Medicolegal and epidemiological aspects of nosocomial infection in Tanta University Hosital

ABSTRACT

Nosocomial infection [NCI] is considered a major problem of continuous forensic and public health interest. This study aimed at studying the magnitude of nosocomial infections [NCIs] at Tanta University Hospitals and some medicolegal and epidemiological aspects of this problem. A prospective surveillance was conducted to all admitted patients [8427] at the main six wards, at Tanta University Hospitals, during the first 6 months of the year 1998 for detecting cases of NCIs. Bacteriological examination was conducted to 480 patients of NCIs to isolate the causative organisms. All the detected cases were followed up to study mortality. 1535 cases of NCIs were detected out of 8427 patients admitted to the studied six wards during the 6 months period of the study, with a rate of 18.22%. The highest age group of affected male and female patients was 20 - < 30 years, followed by those aged 50 - < 60 years and children aged 1 - < 10 years. Males were significantly more affected than females with male/female ratio 1.06/1. The highest rate among male cases was in the intensive care unit [ICU] [28.37%], urology ward [26.20%] and pediatric ward [20.67%]. Among female cases, the highest rate was in the urology ward [44.94%], burn ward [31.71%] and both ICU and surgery wards in equal percents [25%]. Wound sepsis was the most frequent NCIs [48.14%]. Of them 75.64% were post-operative; especially in surgery and the obstetric and gynecology wards. The non post-operative wound sepsis represented 24.36% of all cases of wound sepsis. The most frequent NCIs in urology department were; UTIs [40.93%], and surgical procedures [31.63%], in the ICU were; cellulitis [27.27%] and both enteritis and pneumonia in equal percents [22.73%], in burn ward was only wound sepsis and in pediatric ward were; enteritis [33.21%], upper respiratory infections [27.86%] and UTIs [12.5%]. Gram -ve bacteria and Staphylococcus aureus were the commonest causative organisms [38.13% and 33.33% respectively]. Gram -ve bacilli were the causative organisms in about half of all NCIs in urology patients [49.67%], while Staphylococcus aureus was the most common causative organism in obstetric and gynecology department [52.20%]. Out of 1535 [total cases of NCIs], 102 [6.64%] patients died from nosocomial bacteremia [blood stream infection] and the main cause was respiratory infections [41.20%]. The dead cases represented the highest percents out of cases in the burn ward [68.18%], ICU [45.45%] and urology ward [10.23%]. The dead cases represented 6.72% in surgery ward, 4.11% in pediatric ward and 2.72% in the obstetric and gynecology ward. Dead cases represented the highest percents among male patients aged 10-< 20 years [11.86%] and elder patients 60-70 years [11.27%] Among female cases of NCIs, dead cases represented the highest percents among those aged 10 - < 20 years [10.98%] and 40 - < 50 years [8.47%]. The percent of deaths among male cases of NCIs was higher than female ones [7.47% and 5.77% respectively], with no significant difference. The highest frequency of antibiotic usage was reported for patients in the ICU [36.41%], followed by those in pediatric ward [26.80%] and urology ward [26.10%] The medical records in different wards were not properly written especially as regard history of previous diseases or previous hospitalization. Negligence was present in recording NCIs in the patients files and discharge abstract. There was a delay in performing laboratory procedures [especially microbiological]. So, proper recording of discharge diagnosis including complications of medical care is essential for accurate evaluation of care. Establishment of an infection control unit, for registration, prevention and control of NCIs in different wards at Tanta University Hospitals was recommended