| Objective:1.To investigate the present situation and characteristics of hospital-acquired infections(HAIs)in elderly patients,and identify the key parts and main pathogenic bacteria of HAIs in elderly patients,so as to provide the basis for carrying out targeted monitoring.2.Assess the economic burden of HAIs in elderly patients,and hope that by quantifying the burden of HAIs in monetary form,medical institutions will be forced to pay attention to patient safety and enhance the implementation of existing control measures.3.Analyze the risk factors of HAIs in elderly patients,build a risk prediction model of HAIs and determine the risk threshold,so as to help medical institutions find potential high-risk patients with HAIs as early as possible,realize the advancement of infection management and reduce unnecessary waste of health resources.Method:1.Investigation on the status of HAIs in elderly patients: The data of4548 elderly inpatients discharged from the Department of Geriatrics of a Grade A hospital from January 1,2017 to December 31,2019 were collected retrospectively,and descriptive statistical analysis was made on the HAIs status of patients by frequency,composition ratio and rate.2.Study on the economic burden of HAIs in elderly patients: The research samples come from the first step of “Investigation of HAIs Status”(but in order to avoid the influence of death on the follow-up medical expenses,the dead cases were excluded),with the patients with HAIs as the infection group and the patients without HAIs as the control group,and the PSM matching method was used for 1:1 case-control matching.Wilcoxon rank sum test was used to compare the hospitalization expenses and hospitalization days of two groups of patients,so as to evaluate the direct economic burden of HAIs,and on this basis,to evaluate the indirect economic burden of HAIs,the economic burden of hospitals and the loss of medical insurance funds.3.Study on the construction of HAIs risk prediction model for elderly patients: Taking the data of 4548 cases in the first step “Investigation of HAIs Status” of this study as the modeling group,the independent risk factors of HAIs were screened out by univariate analysis and binary Logistic regression analysis,and the HAIs risk prediction model was constructed and verified internally.Determine the risk threshold of forecasting model by integrating the area under ROC curve.Using convenient sampling method,the newly collected data from the same center(500 elderly patients from January to April,2020)were collected as the validation group,and the model was validated in external time.Results:1.Investigation on the status of HAIs in elderly patients(1)Incidence of HAIs: There were 372 cases of HAIs(8.18%),616 cases of HAIs(13.54%),which was higher than the level of HAIs in the whole hospital during the same period(infection rate was 2.65%,infection rate was 3.45%).From 2017 to 2019,the incidence of HAIs and the incidence of HAIs cases of elderly patients in geriatrics department showed an upward trend.(2)Sites of HAIs: Among the 616 HAIs sites,the following respiratory tract infections were the main ones(383 cases,with a composition ratio of 62.18%),followed by urinary system infections(114cases,with a composition ratio of 18.51%).(3)Pathogens of HAIs: 523 strains of pathogenic bacteria and 342 strains of gram-negative bacteria were detected in the samples,accounting for 66.15% of the total number of pathogenic bacteria;124 strains of gram-positive bacteria,accounting for 23.99% of the total number of pathogenic bacteria;50 strains of fungi,accounting for 9.67% of the total number of pathogenic bacteria;1 strain of mycoplasma,accounting for0.19% of the total pathogenic bacteria.Among gram-negative bacteria,Pseudomonas aeruginosa ranked first,followed by Escherichia coli.Among gram-positive bacteria,Enterococcus ranked first,followed by Staphylococcus aureus.Pseudomonas aeruginosa and Klebsiella pneumoniae were the main pathogens in lower respiratory tract infection,and Escherichia coli and Enterococcus were the main pathogens in urinary system infection.2 The economic burden of HAIs in elderly patients(1)Economic burden of patients: The median hospitalization expenses of patients with infection group were 39 048.96 yuan,while the median hospitalization expenses of patients with control group were 13 952.87 yuan,with a median difference of 25 096.09 yuan;The median hospitalization days of infected patients were 33.00 days,while the median hospitalization days of control patients were 13.50 days,with a median difference of 19.50 days.The indirect economic burden were 6,639.36 yuan.The total economic burden of each infected patient were 31 735.45 yuan.The economic burden of HAIs increased with the increase of age,number of infected sites and CCI score.(2)Medical insurance and hospital economic burden: The loss of medical insurance funds were 17,573.81 yuan per employee medical insurance patient and 3,595.33 yuan per resident medical insurance patient.For every case of HAIs,the number of patients admitted to the hospital decreased by 1.44,and the income of the hospital decreased by 1004.60 yuan due to the decrease of one patient admitted to the hospital.(3)Details of increased costs of HAIs: The increase of medical expenses mainly included western medicine,antibacterial drugs,treatment and laboratory expenses,accounting for 68.18% of the total increased costs.3 Construction of risk prediction model for HAIs in elderly patients(1)Risk factors of HAIs: Binary Logistic regression analysis showed that there were 12 independent risk factors of HAIs in elderly patients: age,admission route,HAIs,indwelling catheter,antibiotic types,antibiotic days,disease types,chronic lung disease,hemiplegia,malignant tumor,CCI score and hospitalization days.(2)HAIs prediction model: According to the independent risk factors of HAIs and the corresponding regression coefficient,the regression equation was constructed as follows: Logistic(P)=-7.309+0.225*age+coefficient * admission route +0.556* infection outside hospital+0.661* catheter use +0.503* antibiotic type +0.242* antibiotic days used.(3)Internal and external test of the model: The area under the ROC curve of the model in the modeling group was 0.932,and the specificity sensitivity,and prediction accuracy of the model were 87.43%,84.41% and87.18%,respectively.In the validation group,the area under ROC curve was 0.923,the specificity,sensitivity and prediction accuracy of the model were 82.33%,94.44% and 86.4%,respectively.Regression model has a good ability to discriminate HAIs.(4)Risk threshold of infection: When the predictive probability of HAIs rate was > 0.06615(6.615%),the patient will have HAIs.That is,the risk threshold of HAIs was 0.06615(6.615%).Conclusion:1.Elderly patients were the high-risk group of HAIs,which leaded to heavy economic burden.It reminds medical workers to take elderly patients as the key monitoring group of HAIs,strengthen the implementation of existing control measures,and determine the threshold of infection risk by using the early warning and management system of HAIs risk,so as to promote the transformation from post-treatment to pre-prevention of HAIs.Reduce the incidence of HAIs and save medical and health resources.2.Western medicine,antibacterial drugs,treatment and laboratory fees have become important breakthroughs in controlling direct medical costs.Good disinfection and isolation measures,focusing on prevention and treatment of multi-site infection and lower respiratory tract infection,accurate and rational use of antibiotics according to drug sensitivity test results,and shortening hospital stay of patients have become important strategies to reduce economic burden. |
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