A Study On Influencing Factors And Direct Economic Losses Of Nosocomial Infection In A Tertiary Teaching Hospital's Integrated ICU

Part I The investigation about Influencing Factors of Nosocomial Infection in ICUObjective Investigating the actual state and the characteristics of nosocomial infections (NI) in integrated ICU and analysing the related risk factors of NI in order to supply scientific evidences for intervening measures and reduce the incidence of NI in integrated ICU.Methods NI of all the integrated ICU inpatients in a tertiary teaching hospital from January 2004 to December 2010 were retrospectively studied and prospectively surveyed (The inpatients before 2007 were retrospectively studied and the inpatients after 2007 were prospectively surveyed). Through Chi-square test, the data was classified and compared.Results Of the 2060 integrated ICU inpatients investigated during 7 years, 662 patients and 911 cases suffered from NI with infection. Hospital infection rate was 32.14% and the infection case-rate was 44.22%. Lower respiratory tract infection ranked first in nosocomial infection, followed by the urinary tract. Of 662 infected cases,1 439 strains were detected of which 1033 strains were Gram-negative bacteria (71.79%). Pseudomonas aeruginosa ranked first, followed by Acinetobacter baumannii. The infection rate of the integrated ICU inpatients who was dead was 41.5%. Which was higher than that was not dead (27.69%). Of all the inpatients in ICU, the NI rates in the patients with complex trauma, lung infection and cerebrovascular disease were 50.89%,49.02%,48.24% respectively. After Chi-square test, that was known different sex, length stay, disease grading, some kinds of disease, the amount of primary disease, invasive operation and immunosuppressant, but no statistical significance was among the difference from hospital infection rate of patients with different age. Conclusions We should take effective measures to reduce the morbidity of NI of the patients in ICU because they are the high risk population. We should pay more attentions to the patients with the disease as follows: complex trauma, lung infection, cerebrovascular disease, and respiratory disease. The hospital infection rate in men was higher than in women (P<0.05). And it increased gradually along with the severity of illness, the amount of the previous diseases and the hospitalization time (P<0.05).The patients in ICU are susceptible population of nosocomial infection. We should pay much more attention to monitor the main factors and take effective measure to reduce the incidence of infection and improve the medical quality.PartⅡStudy on Direct Economic Losses of Nosocomial Infections in ICUObjective To evaluate the direct economic costs of nosocomial infections in ICU, to analyse the related factors.Methods The retrospective study and prospectively surveyed were conducted and according to the mate conditions,182 pairs of cases (patients with nosocomial infection were described as infection group and patients without nosocomial infection were described as control group) that were collected in a tertiary teaching hospital during from January 2004 to December 2010. The direct economic losses and the time of hospitalization were analyzed. Results The median of total hospitalization expenses of each case were 91 977.12 and 31 015.78 Yuan in infection and control group respectively, infection group was significantly higher than control group (P<0.05).The main increased expenses of hospitalization were medicine cost and therapy costs.The direct economic loss varied from infection sites,the loss from respiratory tract was higher than other single infection. The loss from mulriple infection was heaviest.The direct economic loss of nosocomial infection of patients with circulatory system diseases ranked first, followed by patients with digestive system disease and patients after tumor surgery.The direct economic loss of men is higher than women. The direct economic loss varied from severity of disease. The loss of E grade is highest. The median of hospitalization days of each patient in infection group and control group were 17.0 and 6.0 days respectively, there was significant difference between them(P<0.05). The extension of hospitalization days of patients with multilocation infection was 26.0 days.Conclusions Nosocomial infections of ICU inpatients during hospitalization caused significant increase in the medical expense of managing the underlying disease which led to hospitalization of the patients and reduced the tumover rate of patient bed, and cost of nosocomial infection was much more than that for common nosocomial infections. Good measures of controlling nosocomial infection could bring tremendous social and economic benefits.