The analysis of the occurrence of nosocomial infections in the neurosurgical ward in the District Hospital from 2003-2012.

INTRODUCTION: The patients in the neurosurgical ward are exposed to many risk factors causing nosocomial infections. These factors are related to operations, invasive diagnosing and monitoring of the nervous system and mechanical support of vital functions. Therefore, the objective of the undertaken studies was to assess the prevalence and structure of the healthcare-associated infections (HAI) in patients hospitalized in the neurosurgical ward in the St. Lukas District Hospital in Tarnów.

MATERIAL AND METHODS: The analyzed data concerned 13,351 patients hospitalized from 2003 to 2012. To analyze the data, the standard epidemiological methods and standardized definitions of nosocomial infections proposed by European Center for Disease Prevention and Control (ECDC) were used (1, 2).

RESULTS: 516 cases of nosocomial infections were detected. The most common infections among these cases were surgical site infections (SSI). The number of SSIs cases was 140 and cumulative incidence rate (CI) per 100 operations was 1.72%, including: 52 cases of craniotomy (CRAN) (CI per 100 operations was 2.44%); 50 cases of spinal fusion (FUSN) (CI was 3.32%); 24 cases of laminectomy (LAM) (CI was 0.93%); 10 cases of ventricular shunt operations (VSHN) (CI was 3.75%); 4 cases of other operations (OTH) (CI was 0.23%). The second most common infections were bloodstream infections (BSI) with 128 cases (CI was 0.96%), including: 91 cases of primary BSI and 37 cases of secondary BSI and the incidence density rate (ID) was 4.75 per 1000 central catheter days. The third most common infection was pneumonia (PN) with 127 cases (CI was 1.02%), with incidence density rate of 51.07 per 1000 intubation-days. The next most common detected infections were urinary tract infections (UTI) with 74 cases (CI was 0.58%). This type of infections included: 65 cases of infections associated with a urinary catheter and 9 cases not associated with a urinary catheter. The incidence density for UTI with a urinary catheter was 1.93 per 1000 urinary catheter days. The list of detected infections is closed by gastrointestinal system infections (GI) with 35 cases (CI was 0.23%) and the skin and soft tissue infections (SST) with 12 cases (CI was 0.07%). The etiological agent that was most frequently isolated from materials gathered from patients diagnosed with SSI, BSI and SST was Staphylococcus aureus. Acinetobacter baumannii was the most frequently detected in the cases of PN, Escherichia coli in the cases of UTI, and Clostridium difficile in the cases of GI.

CONCLUSIONS: Ten-year observation of infections detected in the neurosurgery ward gave the possibility to conduct a thorough epidemiological analysis of prevalence of nosocomial infections with recommendation aiming at reasons for prevention.