Study On The Related Factors Of Nosocomial Infection And Direct Economic Losses In Renal Transplant Patients In A Tertiary Teaching Hospital

ObjectiveUsing the method of prospective target monitoring, renal transplant patients in department of organ transplantation in a tertiary teaching hospital were investigated. To investigate the status of nosocomial infection and analyze the related factors, interventions were taken to reduce the incidence of nosocomial infection. Investigate the cost and hospitalization time of patients and analyze the direct economic losses caused by nosocomial infection to supply basis for health department to develop relevant policies.MethodsUsing of cluster sampling methods, renal transplant patients at department of organ transplantation from January1,2008to December31,2012were objective monitored of nosocomial infection and filled in the self-made "the registration forms of the renal transplantation patients" and "the Nosocomial infection questionnaire", and the hospitalization expenses were collected. Patients with nosocomial infection were described as infection group and patients without nosocomial infection was described as control group. All the data were analyzed by SPSS (version16.0). General information was described with rate, percentage and other descriptive indicators and Chi-square test and logistic regression analysis were used to analyze the related factors. The expenses and hospitalization time were skewed distribution, and we used the median and nonparametric test to analyze the difference between two groups.Results1. Of the383patients investigated,117patients and137cases suffered from nosocomial infection with an infection rate of30.55%and the infection case-rate was35.77%. The incidence of nosocomial infection was declining trend from2008to2012.2. The infection occurred mainly in the urinary tract and accounted for58.39%, then followed by the lower respiratory tract infection and accounted for32.85%.3. Of the117infectioned patients,101strains were detected.46strains were Gram-negative bacteria (45.55%) and the top one was Neisseria meningitides bacteria;48strains were Gram-positive bacteria (47.52%) and the top one was Streptococcus viridians and7strains were fungi (6.93%). There was no virus infection.4. According to the Chi-square test results, the nosocomial infection was associated with hospitalization time, length of stay after operation, season, combing with other operations, dialysis after operation, urinary catheter indwelling time, extra peritoneal drainage tube indwelling time, anaemia, white blood cells, and rejection after operation. And there were no statistical significance among patients with different age and gender.5. The results of multiple regression analysis showed that gender, urinary catheter indwelling time, extra peritoneal drainage tube indwelling time and hemoglobin were influencing factors of nosocomial infection among renal transplant patients.6. The median of total hospitalization expenses of each case were84138yuan and72185yuan in infection and control group, and medicine and therapy cost accounted for the largest share. The median total expenses in infection group were significantly higher than that in control group and there was statistically significant difference(Z=-2.571, P=0.010). The main increased expenses were medicine and therapy cost.7. The median of hospitalization days of each cases were29days and20days in infection and control group. The hospitalization time of infection group patients was9days longer than patients in control group and there was statistically significant difference(Z=-3.125, P=0.002).8. The economic losses varied from infection sites. The loss from multi-site infection was highest and it was14647yuan; the prolong hospitalization time were also longest and it was21days. Then followed by urinary infection, the economic loss was14434yuan and the prolong hospitalization time was1day. The economic loss of lower respiratory tract infection was7106yuan and the prolong hospitalization time was7days.9. The economic losses varied from age. Patients older than40years old had the highert increased losses and it was18484yuan, then it was followed by patients younger than40years old (707yuan). The prolong hospitalization times between18-40years was10days and it was higher than other patients (6days).ConclusionsThe incidence of nosocomial infection in renal transplant patients was high, and it was associated with gender, urinary catheter indwelling time, extra peritoneal drainage tube indwelling time and hemoglobin. The occurrence of nosocomial infection can cause an increase in hospitalization expenses and prolong hospitalization time, which were affected by infection sites and age. Nosocomial infection can increase patients’burden and lead to economic losses to patients, hospitals and to the country.