Status and trends of nosocomial infection in cardiovascular and cerebrovascular disease specialist hospital at high altitude from 2012 to 2017

Abstract

Objective To investigate the status and trends of nosocomial infection in cardiovescular and cerebrovascular disease specialist hospital at altitude, and to provide references for prevention and control of nosocomial infection. Methods The incidence of hospital infection rate, the distribution of infection sites, the distribution of pathogenic microorganisms and the use of antibiotics of 93 014 cases in Qinghai Cardio-Cerebro-Vescular Special Hospital from 2012 to 2017 were analyzed, retrospectively. Results A total of 93 014 incharged patients were collected, among whom, 1 440 cases occurred nosocomial infection, with the average infection rate of 1.5%. The top five departments of nosocomial infection rate were Intensive Care Unit (5.1%, 103/2 017), Cardiac Surgery Unit (3.4%, 198/5 847), Vascular Surgery Unit (1.9%, 105/5 613), Arrhythmia Unit (1.8%, 191/10 384) and Emergency Unit (1.7%, 60/3 412). There was significant difference in the infection rates of nosocomial infection sites from 2012 to 2017 (χ2 = 1 861.181, P < 0.001). The chi-square trend test showed that the rate of the lower respiratory tract infection increased by years (χ2 = 12.653, P < 0.001), and the infection rates of urinary system (χ2 = 17.710、P < 0.001) and mucous membrane (χ2 = 5.738、P = 0.017) decreased by years. The rate of lower respiratory tract infection at ICU Ward was the highest, accounting for 70% (72/103), followed by Arrhythmias 2nd Unit, accounting for 50% (28/56). The lower respiratory infection rates of Chest Surgery, Coronary Heart Disease 1st Unit, Coronary Heart Disease 3rd Unit, Emergency Department and Neurology Department were all above 40%. The rate of surgical site infection at Vascular Surgery Unit (29.5%, 31/105) and Cardiac Surgery (29.3%, 58/198) were both higher than others, following by Coronary Heart Disease 2nd Unit, accounting for 15.9% (27/170). The distribution of nosocomial pathogenic microorganisms were Gram-negative bacteria, which accounted for 66.4% (284/428), Gram-positive bacteria accounted for 28.7% (123/428) and fungi accounted for 4.9% (21/428). Acinetobacter baumannii (23.6%, 62/263), Staphylococcus aureus (20.5%, 54/263), Enterobacter cloacae (19.8%, 52/263), Klebsiella pneumoniae (18.3%, 48/263) and Escherichia coli (11.0%, 29/263) were the main five pathogens of nosocomial infection. Methicillin-resistant Staphylococcusaureus (MRSA) was with the highest detection rate among multiple drug-resisitant bacteria, which increased from 11.1% to 28.6% from 2012 to 2017. The use of antibiotics in the treatment of patients with nosocomial infection consisited of single drug for 70.3% (1 013/1 440), two-drug for 26.0% (374/1 440) and three-drug for 3.7% (53/1 440). Conclusions It was an effective way to reduce nosocomial infection to focus on the prevention and control of infection, active monitoring, standardizing the operating procedures, operating strictly in the aseptic technique and using the anti-bacterial drugs effectively and reasonably. Key words: Nosocomial infection; Cardiovescular and cerebrovascular disease specialist hospital; Restrospective study; Highaltitude