Jagannath, C (2008) Prospective study of Nosocomial Infection among Dermatology Inpatients in a Tertiary Care Centre in South India. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Nosocomial infection (NI) is defined as an infection developing in hospitalized patients, which was neither present nor in incubation at the time of their admission. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 10 days after hospital discharge. Nosocomial infections cause substantial morbidity and mortality, prolong the hospital stay of affected patients, and increase direct patient-care costs.3 NI is among the most difficult problems confronting clinicians who deal with severely ill patients. The incidence of these hospital-acquired infections varies with the size of hospitals, with specialties of wards, and with many other factors such as length of hospital stay, local trends in antibiotic usage, nursing and hygiene conditions, hospital design and geographical distribution of patients at risk. An average incidence of NI can be estimated at 5-10%, with higher rates in large university hospitals, and reaching up to 28% in the intensive care unit (ICU). The Study on the Efficacy of NI Control (SENIC) in 1975 in USA, found that NI develops in 5%-6% of hospitalized patients.5 Later in 1984, the National Nosocomial Infection Surveillance (NNIS) in USA, found an overall rate of 3.4 infections per 100 patients discharged and suggested that the true incidence is underestimated. In general, it is expected that the incidence of NIs in dermatology patients will be low, but information on the occurrence of NIs in dermatology care is very limited. However, as these infections may lead to a prolonged hospital stay and severe complications, it is useful to provide dermatologists with more detailed data on the incidence on NIs in this setting. The incidence of sepsis in dermatology inpatients in a study in AIIMS, Delhi in India was reported to be 6.6%. There is a paucity of data on the incidence of NI and of risk factors for acquiring NI among dermatology inpatients and this has prompted this study. AIMS AND OBJECTIVES : 1. To study the incidence of NI among a cohort of dermatology inpatients in a tertiary care centre. 2. To study the pathogens responsible for NI and their antibiotic susceptibility. 3. To study the risk factors for NI in these patients. MATERIALS AND METHODS : STUDY DESIGN : A prospective cohort study STUDY SETTING : The study was conducted in the dermatology inpatient ward of Christian Medical College Vellore, a tertiary care centre, in Tamil Nadu. The dermatology ward included a general ward of 20 beds (a room with 5 beds for females, 2 rooms with 7 beds each for males and a single room), isolation ward and 2 private ward blocks with single and double bed rooms. STUDY SUBJECTS: The patient population included all patients admitted under the department of Dermatology, Venereology and Leprosy during the study period. Inclusion criteria: All inpatients who were admitted with skin diseases to the dermatology ward during the study period and who gave informed consent were included in the study. Exclusion criteria: • Patients who had been hospitalized 10 days prior to the present. episode of hospitalization. • Patients hospitalized for < 48 hours. • Patients who did not give informed consent to participate in the study. DURATION OF STUDY: Patients were recruited in the study from 1st November 2006 till 15th September 2007. RESULTS : A total of 421 patients were admitted during the study period of which there were 260 males and 161 females. Their age ranged from 4 months to 84 years [mean 39.53 ± SD 18.42]. The details of underlying primary dermatological diagnosis of the study group are given in table 4. The most common dermatological condition was psoriasis which was seen in 71 patients (16.86%) followed by autoimmune-bullous disorders in 50 (11.87%), and Hansen’s disease in 43 patients (10.21%). Out of 421, 144 (34.2%) patients had diseases which predisposed to skin failure. CONCLUSIONS : 1. The incidence of NI in dermatology inpatient study group was 4.05 / 100 discharges with an incidence rate of 6.24 infections /1000 hospital days. 2. Autoimmune bullous diseases were the commonest dermatological diagnosis among patients who developed NI (7/17, 41%). 3. The types of NI seen were skin infections in 13 patients, SSI in 2 patients, urinary tract and blood stream infection in 1 patient each. 4. The commonest organism causing an NI in our study population was S. aureus (63.6%) and among these there was only one isolate of MRSA. 5. Gram negative organisms causing NI were 22.72% of the isolates, and pseudomonas, E.coli, and P.mirabilis were resistant to all first line antibiotics. 6. Median time to onset of NI was 11 days (IQR 8.10, 13.90.) 7. Nosocomial infection was significantly associated with the following factors. (a) Previous hospitalization (OR5.09, 95% CI 1.46 – 17.83) p value=0.01. (b) Infection at admission (OR 5.51, 95% CI 1.29 – 111.32) p value=0.029. (c) Invasive procedures (OR 18, 95% CI 3.08 – 93.68) p value=0.0000. 8. Median duration of hospital stay among patients with NI was 21 days (IQR 13, 25) and was significantly associated with NI (OR1.51, 95% CI 1.19 – 1.92) p value=0.001. 9. Overall mortality rate among the study population was 0.48%, and mortality among patients with NI was 11.76%.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Nosocomial Infection ; Dermatology Inpatients ; Tertiary Care Centre ; South India ; Prospective study. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Mar 2018 16:13 |
| Last Modified: | 03 Mar 2018 05:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5999 |
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