Study On The Risk Factors And Direct Economic Losses Of Nosocomial Infection With Acute Leukemia Patients

ObjectiveTo investigate the status and determine the risk factors of nosocomial infection on acute leukemia patients through targeted monitoring on acute leukemia patients in blood center in a tertiary teaching hospital. Specific preventive measures and interventions were taken to reduce the incidence of nosocomial infection in a timely manner. Investigate the hospitalization cost and hospitalization time of acute leukemia patients and analyze the direct economic losses caused by nosocomial infection to supply scientific basis for relevant administrative health department to develop relevant policies.MethodsUsing of cluster sampling methods,994acute leukemia patients at department in blood center in a tertiary teaching hospital from January1st2011to December1st2013were extracted as the study objects. The research contents contain two aspects:(1) Risk factors investigation of nosocomial infection on acute leukemia patients. All study objects were objective monitored of nosocomial infection and filled in the self-design Registration Forms of Nosocomial Infection on Acute Leukemia Patients and Nosocomial Infection Cases Questionnaire. Two people made the data entered to the SPSS software (version19.0). General information of patients was described with mean and standard deviation, rate, percentage, constituent ratio and other descriptive indicators. Chi-square test and logistic regression analysis were used to analyze the risk factors of nosocomial infection.(2) Analyze the direct economic losses of nosocomial infection on acute leukemia patients. Patients with nosocomial infection were described as case group and patients without nosocomial infection was described as control group. Analyzing the direct economic losses and hospitalization time were study contents. We used the median to describe patients’ hospitalization costs and nonparametric test to analyze the difference between two groups.Results1.994acute leukemia patients were investigated,277patients and306cases suffered from nosocomial infection with an nosocomial infection rate of27.87%and the nosocomial infection case-rate was30.78%. The incidence of nosocomial infection was declining trend from2011to2013.2. The upper respiratory tract occurred most of the nosocomial infection on acute leukemia patients and accounted for41.50%, then followed by the lower respiratory tract infection that accounted for34.97%and oral infection, accounted for5.56%.3. Of the277infected patients,442strains of pathogenic bacteria were detected.243strains were Gram-positive bacteria (54.98%) and the most common type were streptococcus viridans and four streptococcus;182strains were Gram-negative bacteria (41.18%) and the most common type was Dry neisseria bacterium;17strains of fungi were detected and accounted for3.85%. No virus strains were detected.4. According to the univariate analysis results, the nosocomial infection on acute leukemia patients was associated with hospital days, community infection, immunity regulator, cycles of chemotherapy, chemotherapy or not, numeration of leukocyte, platelet count, hemoglobin, neutrophil count, phrase of chemotherapy, preventive antimicrobial agents, hyperplasia of the bone marrow and basic diseases(P<0.05). There were no statistical significance between nosocomial infection with patients’gender, age, season, stimulating factor, hormone application, type of leukemia and body mass index (P>0.05)5. The results of Logistic regression analysis showed that preventive application of antimicrobial agents, community infection, longer length of stay, numeration of leukocyte reduced, no use of immune regulators, neutropenia and thrombocytopenia were risk factors of nosocomial infection among acute leukemia patients. 6. The median total hospitalization expenses of case group were34394yuan and the control group was14049yuan, medicine cost accounted for the largest share in both groups. The median total hospitalization expenses in case group were significantly higher than that in control group, there was statistically significant difference (Z=-7.304, P=0.000). The direct economic loss caused by nosocomial infection was20345yuan, and the main increased expenses were medicine and transfusion cost.7. The median of hospital days of case group were21days and the control group was10days, the hospital days of case group was11days longer than patients in control group and there was statistically significant difference (Z=-8.672, P=0.000).8. The direct economic losses varied from the type of leukemia. The direct economic losses was21565yuan in acute non-lymphocytic leukemia patients and13089yuan in acute lymphoblastic leukemia patients, both of the economic losses were statistically significant. The median of prolonged hospital days of acute lymphoblastic leukemia patients was10.5days, longer than10days in acute non-lymphocytic leukemia patients.9. The direct economic losses varied from age. Patients over60years old had the highest economic losses caused by nosocomial infection that is27197yuan and the prolong hospital time was11.5days, then it was followed by patients between41～60years old (22823yuan,9days) and18～40years old (13969yuan,8days).10. The direct economic losses varied from infection sites. The economic loss from multi-site infection was the highest and it was39828yuan and the prolong hospital time was15days; then followed by lower respiratory infection, the direct economic loss was39675yuan and the prolong hospital time was15days. The direct economic loss of other parts infection was27256yuan and the prolong hospital time was10days.ConclusionsAcute leukemia patients are more likely to develop nosocomial infection for a a high rate of nosocomial infection. The preventive application of antimicrobial agents, community infection, longer length of stay, numeration of leukocyte reduced, no use of immune regulators, neutropenia and thrombocytopenia were independent risk factors of nosocomial infection among acute leukemia patients. After the occurrence of nosocomial infection, there will be an increase in hospitalization costs and prolonged hospital time in acute leukemia patients, which were affected by type of leukemia, infection sites and age.