Skip to main content
Journal of Clinical and Diagnostic Research : JCDR logoLink to Journal of Clinical and Diagnostic Research : JCDR
. 2014 Feb 3;8(2):81–83. doi: 10.7860/JCDR/2014/6673.4014

Hospital Acquired Infections Among Patients Admitted in the Medical and Surgical Wards of a Non-Teaching Secondary Care Hospital in Northern India

I Ginawi 1,, Mohd Saleem 2, Mastan Sigh 3, AK Vaish 4, I Ahmad 5, VK Srivastava 6, A Fahad M Abdullah 7
PMCID: PMC3972606  PMID: 24701489

Abstract

Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India.

Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study.

Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient’s bacterial isolates were Gram positive (Surgical=64.1, Medical=80%).

Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals.

Keywords: Hospital infection, Gram positive bacteria, Bacterial isolates

Introduction

Nosocomial Infections (NI) occur worldwide and affect both developed and developing countries. Infections acquired in health care settings are among the major causes of death and increased morbidity among hospitalized patients. These infections result in substantial morbidity, mortality and increased financial burden. NI are also important public health problems in developing countries as well as in developed countries. The socio-economic impact, i.e., prolongation of hospitalization, mortality and cost, of these infections adversely affects patients and nation’s economic well-being [1,2]. A incidence survey was conducted under the auspices of World Health Organization (WHO) in 55 hospitals of 14 countries representing four WHO Regions (Europe, Eastern Mediterranean, South-East Asia and Western Pacific) showed an average of 8.7% of hospital patients had NI. At any time, over 1.4 million people worldwide suffer from infectious complications acquired in hospital [3]. The highest frequencies of NI were reported from hospitals in the Eastern Mediterranean and South-East Asia Regions (11.8 and 10.0% respectively), with a incidence of 7.7 and 9.0% in the European and Western Pacific Regions respectively [4].

Risk factors for the development of NI in the Surgical Intensive Care Unit (SICU) setting include poor nutritional status, exposure to multiple antibiotics, indwelling central venous catheters, mechanical ventilation and length of Intensive Care Unit stay [5]. The most common resistant gram-positive organisms encountered in the hospital setting are methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE). Among nosocomial gram-negative pathogens, Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter baumannii are most prevalent.

The present study was carried out to investigate the incidence of NI and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in northern India.

Materials and Methods

Study Design

This was a cross-sectional hospital based study conducted in a non-teaching secondary care hospital between January 2011 to December 2012.

Study Site

Wards of General Medicine, General Surgery and Orthopaedic departments of the hospital.

Patients

The patients were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study.

Nosocomial Infection

Patients who had no infection or they had not been in incubation period on the basis of signs and symptoms; at the admission time and had positive culture after third day of admission, were defined as patients with NI in the present study [6].

Data Collection

Pus, blood, urine, sputum and swabs from various lesions if present among study patients was taken after 48 hour of admission and followed till discharge from the hospital.

Strain Identification

Bacterial strain was identified with the help of gram staining and biochemical tests. Mainly, facultative anaerobes and aerobic bacteria such as Staphylococcus aureus, streptococcus facealis, bacillus subtilis, E-coli, Klebsiella, Proteus species, Pseudomonas species and clostridium species was taken into consideration as per guidelines of CDC [7].

Statistical Analysis

The data collected was entered in the Microsoft Excel computer program and checked for any inconsistency. The results are presented in proportions/percentages. The Chi-square test was used to assess the associations. The p-value <0.05 was considered as significant. All the analysis was carried out by using SPSS 16.0 version.

Ethical Consideration

Ethical clearance was taken from the Ethical Committee of the hospital. The consent was taken from each patients included in the study.

Results

A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. [Table/Fig-1] describes the bio-social characteristics of the patients. Overall incidence of NI was found to be 26.1%. The incidence of NI was higher among the patients of medical (28%) ward than surgical (24.5%) ward, however, the difference was statistically insignificant (p=0.58) [Table/Fig-2].

[Table/Fig-1]:

Distribution of patients by bio-social characteristics

Bio-social characteristics Medical (n=82) Surgical (n=94) Total (n=176)
no. % no. % no. %
Age Group
<15 4 4.9 4 4.3 8 4.5
15-25 12 14.6 12 22.3 33 18.8
26-35 15 18.3 15 12.8 27 15.3
36-45 14 17.1 14 19.1 32 18.2
46-55 19 23.2 19 11.7 30 17.0
>55 18 22.0 18 29.8 46 26.1
Sex
Male 45 54.9 65 69.1 110 62.5
Female 37 45.1 29 30.9 66 37.5
Religion
Hindu 74 90.2 89 94.7 163 92.6
Muslim 8 9.8 5 5.3 13 7.4
Cast
General 16 19.5 18 19.1 34 19.3
Backward 22 26.8 23 24.5 45 25.6
Scheduled 44 53.7 53 56.4 97 55.1
Education
Illiterate 53 64.6 57 60.6 110 62.5
< High school 12 14.6 16 17.0 28 15.9
High school-Intermediate 12 14.6 17 18.1 29 16.5
Graduate+ 5 6.1 4 4.3 9 5.1
Occupation
Service 26 31.7 31 33.0 57 1.7
Professional 0 00 3 3.2 3 7.4
Agriculture 11 13.4 2 2.1 13 26.7
Housewife 28 34.1 19 20.2 47 21.6
Unemployed 13 15.9 25 26.6 38 10.2
Labour 4 4.9 14 14.9 18 10.2
SES
II 6 7.3 9 9.6 15 8.5
III 6 7.3 9 9.6 15 8.5
IV 5 6.1 11 11.7 16 9.1
V 65 79.3 65 69.1 130 73.9

[Table/Fig-2]:

Prevalence of Nosocomial Infection (NI) in different wards of the hospitals *p=0.58

Wards Nosocomial infection
No. screened No. with NI % with NI
Medical* 82 23 28.0
Surgical* 94 23 24.5
Total 176 46 26.1

Acinetobacter baumanii was isolated in 89.1% patients. The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards [Table/Fig-3].

[Table/Fig-3]:

Distribution of different types of organism among patient’s biological specimen *Multiple responses, 1Between tertiary and secondary care hospitals, *Significant

Type of hospital/organism* Nosocomial infection p-value1
Medical patient with organism (n=23) Surgical patient with organism (n=23) Total patient with organism (n=46)
Enterococcus faecalis No 21 13 34 0.007*
% 91.3 56.5 73.9
Acinetobacter baumanii No 22 19 41 0.15
% 95.7 82.6 89.1
Escherichia coli No 13 8 21 0.13
% 56.5 34.8 45.7
Pseudomonos aeruginosa No 10 10 20 1.0
% 43.5 43.5 43.5
Staphylococcus aureus No 9 7 16 0.53
% 39.1 30.4 34.8
Klebsiella pneumoniae No 10 13 23 0.37
% 43.5 56.5 50.0
Coagulase- negative staphylococcus No 0 8 8 0.002*
% 0.0 34.8 17.4

Overall, among the patients who developed NI, 27.2% patient’s bacterial isolates were Gram positive and 72.8% patient’s bacterial isolates were Gram negative. The Gram negative bacterial isolates were lower in surgical ward (64.1%) than medical ward (80%) [Table/Fig-4].

[Table/Fig-4]:

[Table/Fig-4]:

Distribution of Gram positive and Gram negative bacterial isolates among patient’s biological specimen

Discussion

NI are infections acquired during hospital cares which are not present or incubating at admission. Infections occurring more than 48 hours after admission are usually considered nosocomial. Definitions to identify NIs have been developed for specific infection sites (e.g., urinary, pulmonary). These are derived from those published by the Centers for Diseases Control and Prevention (CDC) in the United States of America [8,9] or during international conferences [10] and are used for surveillance of NI. They are based on clinical and biological criteria, and include approximately 50 potential infection sites. NI may also be considered either endemic or epidemic. Endemic infections are most common. Epidemic infections occur during outbreaks, defined as an unusual increase above the baseline of a specific infection or infecting organism.

In the present study, overall incidence of NI was found to be 26.1%. The incidence of NI was higher among the patients of medical (28%) ward than surgical (24.5%) ward, however, the difference was statistically insignificant (p=0.58). Similar finding was seen by Kamat et al., [11], which is higher than the previous studies in which Infection rate were 16.4% [12] and 13% [13] and lower than following studies where NI rate was 27.4% [14].

Incidence of NI is increasing day by day. The factor that can account for the higher infection rate may be the availability of high number of visitors, lack of knowledge and proper monitoring and setup of the hospital. This slight increase in the incidence of NI in this hospital may paralleled to paying attention to well established processes for decontamination and cleaning of soiled instruments and other items, followed by sterilization and high-level disinfection processes and improving safety in operating rooms and other high-risk areas where the most serious and frequent injuries and exposures to infectious agents occur.

In other studies, the commonest bacterial organisms were Escherichia coli (51.0%), Klebsiella species (19.6%) and Proteus mirabilis (10.0%) [15]. Gram negative bacilli accounts for 194 (54.34%), Klebsiella pneumoniae 60 (31%) was the commonest [16] and Acinetobacter baumannii accounted for 41.8% (n=18) of all the infections [17]. In another study the most common microorganisms were Escherichia coli (64.3%), coagulase negative staphylococci (11.2%) and Klebsiella (8.1%) [18]. In this study, the isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. These findings are almost in agreement with other studies.

Gram negative bacteria causes thousands of hospital acquired infections each year. It is estimated that approximately 30% of all the hospital acquired infections are caused by Gram negative bacteria, and that they are responsible for approximately 70% of all hospital acquired infections contracted in the Intensive Care Unit [19]. In the present study, Overall, among the patients who developed NI, 27.2% patient’s bacterial isolates were Gram positive and 72.8 percent patient’s bacterial isolates were Gram negative. The Gram negative bacterial isolates were lower in surgical ward (64.1%) than medical ward (80%). Vanitha et al., [20] reported that in most of the studies, Gram-negative bacilli have taken over the Gram positive organisms, especially in hospital settings and Gram negative bacteria were predominant (58%). Another study reported the incidence of 80.96% for Gram-negative and 18% for Gram-positives [21].

Conclusion

The incidence of NI is increasing in the hospitals, so that the more care has to be taken in the cleaning the wards of the hospitals.

Financial or Other Competing Interests

None.

References

  • [1].Apostolopoulou E, Katsaris G. Socioeconomic Impact of Nosocomial Infections. Icus Nurs Web J. 2003 [Google Scholar]
  • [2].Celik I, Inci N, Denk A, Sevim E, Yasar D, Yasar MA. Prevalence of hospital acquired infections in anesthesiology intensive care unit. Fırat Tıp Dergisi. 2005;10:132–35. [Google Scholar]
  • [3].Tikhomirov E. WHO Programme for the Control of Hospital Infections. Chemiotherapia. 1987;3:148–51. [PubMed] [Google Scholar]
  • [4].Mayon-White RT, et al. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect. 1988;11(Supplement A):43–48. doi: 10.1016/0195-6701(88)90164-8. [DOI] [PubMed] [Google Scholar]
  • [5].Apostolopoulou E, Stergiopoulou A, Telalidou K, Konstantopoulou G, Giannatou M, Skotis I. Socioeconomic impact of nosocomial infections in surgical intensive care unit. Icus Nurs Web J. 2005 [Google Scholar]
  • [6].Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128–40. doi: 10.1016/0196-6553(88)90053-3. [DOI] [PubMed] [Google Scholar]
  • [7].Teresa C Horan, Mary Andrus, Margaret A. Dudeck, Atlanta, Georgia. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32. doi: 10.1016/j.ajic.2008.03.002. [DOI] [PubMed] [Google Scholar]
  • [8].Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control. 1988;16(3):128–40. doi: 10.1016/0196-6553(88)90053-3. [DOI] [PubMed] [Google Scholar]
  • [9].Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definition of surgical wound infections. Am J Infect Control. 1992;20(5):271–74. doi: 10.1016/s0196-6553(05)80201-9. [DOI] [PubMed] [Google Scholar]
  • [10].McGeer A, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991;19:1–7. doi: 10.1016/0196-6553(91)90154-5. [DOI] [PubMed] [Google Scholar]
  • [11].Kamat US, Ferreira AMA, Savio R, Motghare DD. Anti Microbial Resistant Among Nosocomial Isolates in a teaching Hospital in Goa. Ind J of Comm Med. 2008;33:89–92. doi: 10.4103/0970-0218.40875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [12].Habte-Gabr E, Gedebou M, Kronvall G. Hospital-acquired infections among surgical patients in Tikur Anbessa Hospital, Addis Ababa, Ethiopia. Am J Infect Control. 1988;16:7–13. doi: 10.1016/0196-6553(88)90004-1. [DOI] [PubMed] [Google Scholar]
  • [13].Gedebou M, Kronvall G, Habte-Gabr E, Ringertz S. The bacteriology of nosocomial infections at Tikur Anbessa Teaching Hospital, Addis Ababa. Acta Pathol Microbiol Immunol Scand (B) 1987;95:331–36. doi: 10.1111/j.1699-0463.1987.tb03134.x. [DOI] [PubMed] [Google Scholar]
  • [14].Shalini S, Kranthi K, Bhat Gopalkrishna K. The Microbiological Profile of Nosocomial Infections in the Intensive Care Unit. Journal of Clinical and Diagnostic Research. 2010;(4):3109–12. [Google Scholar]
  • [15].Nwadioha SI, Nwokedi EE, Jombo GTA, Kashibu E, Alao OO. Antibiotics susceptibility pattern of uropathogenic bacterial isolates from community- and hospital- acquired urinary tract infections in a nigerian tertiary hospital. The Internet Journal of Infectious Diseases. 2010;8(1) [Google Scholar]
  • [16].Anbumani N, Kalyani J, Mallika M. Distribution and antimicrobial susceptibility of bacteria isolated from blood cultures of hospitalized patients in a tertiary care hospital. Indian Journal for the Practising Doctor. 2008;5(2):5–6. [Google Scholar]
  • [17].Prashanth K, Badrinath S. Nosocomial infection due to acinetobacter species: Clinical findings risk and prognostic factors. Indian Journal of Medical Microbiology. 2006;24(1):39–44. doi: 10.4103/0255-0857.19893. [DOI] [PubMed] [Google Scholar]
  • [18].Sohrabi MB, Khosravi A, Zolfaghari P, Sarrafha J. Evaluation of nosocomial infections in Imam Hossein (as) Hospital of Shahrood, 2005. Journal of Birjand University of Medical Sciences. 2009;16:33–39. [Google Scholar]
  • [19].Peleg Anton Y, Hooper David C. Hospital-acquired infections due to gram negative bacteria. The New England Journal of Medicine. 2010;362:1804–13. doi: 10.1056/NEJMra0904124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [20].Vanitha Rani N, Kannan Gopal, Venkata Narendra M, Vishwakanth D, Nagesh VRD, Yogitha M. Aretrospective study on blood stream infections and antibiotic susceptibility patterns in a tertiary care teaching hospital. Int J Pharm Sci. 2012;4(1):543–48. [Google Scholar]
  • [21].Mehta MP, Dutta, Gupta V. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in North India. Jpn J Infect Dis. 2005;58:174–76. [PubMed] [Google Scholar]

Articles from Journal of Clinical and Diagnostic Research : JCDR are provided here courtesy of JCDR Research & Publications Private Limited

RESOURCES