Original Article Prevalence survey of nosocomial infections in the Inner Mongolia Autonomous Region of China [2012-2014] Wei-Ping Liu1,2, Yong-Quan Tian1, Yun-Ting Hai2, Zhi-Nan Zheng2, Qing-Ling Cao2 1Public Health School of Central South University, Changsha 410078, China; 2Inner Mongolia Autonomous Region People’s Hospital, Hohhot 010010, China Contributions: (I) Conception and design: WP Liu, YQ Tian; (II) Administrative support: YQ Tian; (III) Provision of study materials or patients: WP Liu, YT Hai, ZN Zheng; (IV) Collection and assembly of data: YT Hai, QL Cao; (V) Data analysis and interpretation: WP Liu; (VI) Manuscript writing: WP Liu; (VII) Final approval of manuscript: All authors. Correspondence to: Yong-Quan Tian. Public Health School of Central South University, Changsha 410078, China. Email: [email protected]. Background: To investigate the prevalence of nosocomial infections, the distribution of nosocomial infection sites, the use of antibiotic and the situation of detected nosocomial infection pathogens in the Inner Mongolia Autonomous Region of China from 2012 to 2014, to grasp the current conditions of regional nosocomial infections in timely, for the development of infection prevention and control measures to provide a basis for effective hospital. Methods: A survey of the prevalence of nosocomial infections was conducted in target hospitals using the combination of a bedside survey and medical record review. Results: In total, 101,907 inpatients were surveyed from 2012 to 2014. There were 1,997 cases of nosocomial infections, accounting for an average prevalence of 1.96%. The infection site was mainly the lower respiratory tract. Higher prevalence of nosocomial infections occurred in the comprehensive intensive care unit (ICU), Neurosurgery Department, and Hematology Department. The average rate of antibiotic use was 33.72%, and the average submission rate for bacterial cultures for patients who received therapeutic treatment with antibiotics was 28.26%. The most common pathogens associated with nosocomial infections were Gram-negative (G−) bacteria, and frequently detected bacterial pathogens included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus. Conclusions: The survey of the prevalence of nosocomial infections helped to identify problems in the control process of nosocomial infections and to develop targeted measures for the prevention and control of these infections accordingly. Keywords: Nosocomial infection; prevalence; antibiotics Submitted May 29, 2015. Accepted for publication Sep 09, 2015. doi: 10.3978/j.issn.2072-1439.2015.09.41 View this article at: http://dx.doi.org/10.3978/j.issn.2072-1439.2015.09.41 Introduction prevalence of nosocomial infections in the Inner Mongolia Autonomous Region of China from 2012 to 2014. The With the development of medical technology, the problem of nosocomial infection has become serious increasingly, objectives were to investigate the current situation and which affect the life safety of patients and medical staff trends of nosocomial infections in the Inner Mongolia seriously. Reducing the occurrence of hospital infection Autonomous Region and provide theoretical support for effectively not only can reduce the patient’s medical developing effective measures for the prevention and expenses, but also can avoid the medical resources waste. control of nosocomial infections to facilitate regional This study reports the findings from a survey of the nosocomial infection management. © Journal of Thoracic Disease. All rights reserved. www.jthoracdis.com J Thorac Dis 2015;7(9):1650-1657 Journal of Thoracic Disease, Vol 7, No 9 September 2015 1651 Materials and methods of a disagreement, the survey team members discussed the situation to reach a decision. After the completion of Survey subjects the survey, the survey forms were checked by full-time The subjects included all inpatients on the days that the staff, and problems were fixed in a timely manner. The survey was conducted in the target hospitals from 2012 to survey data were imported into the National Nosocomial 2014, including patients discharged or dead on the days Infection Control Office Automation System (http:// the survey was conducted, but patients newly admitted to oa.yygr.cn/) and reported by full-time staff. Staff at the the hospital were excluded. In total, 26,940, 31,504, and National Nosocomial Infection Management and Quality 43,463 inpatients were surveyed in 2012, 2013, and 2014, Control Center reviewed the reported data again to ensure the hospital is divided into 66, 91, 118 were investigated, the accuracy of the survey data. respectively. Statistical analysis Survey methods The survey data were imported into the National A cross-sectional survey was conducted, and the survey Nosocomial Infection Control Office Automation System plan was implemented in accordance with the survey and then exported for statistical analysis using SPSS 19.0. method developed by the National Nosocomial Infection Categorical data were compared by χ2 tests, and a P value Surveillance and Management Training Base. According of less than 0.05 was considered to indicate statistical to the situation, each hospital was surveyed by full-time significance. staff of the nosocomial infection management team in cooperation with the physicians and nurses of responsible for nosocomial infection control from different clinical Results departments. The investigators were divided into two Prevalence of nosocomial infection groups: one group reviewed medical records, and the other group performed the bedside survey. These two sets The prevalence of nosocomial infections were 2.05% in of survey data were summarized and input into a “Case 2012, 1.82% in 2013, and 2.00% in 2014, with a 3-year Registration Form of the Nosocomial Infection Prevalence average of 1.96%. There were no significant differences in Survey” by full-time staff of the nosocomial infection the prevalence of nosocomial infections between different 2 management team. years (χ =4.91, P=0.09>0.05) (Table 1). Table 2 shows the prevalence of nosocomial infections from 2012 to 2014 in different areas of Inner Mongolia. Diagnostic criteria Nosocomial infection was diagnosed according to the Nosocomial infections in different clinical departments Diagnostic Criteria for Nosocomial Infection (Trial) issued by the original Ministry of Health of the People’s Republic The results of the 2012-2014 survey showed that of China in 2001. When a discrepancy regarding a diagnosis comprehensive intensive care unit (ICU) and the occurred, a decision was reached by discussion among the Neurosurgery Department, Hematology Department, investigators. Neonatology Group of the Pediatrics Department, Gynecology Department, Thoracic Surgery Department, and Nephrology Department were associated with high Quality control prevalence of nosocomial infections (Table 3). One week prior to the survey, a notice that included the survey methods and diagnostic criteria was issued to the Distribution of nosocomial infection sites clinical departments. Two days before the survey, pre- survey training of investigators was conducted by full- The 3-year survey data showed that nosocomial infections time staff of the nosocomial infection management team, were mainly distributed in the lower respiratory tract, which included the survey plan, diagnostic criteria, and upper respiratory tract, urinary tract, and superficial instructions for completing the survey form. In the case incisions (Table 4). © Journal of Thoracic Disease. All rights reserved. www.jthoracdis.com J Thorac Dis 2015;7(9):1650-1657 1652 Liu et al. Prevalence survey of nosocomial infections Table 1 The survey rates (%) and prevalence (%) of nosocomial infections in the Inner Mongolia Autonomous Region of China [2012-2014] Number of Number of Survey Number of Infection Frequency Frequency rate of Year expected patients surveyed patients rate (%) infected patients rate (%) of infection infection (%) 2012 27,285 26,940 98.74 553 2.05 586 2.18 2013 32,013 31,504 98.41 573 1.82 614 1.95 2014 43,720 43,463 99.41 871 2.00 919 2.11 Total 103,018 101,907 98.92 1,997 1.96 2,119 2.08 Table 2 Prevalence of nosocomial infections from 2012 to 2014 in different areas of Inner Mongolia 2012 2013 2014 Inner Mongolia Number of Number Number of Number Number of Number Infection Infection Infection (City/league) surveyed of infected surveyed pa- of infected surveyed of infected rate (%) rate (%) rate (%) patients patients tients patients patients patients Hohhot 6,874 178 2.59 7,126 163 2.29 7,450 157 2.11 Baotou 1,905 42 2.20 2,275 29 1.27 4,608 78 1.69 Ordos 1,665 31 1.86 1,908 37 1.94 2,261 46 2.03 Hulun Buir 3,621 54 1.49 3,898 40 1.03 5,914 90 1.52 Hinggan 1,857 32 1.72 2,034 49 2.41 2,775 82 2.95 Tongliao 2,654 53 2.00 3,007 34 1.13 3,752 52 1.39 Chifeng 3,813 75 1.97 4,896 105 2.14 9,617 245 2.55 Xilin Gol 356 6 1.69 353 6 1.70 732 23 3.14 Ulan Qabu 962 20 2.08 967 18 1.86 1,241 14 1.13 Bayan Nur 2,168 44 2.03 3,581 68 1.90 3,676 63 1.71 Wuhai 882 16 1.81 1,221 20 1.64 1,177 15 1.27 Alxa 183 2 1.09 238 4 1.68 260 6 2.31 Total 26,940 553 2.05 31,504 573 1.82 43,463 871 2.00 Table 3 Top five clinical departments with respect to nosocomial infection rates from 2012 to 2014 Year Infection rates in different departments (%) 2012 Comprehensive ICU Neurosurgery Department Otolaryngology Gynecology Department Hematology (18.27) (6.75) Department (3.57) (3.37) Department (Group) (3.29) 2013 Comprehensive ICU Neurosurgery Department Hematology Department Thoracic Surgery Neonatology Group (12.92) (6.72) (Group) (6.14) Department (3.83) of the Pediatrics Department (3.49) 2014 Comprehensive ICU Neurosurgery Department Hematology Department Neonatology Group of the Nephrology (26.70) (7.53) (Group) (6.04) Pediatrics Department Department (Group) (3.90) (2.56) ICU, intensive care unit.