of nosocomial infection,the nosocomial infection cases could be identified and controlled at early stage.The clinical diagnostic criteria for nosocomial infection used in China is the one issued by Chinese Ministry of Health in2001 and some following diagnostic criteria,including three technical instructions publicized in 2010 and the prophylaxis and treatment instructions of VAP in 2013.The related factors of nosocomial infection have significantly changed now and the modification of the diagnostic criterial is needed.CDC of US and its National Healthcare Safety Network annually update their diagnostic criteria for nosocomial infection,which is widely approved by professionals and implemented in countries around the world after minor modification.Recently,China's Administrative Department is considering updating China's current diagnostic criteria for nosocomial infection.So before the experts lay down the new criteria,it is necessary to study the application of the new criteria in comprehensive hospitals.Hopefully,it will help identify the shortcoming of the criteria and provide valuable reference for further modification of the diagnostic criteria of nosocomial infection.Firstly,this study compares the relevant contents of diagnostic criteria for nosocomial infections between China and the United States by literature research.The results showed that:The diagnostic criteria for nosocomial infections in China include41 diseases and 44 diseases in the United States.The American diagnostic criteria include 7-day infection window period and repeated infection period.China-US diagnostic criteria differ in the basis for determining some types of infection,including monitoring time,symptoms,signs and auxiliary examinations.Then a cross-sectional survey was conducted.975 inpatients from a tertiary general hospital in Beijing on May 23,2018 were investigated,and the contents of hospital infections were investigated and analyzed using the monitoring items in the CDC/NHSN nosocomial infection diagnostic criteria in China and the United States.The key monitoring items such as catheter-related blood flow infection,catheter-related urinary tract infection,ventilator-related pneumonia and surgical cite infection were analyzed with in-depth case study.Among 975 inpatients from the hospital,there were 530 males(54.4%)and 445females(45.6%);aged from 6~94 years old,the average age was(62.1±0.6)years,median age was 63 years old.The main patient group is between 50 and 90 years old(76.7%);there were 229 cases(23.5%)who had surgery already;92 cases(40.1%)used antibiotics before surgery;371 cases(38.3%)used antibacterial drugs;165 patients(16.9%)with arteriovenous intubation;153 patients(15.7%)with urinary tract intubation;and 12 patients(1.2%)with respirator.Using the diagnostic criteria of nosocomial infection in China,23 cases of nosocomial infection were identified,the prevalence rate was 2.4%,which was lower than the relevant national standards(?10%in tertiary hospitals),and was lower than the national level(3.2%),and was consistent with the current prevalence rate in Beijing(The average level was 2.4%).34 cases of nosocomial infection were identified according to the diagnostic criteria for nosocomial infection in the United States(CDC/NHSN),and the prevalence rate was 3.5%.Statistical analysis showed that there was significant difference in the prevalence of nosocomial infection between China and the United States under different diagnostic criteria(?~2=9.09,P=0.001).In the diagnosis of device-related nosocomial infection,there were 165 patients with arteriovenous intubation.According to Chinese and American diagnostic criteria,there were 3 and 5cases of Central Line-associated Bloodstream Infection(CLABSI).The infection rates were 1.8%and 3.0%,respectively;Among 153 patients with urinary catheterization,5cases and 6 cases of catheter-related urinary tract infection(CAUTI)were identified according to the diagnostic criteria of China and America,the infection rates were 3.3%and 3.9%,respectively;Among the 12 patients with ventilator,4 patients and 5 patients with Ventilator-associated Pneumonia(VAP)were identified according to Chinese and American diagnostic criteria,the infection rates were 33.3%and 41.7%,respectively;In the diagnosis of surgical site infection,there were 227 patients with surgical incision.According to Chinese and American diagnostic criteria,5 cases and 9 cases were identified as surgical site infections.The infection rates were 2.2%and 4.0%,respectively.There were no significant differences in the diagnosis of nosocomia infections like bloodstream infection,urinary tract infection,ventilator-associated pneumonia,and surgical site infection(P>0.05).In-depth analysis of typical medical records of different infection types revealed the following results:First,in the diagnosis of device-related nosocomial infections,the diagnostic criteria for nosocomial infections between China and the United States differ in symptoms and manifestations.For the diagnositic of CAUTI,Chinese criteria is a pain in the lower abdomen and pain in the kidney area;the pain or tenderness of the ribs in the American criteria can be diagnosed;CLABSI signs such as Chinese criteria needs to have purulent secretions,the American criteria can have an exudate to diagnose;imaging examinations such as VAP in Chinese criteria need to have imaging changes,the American criteria doesn't need imaging changes.Individual cases of infection were judged differently.The results of the judgment were different,and the number of diagnosed cases increased from 12 to 16 cases,and new cases were related to this.Second,in the diagnosis of surgical site infection between China and the United States,the diagnostic criteria for hospital infections in China and the United States vary in length,such as 30 days after surgery in China,and the United States considers surgical cite infection for 90 days after surgery.The number of cases increased by 4cases,and new cases were related to this.Third,in other types of infections,such as Clostridium difficile infection and external auditory canal infections,there is a lack of diagnostic criteria in China.In summary,we found that there was significant difference in the overall prevalence of nosocomial infections between the two diagnostic criteria of nosocomial infections in China and the United States in this study.And there was no significant difference in the prevalence of three types of device-related infections,and the prevalence of surgical cite infections between the two diagnostic criteria of nosocomial infections in China and the United States in this study.After further investigation and analysis,We found that the diagnostic criteria for nosocomial infections in China and the United States differ in terms of time,symptoms,signs and imaging examinations.This may be the main reason for the different judgment results of individual cases of infection.The diagnostic criteria for device-related nosocomial infections in the United States are broader,the diagnostic criteria in China are stricter.For example,CLABSI signs such as Chinese creatia need to have purulent secretions,the United States can have an exudate to diagnose;For CAUTI China has lower abdominal tenderness,kidney percussion pain,and the United States has costal angular pain or tenderness,considering both clinical diagnosis.This may lead to underestimation and misjudgment of nosocomial infection.To accurately determine the occurrence of nosocomial infection,it is very important to study the trend of nosocomial infection,to control the spread of nosocomial infection and to improve the management of nosocomial infection.At present,there is no comparative study on different diagnostic criteria in China.It is suggested that the applicability of US diagnostic criteria for nosocomial infections in China be further studied to provide scientific basis for updating and revising the diagnostic criteria of nosocomial infection in China. |
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