Nosocomial Infections
2017
Evaluation of the incidence of nosocomial infection in one of the hospitals in Qom province (2007)
Mohaddseh Laripour (1)* (responsible author), Shirin Farsad (2)
1-Ph.D Student of Veterinary Mycology, Islamic Azad University, Science and Research Branch of Tehran
- Member of the faculty of Payame Noor University of Qom
Postal address: Tehran-14566-14516, Fax: 66035031
E-mail: mlarypoor@yahoo.com
The following article was published in Iranian Journal of Microbiology, Vol. 5, No 6, Autumn 2011.
Abstract
Backgrounds and objectives
This study presents new information on the prevalence of microbial agents involved in hospital infections and its environmental factors affecting it in one of the hospitals in Qom province.
Introduction
Each year, two million patients get infections in the hospitals. These infections called nosocomial infections include infections that are not present when the patient is admitted to the hospital or in the incubation period of the disease, cause the death of more than 19,000 people and impose a cost of more than $ 4.5 million a year.
Despite the fact that one-third of nosocomial infections are controlled, it is still considered seriously threatening in developed and developing countries.
Materials and methods
In this descriptive prospective study, patients admitted to CCU, ICU, men and women surgery, nephrology, infants, infection and other wards were studied from March 21, 2007 to March 20, 2008.
The nurses in these wards filled in questionnaires with parameters such as surname, age, sex, hospitalization date, hospitalization ward, cause of hospitalization, incidence of nosocomial infection, place of incidence of nosocomial infection, date of incidence of nosocomial infections.
Then sampling was made from the site of infection and determined the agent type with examining the direct sample and the type of agent. Samples included phlegm, blood, urine, and ulcers.
Correlation test was used to analyze the results.
Results
From the 21054 patients that were studied during one year, 105 patients with a mean age (16.64 ± 4.26) years and (age range from 30 days to 126 days) got nosocomial infections and 19 people died after 48 hours.
The number of hospitalized women was 50 and the number of men was 55. The incidence of infection was 35 in 10,000 patients. In this study, bacteria, viruses and fungi were isolated as secondary infectious agents in hospitalized patients.
In this study, bacteria isolated from patients with nosocomial infections are as follows:
From 37 people (35.2%): E.coli
From 14 people (33/13): Gram positive Cocci
From 12 people (11/42): Enterobacter
From 10 people (9/52): Alkaligenes
From 9 people (8/57): Klebsiella
From 8 people (7/61): Pseudomonas
Also, from 5 people (4/76): HBS Virus and from 4 people (3/80) HCV Virus were isolated.
Also, from 4 people (3/80) Candida albicans fungus and from 2 people (1/90) Aspergillus fungus were isolated.
The incidence density of infection in wards of ICU was 60, in the CCU 39.64, in the internal ward 37.71, in the surgical ward 28.67, in the orthopedic ward 14.19, in the pediatric ward 12.42, in the infection ward 9.77, in the heart ward 5.4, in the nephrology ward 4.67, and in the ear, throat and nose ward 2.44 patients in ten thousand patients a day.
According to correlation test, there was a significant relationship between age and increase in incidence of hospital infection (P <0.01). Also, with this test, there was no relationship between gender and the incidence of nosocomial infections (P <0.05).
Discussion
According to the results, it was shown that the nosocomial infection with the specified factors is created in the range of 60-90 years old with the most frequent incidence due to immune system deficiencies, avitaminosis, diabetes, surgery, pneumonia and treatment staff (not observing the health by the doctor and nurse).
After this range, the most frequent incidence was observed in hospitalized infants. The relative frequency of nosocomial infections in this study was reported by urinary catheterization (42%), surgical wound (24%), lower respiratory tract (18%), blood flow (12%) and the other organs (14%). It shows that bacterial and fungus agents can lead to infection and even death, with the formation of biofilms on the equipment within the vessels and urinary catheterization. Therefore, it is essential to pay attention to the results of this research and to prevent the patients’ deterioration and their mortality with a low level of observance of the principles of prevention of these infections.
The results of this study, compared to other studies, show a lower incidence of nosocomial infections in this hospital that is due to the timely use of medical interventions, hand washing, health education, continuous monitoring of authorities, proper use of disposables, controlled use of antibiotics And proper care of the wounds of the surgery.
Since hospitals are the most important center in providing health services, due to having special conditions in terms of admission of people with different diseases, the existence of different service providers, visitors and companions of the patient is considered as a center of infection transmission. . Technological advances, the reduction of human resistance, the emergence of new drugs and, consequently, the reduction of the body’s defenses have increased the variety and number of nosocomial infections. This research, due to the clinical significance of this problem described above and the lack of accurate statistics of nosocomial infections in the country, especially in Qom province, in patients admitted to one of the major hospitals in Qom in 2007, which for special reasons Sorry it’s done. The results of this study, while comparing international statistics and detecting problems in the service system, require us to explain specific regulations to reduce the mortality rate of hospitalized patients with nosocomial infections.
Methods
This study is an incidence study and the data is collected prospectively. The study population was patients admitted to CCU and ICU wards
Men and women surgery, nephrology, neonatology and infectious diseases were one of the hospitals in the holy city of Qom during 2007-2008 – 2931.
At the beginning of the research, questionnaires were prepared and all points related to the diagnosis of nosocomial infections were taught to nurses working in the wards, especially head nurses. These included fever, weakness, lethargy, skin rashes, and muscle aches, and specific symptoms, including urinary tract, lung, and skin infections that appeared 48 hours after hospitalization, were isolated and evaluated.
In sterile conditions, specific samples of wounds, sputum, blood and urine were prepared from these patients and their associated components (such as angio, catheter, catheter, etc.) and transferred to the laboratory. Giemsa was performed simultaneously. For urine culture, two agar media: mechanical, mechanical, EMB were used, and for blood culture, two liquid culture media, TSB Castanda and lyscentrifuge method were used. Blood and mechanical agar were used in sputum culture and blood agar and chocolate agar were used in wound culture.
Sabour and dextrose agar with chloramphenicol and malt dextrose agar with chloramphenicol were used to detect fungi in the samples. After 24 hours of incubation, differential tests, catalase, oxidase, coagulase, indole, SIM, TSI, MRVP, citrate and urease were used to identify bacteria at the species level. After examining the direct sample and spreading if the fungus was seen, it was cultured in Saburo dextrose agar medium with chloramphenicol and malt dextrose agar with chloramphenicol and incubated after 24 hours for yeast and one week for saprophytes.
Yeast samples were then confirmed by biochemical test and chromium agar culture medium. The saprophyte sample was also confirmed by observing a direct sample of culture and culture slide preparation. Then the information obtained along with the information in each ward separately from the Hospital Information Information Software (HIS) such as name, age, sex, date of hospitalization, ward ward, disease cause of hospitalization, incidence of nosocomial infection, location Incidence of nosocomial infection, date of nosocomial infection and type of laboratory sample were recorded in the questionnaire.
To calculate the number of patients – days of hospitalization, the length of stay of patients was multiplied by the number of patients in each ward. To determine the incidence density, the number (Incidence Density) of the number of cases of nosocomial infections diagnosed in 2007 was divided by the total number of patients – the day of hospitalization in the same year and expressed in terms of ten thousand patients – days. The incidence of nosocomial infections was calculated as the number of nosocomial infections divided by the total number of hospitalized patients during 2007 with SPSS software.
Results
During 2008-2007, among the patients admitted to different wards of the hospital, 105 patients with nosocomial infections were identified based on the parameters of nosocomial infection, of which 50 (47.61) were female and 55 were male (52.38). The mean age was 26.4 ± 64.16 years with a range of several months to 121 years, of which 10.16% (12 patients) under 30 years, 23.72% (28 patients) between 30 and 59 years and 67 years. 79% (80 patients) were over 60 years old. The incidence of nosocomial infections in 2007 in this study was 35 per ten thousand patients. Depending on the duration of the study, the one-year incidence of nosocomial infections is 0.35%. Table 1, which we have rejected for the next article, shows the frequency of patients, patient rate – day of hospitalization, incidence rate and incidence rate by hospital treatment departments.
