The Necessity to Change the Approaches to the Registration of Healthcare-Associated Infections Newborns and Intrauterine Infections

Abstract

Objective: To estimate the registration quality of neonatal healthcare-associated infections (HAI) and intrauterine infections in separate maternity hospitals in Moscow. Material and methods : We carried out a retrospective epidemiological analysis neonates HAIs and intrauterine infections. In this study was conducted patients from Moscow during 2008–2017 and three maternity hospitals in Moscow during 2009–2017. These case study maternity hospitals would be known as MH № X01, № X02 and № X03. Also in this study we assessed postpartum woman’s HAIs morbidity in MH during 2009–2017. From these patients we selected cases where not only newborn suffered the disease but mother got sick neither. Then we analyzed on which day after day birth the child got the diagnosis HAIs or intrauterine infections. In addition, the quality of registration was established on the basis on Rospotrebnadzor order № 29 dated on 16.03.2018 «About an order of case registration of infectious and parasitic diseases in the city of Moscow». The data selection was from Statistical Reporting Form № 2 in Moscow. Also, were used data from infectious and parasitic diseases accounting and registration department of The Hygiene and Epidemiology Center in Moscow. The morbidity rate of HAIs and intrauterine infections of newborns was counted on 1,000 births newborns. The morbidity rate of HAIs of postpartum women was counted on 1000 births. For this purpose «Microsoft Office Excel 2010» software packages were used. The calculation of the increase/decrease rate was made by the method of least squares. Results: On basis of conducted analysis it was determined that morbidity HAIs newborn has tended to be on the decline, especially compared with a sharp and considerable increase in the intrauterine infections morbidity. This trend can be observed both in Moscow and in the three described MH. The incidence of HAIs of postpartum woman is represented by a single registration. It had been identified a minimal number of cases, when the disease was being recorded in both the mother and the baby. Analyzing the timing of intrauterine infections and HAIs diagnosis from the moment of birth, it was found that about a quarter of all cases of intrauterine infections should have been registered as nosocomial infections. According to the Order № 29 on the basis on the nosology list (diseases which can only be registered as HAIs) it was established that about 10% of cases of intrauterine infections was misdiagnosed. Thus, the analysis indicators once again do not refute, but only proves the poor-quality registration of moving the newborn HAIs and cases of intrauterine infections from one category to another. The identified problem is extremely relevant and requires action to solve it. Conclusion : Multi-criteria analysis, revealing the quality of newborns HAIs and intrauterine infections registration, such as an incidence rate, the ratio intrauterine infections and HAIs newborns, the number of the disease in mother and baby’s cases registration, compliance with normative documents, showed that official statistics are unreliable. The register system for the described infections is in needed of be reformed. First of all, it is necessary to standardize the diagnostic process, that mean the development of a standard case definition for each nosology among the HAIs and intrauterine infections.