Health Care-associated Infection Among Stroke Patients Undergoing Surgical Treatment:Risk Factor And Economic Burden Evaluation

ObjectivesWe aimed to explore the risk factors related to health care-associated infection(HAI)among stroke patients undergoing surgical treatment comprehensively by investigating the current situation of HAI in target population.Besides,the economic burden of HAI was also evaluated,including incremental medical costs and prolonged length of stay(LOS).Hopefully,scientific evidence could be provided for medical staff to adopt specific strategies in order to reduce HAI incidence,and theoretical evidence could be also provided for health administrative departments to formulate HAI preventive policies and cut related medical costs.MethodsEligible patients hospitalized in the neurosurgery department in a tertiary comprehensive teaching hospital during January 1st,2016 and December 31st,2017 in Shandong province were recruited using cluster sampling methods.466 patients were included in this study.HAI prospective target surveillance was consistently performed during the study period,and necessary information of patients was collected and filled in the self-designed forms,?Target surveillance investigation forms of health care-associated infection among stroke patients undergoing surgical treatment?and?Economic burden investigation forms of health care-associated infection among stroke patients undergoing surgical treatment?.(1)Risk factor analysis:SPSS 22.0 was used for statistical analysis,means,standard deviation,median,number and percentage were used to describe the general information,and between group differences were calculated using t test,Mann-Whitney U test and Chi-square test.Univariate and multiple logistic regression were used for risk factor analysis.(2)Economic burden evaluation:1:1 matching criteria were used for infection and control groups and rank sum test was used for comparison between group differences.Results1.Overall,466 eligible patients were enrolled in this study with 221 male patients(47.42%)and 245 females(52.58%).The average age was 55.09±12.36 years old,ranging 19?85 years old.Among which,there were 144 patients with ischemic stroke and 352 with hemorrhagic stroke undergoing 200 open surgery and 266 interventional surgery.2.133 HAI cases(154 episodes)were identified with the incidence rate reaching 28.54%,and the incidence of HAI cases was 33.05%.The most common infection site was pulmonary infection with proportion of 67.67%,surgical site infection and multiple site infection ranked the second(both 12.78%),next was urinary tract infection and bloodstream infection,occupying 5.26%and 1.50%,respectively.3.120 strains of pathogenic bacteria were detected among 173 clinical samples after operation.As the main infectious bacteria,87 strains of Gram-negative bacteria were identified with a constitute ratio of 72.50%,among which,the major infectious bacteria were Acinetobacter baumannii and klebsiella pneumoniae.Another 32 strains of Gram-positive bacteria(26.67%)were spotted with Staphylococcus epidermidis and Staphylococcus aureus as the major pathogenic bacteria.The rest 1 stain was fungi,occupying 0.83%.4.By performing multiple logistic regression analysis,HAI risk factors for stroke patients undergoing surgical treatment were determined as hemorrhagic stroke,glasgow coma scale(GCS)at admission,LOS,venous thrombosis,postoperative body temperature on 1st day and mechanical ventilation.5.The median medical cost for infection group was 126280.08 yuan,and for control group was 72333.87 yuan,and thus the economic burden of HAI achieved 53946.21 yuan per patient.On items for extra medical costs,expenses on western medicine occupied the largest proportions(20070.65 yuan).Besides,the prolonged LOS reached 6 day after acquiring an HAI episode.6.Economic burden and prolonged LOS related to multiple site infection were the most,achieving 63821.44 yuan and 14 days respectively;This was followed by pulmonary infection(54137.45 yuan and 5 days).ConclusionsThe HAI incidence rate in stroke patients undergoing surgical treatment in neurosurgery department is quite high.Therefore,these should be listed as the vital department and high risk group and under close HAI monitoring program through prospective target surveillance.In addition,feasible preventive controls should be facilitated based on the aforementioned risk factors,namely,hemorrhagic stroke,GCS score at admission,LOS,venous thrombosis,postoperative body temperature on 1st day and mechanical ventilation,in order to reduce the infection rate and cut medical costs.The economic burden of HAI mainly included the incremental medical costs and extra LOS,and medical costs may be different due to various infection site.