ENVIRONMENTAL RISK FACTORS OF NOSOCOMIAL INFECTIONS IN NEUROLOGICAL INTENSIVE CARE UNIT

Background: The Centers of Disease Control and Prevention (CDC) estimate that 2 million patients develop hospital-acquired infection annually and as many as 88,000 die as a result, adding an estimated $5 billion to the annual national health care costs. Object:  To evaluate risk factors and methods of infection control in surgical site infections in postoperative neurosurgical patients.
Methods:  This study was prospective, uncontrolled and observational study conducted on patients with postoperative neurosurgical operation and admitted to Intensive Care Unit postoperatively.  The study was done in
Al-Azhar university hospitals from March 2017 to March 2018. The study aim was. Analysis of data was done by IBM computer using SPSS (statistical program for social science version 25).
Results:  In the study sample, the mean age and standard deviation (SD) were 42.5 years ±19.1. Female patients were about 40%. Most male patient were above median age of the sample (37.8 years). The overall admission period includes pre-ICU admission, ICU admission and post-ICU admission. The mean and standard deviation of overall admission was 43.7 day±5.5. From the whole study sample, nosocomial infection was estimated to be 88.4% of cases (69 patients). Postoperative mortality among cases was 36%. The rest of cases were either referred or discharged to ward. Comorbid conditions may present as single factor or multiple factors in the same patient. Patients with nosocomial infections were found to have two or more comorbid conditions while infection-free cases were found to have no or at least one factor in a statistically significant association. It has been found that most cases with traumatic brain injury and hemorrhagic stroke had nosocomial infection (74%). Both types mentioned previously had longer ICU stay.  It has been found that nosocomial infection is commonly predominant in traumatic brain injury and intracranial hemorrhage cases (ICH). 
Nosocomial infections were found to be either single or multiple infections in the same person. Most of infections were; respiratory tract infection, urinary tract infection or septicemia. When the entire study sample was subjected to logistic regression analysis, age, diagnosis and hospital stay, necessity for ventilation, low Glasgow Coma Scale (GCS), high temperature, high humidity and low karnofsky were found to be significantly independently predictive of postoperative nosocomial infection. Among these patients, type and timing of operative intervention and environmental factors did not significantly affect outcome.
Conclusion:  There are many risk factors of nosocomial infection in hospitalized neurosurgical treated, which requires strict monitor, including the development of various effective prevention measures and check of their implementation as well as effectiveness, to reduce the incidence of hospital infection.