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

ObjectiveUsing the method of prospective target monitoring, stroke patients in department of neurology 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 stroke patients and analyze the economic losses caused by nosocomial infection to supply basis for health department to develop relevant policies.MethodsUsing of cluster sampling methods, stroke patients at department of neurology from January2012to December2013were investigated for two aspects of content:(1) Epidemiological investigation of nosocomial infection. All the patients were objective monitored of nosocomial infection and filled in the self-made "the registration forms of the stroke patients" and "the Nosocomial infection questionnaire". All the data were analyzed by SPSS (version17.0). General information was described with mean±standard deviation,rate, percentage and other descriptive indicators and Chi-square test and logistic regression analysis were used to analyze the related factors.(2)Analyze the economic losses of nosocomial infection. Patients with nosocomial infection were described as infection group and patients without nosocomial infection was described as control group, and the direct economic losses and hospitalization time were analyzed. The data were skewed distribution, and we used the median and nonparametric test to analyze the difference between two groups.Results1. Of the552patients investigated,55patients and133cases suffered from nosocomial infection with an infection rate of9.96%and the infection case-rate was24.10%. The incidence of nosocomial infection was significantly declining from2012to2013.2. The infection occurred mainly in the lower respiratory tract and accounted for44.83%, then followed by the upper respiratory tract infection and accounted for22.39%.3. Of the55infected patients,29strains were detected.13strains were Gram-negative bacteria (44.83%) and the top one was Neisseria meningitides bacteria;11strains were Gram-positive bacteria (37.93%) and the top one was Streptococcus viridians and11strains were fungi (17.42%). There was no virus infection.4. According to the Chi-square test results, the nosocomial infection was associated with age, hospitalization time, ADL score, combing with other diseases. And there were no statistical significance among patients with different gender, urinary catheter indwelling time, onset time.The nosocomial infection was associated with cases incidence though there was no statistical significance among patients with different seasons.5. The results of multiple regression analysis showed that age, hospitalization time, admission season, ADL score and urinary catheter were influencing factors of nosocomial infection among stroke patients.6. The median of total hospitalization expenses of each case were14629.88yuan and10154.07yuan 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=-5.852, P<0.010). The main increased expenses were medicine and therapy cost. 7. The median of hospitalization days of each cases were12days and10days in infection and control group. The hospitalization time of infection group patients was2days longer than patients in control group and there was statistically significant difference(Z=-5.483, P=0.000).8. The economic losses varied from infection sites. The loss from multi-site infection was highest and it was6766.88yuan; the prolong hospitalization time were also longest and it was6days. The economic loss of lower respiratory tract infection was3234.46yuan and the prolong hospitalization time was3day. The economic loss of upper respiratory tract infection was3192.15and of urinary infection was2495.07yuan, the prolong hospitalization time was1.5days.9. The economic losses varied from age. Patients more than80years old had the highest increased losses and it was12208.03yuan, then it was followed by patients between41-60years old (6216.77yuan) and61-80years old (4350.05yuan). Patients between40～80years old suffered from nosocomial infection could prolong hospitalization time.ConclusionsThe incidence of nosocomial infection in stroke patients was high, and it was associated with age, hospitalization time, ADL score and combing with other diseases. 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.