[Monitoring of hospital infections in cardiac surgery ward].

INTRODUCTION

The development of techniques applied in cardiac surgery changed the profile of operated patients. Patients with small lesions within the cardiovascular system are treated using invasive cardiology. The occurrence of infections is directly related to the type of surgery and the implanted material. Many hospitals, even in the developed countries, contend with hospital infections, which are the source of serious clinical and economic problems. Paradoxically, problems associated with hospital infections have grown worse along with advances in medicine and the implementation of new invasive diagnostic methods. Cardiac surgery wards are specialist units, where infections among patients are quite common. Hospital infections are dangerous for patients' health and even life. They also contribute to the failure of therapy. Therefore, the awareness of infections and their reasons, which may help to control and eliminate this problem, is so important. The aim of this study was an annual forward-looking analysis of hospital infections in the cardiac surgery ward, which included: patients' profiles, clinical forms of infections, aetiological factors and infection risk factors in patients with various types of cardiac surgical procedures.

MATERIAL AND METHODS

This forward-looking study involved all patients hospitalised in the Cardiac Surgery Clinic, the Pomeranian Medical University of Szczecin in the period 1.01-31.12.2008. The total number of participants was 1127, including 804 (71.3%) men and 323 (28.7%) women. analysis of procedures used in cardiac surgery wards so far and the offer of optimal prevention measures. Each patient had his/her own infection registration card. The material for microbiological tests was taken in accordance with a routine procedure once a week or in cases of suspected infections.

CONCLUSIONS

1. Infections were detected in 7.2% of patients. 2. Death rates among patients with infections was higher in women than in men (46.2% vs 33.3%). 3. The most common clinical forms of infection were pneumonia (44.4%), sepsis (42.0%) and surgical site infection (33.3%), however every infected patient had 1-4 clinical forms. 4. The most common aetiological factors of infection, irrespective of a clinical form, were Gram-negative rods with the prevalence of Enterobacter cloacae and Pseudomonas aeruginosa. 5. Patient-related infection risk factors included overweight and womens' age > 72, while a statistically significant increase in the incidence of infections was found in patients who had not received anti-thrombosis treatment. 6. Infection risk factors associated with treatment and specificity of the cardiac surgery ward were mainly: artificial ventilation > 24 h, the necessity for reoperation, a blood transfusion, pressor administration, treatment complications, as well as not using extracorporeal circulation and surgical site drainage. 7. Risk factors related to treatment complications included mainly: circulatory problems, renal insufficiency, respiratory insufficiency, low cardiac output syndrome and ischaemic cerebral stroke. 8. There were no correlations between infections and the course of surgery, the type of a prosthesis (mechanical/biological) or catheterization of vessels and the bladder. 9. The presented results enable the analysis of procedures used in cardiac surgery wards so far and the offer of optimal prevention measures.