Impact Of Nosocomial Infections Research Articles

Impact of Nosocomial Infection on in-Hospital Mortality Rate in Adult Patients Under Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery.

There was no consensus on the impact of nosocomial infection on In-hospital mortality rate in patients receiving ECMO. This study aimed to investigate the impact of nosocomial infection (NI) on In-hospital mortality rate in adult patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac surgery. This retrospective study included 503 adult patients who underwent VA-ECMO after cardiac surgery. The impact of time-dependent NIs on In-hospital mortality rate within 28 days of ECMO initiation was investigated using a Cox regression model. The cumulative incidence function for death was compared between patients with NIs and those without NIs using a competing risk model. Within 28 days after ECMO initiation, 206 (41.0%) patients developed NIs, and 220 (43.7%) patients died. The prevalence rates of NIs were 27.8% and 20.3% during and after ECMO therapy, respectively. The incidence rates of NIs during and after ECMO therapy were 49‰ and 25‰, respectively. Time-dependent NI was an independent risk factor for predicting death (hazard ratio = 1.05, 95% confidence interval = 1.00-1.11). The cumulative incidence of death in patients with NI was significantly higher than that in patients without NI at each time point within 28 days of ECMO initiation. (Z = 5.816, P = 0.0159). NI was a common complication in adult patients who received VA-ECMO after cardiac surgery, and time-dependent NI was an independent risk factor for predicting mortality in these patients. Using a competing risk model, we confirmed that NIs increased the risk of In-hospital mortality rate in these patients.

Predictors and mid-term outcomes of nosocomial infection in ST-elevation myocardial infarction patients treated by primary angioplasty.

Nosocomial infections (NI) are associated with high morbidity and mortality. Existing data on the impact of NI on patients with ST-elevation myocardial infarction (STEMI) is scarce. Our aim was to determine the incidence, predictors, and prognosis of NI in a contemporary series of STEMI patients. 1131 consecutive STEMI patients treated by primary percutaneous coronary intervention from January 2008 to December 2017 were analyzed. Binary logistic regression and Cox proportional hazard models were used to identify predictors of NI and major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up, respectively. Of all patients, 126 (11.1%) were diagnosed with NI (>48 hours from admission), mostly of respiratory (50.8%) and urinary (39.7%) tract origin. Insulin-treated diabetics were 3-fold more likely to develop NI. Other independent predictors were peripheral arterial disease, intra-aortic balloon pump insertion, age, lower systolic blood pressure, and higher peak creatine-kinase. Only pre-infarction angina was negatively related to NI. Age, peripheral arterial disease, femoral approach and larger infarct were related to MACCE at 1-year follow-up. NI in isolation was not independently related to MACCE (hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.80-1.94; P = 0.34). However, we found a significant interaction between NI and smoking (HR, 2.33; 95% CI, 1.03-5.24; Pinterc = 0.04). Larger infarct size, hemodynamic instability, and co-morbidities were related to both NI and 1-year adverse events. Smokers who developed NI also had a higher 1-year risk of MACCE.

Impact of Different Types of Nosocomial Infection on the Neurodevelopmental Outcome of Very Low Birth Weight Infants.

Nosocomial infections (NIs) are important conditions associated with mortality and morbidity in very low birth weight infants (VLBWIs). The aim of this study was to investigate the impact of NIs and the different subtypes on neurodevelopmental outcomes in a cohort of VLBWIs. VLBWIs born with a gestational age between 23 0/7 and 31 6/7 weeks in a level III neonatal center were enrolled. Neonatal morbidities as well as the neurodevelopmental outcome at 2 years of corrected age were analyzed. Six-hundred infants completed the study successfully. Of these, 38% experienced an NI episode. NIs were associated with an increased risk of neonatal complications, such as brain injury, bronchopulmonary dysplasia (BPD) and death, and were a significant risk factor for adverse motor development at 2 years of corrected age in our cohort of VLBWIs. The negative impact of NIs on neurodevelopmental outcomes was particularly associated with necrotizing enterocolitis (NEC), suspected NIs and Gram-positive NIs. This study demonstrated that NIs are a significant risk factor for both morbidity and mortality as well as adverse neurodevelopmental outcomes in VLBWIs.

Potential of Therapeutic Bacteriophages in Nosocomial Infection Management.

Nosocomial infections (NIs) are hospital-acquired infections which pose a high healthcare burden worldwide. The impact of NIs is further aggravated by the global spread of antimicrobial resistance (AMR). Conventional treatment and disinfection agents are often insufficient to catch up with the increasing AMR and tolerance of the pathogenic bacteria. This has resulted in a need for alternative approaches and raised new interest in therapeutic bacteriophages (phages). In contrast to the limited clinical options available against AMR bacteria, the extreme abundance and biodiversity of phages in nature provides an opportunity to establish an ever-expanding phage library that collectively provides sustained broad-spectrum and poly microbial coverage. Given the specificity of phage-host interactions, phage susceptibility testing can serve as a rapid and cost-effective method for bacterial subtyping. The library can also provide a database for routine monitoring of nosocomial infections as a prelude to preparing ready-to-use phages for patient treatment and environmental sterilization. Despite the remaining obstacles for clinical application of phages, the establishment of phage libraries, pre-stocked phage vials prepared to good manufacturing practice (GMP) standards, and pre-optimized phage screening technology will facilitate efforts to make phages available as modern medicine. This may provide the breakthrough needed to demonstrate the great potential in nosocomial infection management.

Update on graft infections in thoracoabdominal aortic aneurysm surgery.

The incidence of an aortic graft infection following the repair of thoracoabdominal aortic aneurysm, is a rare yet insidious complication which requires prompt recognition and management. The decision-making framework for management encompasses the choice or antimicrobial therapy alone versus pursuing surgical intervention, which can then also lead to considering the potential for allografts. The current literature on the matter is heavily burdened by limitations of the reported retrospective experiences consisting of small patient cohorts. Studies have reported the favored approach of surgical intervention, although statistical significance is not reached. There is a clear recognized impact that the event surrounding the initial repair has on the occurrence of graft infection itself; with emergency repairs, and incidence of nosocomial infection being associated with higher rates of graft infection. We must consider the influencers of this ominous complications, which go back to the perioperative events itself, whether the initial intervention was elective or an emergency, the impact of nosocomial infections, the choice of open versus endovascular for initial repair. Only with the appropriate management strategy that encompasses all these factors, will allow the best treatment to be provided for patients. A sound understanding and appreciation for the aforementioned can allow the stratification of the risk associated with the occurrence of an aortic graft infection, leading to surveillance opportunities to provide the crucial ability to rapidly recognize this complication.

Impact of nosocomial infections on patient mortality following cardiac surgery

Study objectiveTo determine the rate of nosocomial infection among patients undergoing cardiac surgery and to identify risk factors and the impact of these infections on patient mortality. DesignProspective observational study. SettingIntensive Care Unit (ICU). Patients1097 adult patients who underwent cardiac surgery at Hospital Clínico Universitario de Valladolid between January 2011 and January 2016. InterventionsNone. MeasurementsPreoperative, intraoperative and postoperative medical, surgical and anaesthetic variables. Main resultsA total of 111 patients (10.1%) acquired a nosocomial infection in the postoperative period. Pneumonia was the most frequent (4.2%) nosocomial infection. Three independent risk factors for the development of a nosocomial infection were identified: cardiopulmonary bypass time, kidney failure and emergency surgery. The stay in the ICU was significantly higher in patients who developed a nosocomial infection (16.6 ± 38.8 vs. 4.4 ± 17.8, P < 0.001). The mortality rate of patients who acquired a nosocomial infection was significantly greater (18%) than that of patients who did not acquire a nosocomial infection (5%) (P < 0.001). The 90-day survival was greater in the group of patients without nosocomial infection (log rank 27.55, P < 0.001). The dynamic modelling of 90-day mortality revealed that in the first week, cardiopulmonary bypass time (HR = 1.00, 95% CI 1.00–1.02, P < 0.001) and emergency surgery (HR = 0.12, 95% CI 0.04–0.37, P < 0.001) were the most important risk factors for mortality, while after the first week, nosocomial infection (HR = 6.23, 95% CI 2.49–15.63, P < 0.001) was the main risk factor, followed by cardiopulmonary bypass time (HR = 1.01, 95% CI 1.00–1.01, P = 0.001) and EuroSCORE (HR = 1.03, 95% CI 1.00–1.06, P = 0.008). ConclusionsNosocomial infections after cardiac surgery constitute the main independent risk factor for mortality after the first week of surgery. These data suggest that its prevention following cardiac surgery must be prioritised to improve patient outcomes.

Incidence and clinical outcomes of nosocomial infections in patients presenting with STEMI complicated by cardiogenic shock in the United States

ObjectivesThis study addresses the incidence, trends, and impact of nosocomial infections (NI) on the outcomes of patients admitted with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (STEMI-CS) using the United States National Inpatient Sample (NIS) database. MethodsWe analyzed data from 105,184 STEMI-CS patients using the NIS database from the years 2005-2014. NI was defined as infections of more than or equal to three days, comprising of central line-associated bloodstream infection (CLABSI), urinary tract infection (UTI), hospital-acquired pneumonia (HAP), Clostridium difficile infection (CDI), bacteremia, and skin related infections. Outcomes of the impact of NI on STEMI-CS included in-hospital mortality, length of hospital stay (LOS) and costs. Significant associations of NI in patients admitted with STEMI-CS were also identified. ResultsOverall, 19.1% (20,137) of patients admitted with STEMI-CS developed NI. Trends of NI have decreased from 2005-2014. The most common NI were UTI (9.2%), followed by HAP (6.8%), CLABSI (1.5%), bacteremia (1.5%), skin related infections (1.5%), and CDI (1.3%). The strongest association of developing a NI was increasing LOS (7-9 days; OR: 1.99; 95% CI: 1.75-2.26; >9 days; OR: 4.51; 95% CI: 4.04-5.04 compared to 4-6 days as reference). Increased mortality risk among patients with NI was significant, especially those with sepsis-associated NI compared to those without sepsis (OR: 2.95; 95% CI: 2.72-3.20). Patients with NI were found to be associated with significantly longer LOS and higher costs, irrespective of percutaneous mechanical circulatory support placement. ConclusionsNI were common among patients with STEMI-CS. Those who developed NI were at a greater risk of in-hospital mortality, increased LOS and costs.

Prevalence of ESBL producing MDR E. coli and Klebsiellae pneumonae from clinical isolates of nosocomial hospital acquired infections

The impact of nosocomial infections (NIs) is an important public health concern due to emergence of new MDR strains of pathogens and approximately 5 to 10% of hospitalized patients are affected by NIs. 90,000 deaths per year in United States only warrant investigation. This study was a hospital based cross sectional study to determine the ESBL producing MDR nosocomial infection and their control from Jun 1st2016 to Dec31st 2017. 500 patients were investigated all demographic data was collected from patients with a history of hospital admission for ≥ 2 days. In this study out of total 500 patients, (62%) patients were female and (38%) were males, 19% isolates were E.coli and 18% were K.pneumonae all were MDR along with other pathogens .most of strains were showing 55%-85% resistance for more than one antibiotics. PCR studies show that SHV (32%) and TEM (18%) genes were found in ESBLs producing organisms. Due to importance of ESBL producing organisms and difficult treatment of infections caused by these bacteria rapid identification of ESBL producing strains should be adopted in enterobacteraciae, infection control strategies are recommended to adopt and warrant investigation.

In-Hospital Mortality, Acute Kidney Injury, Length of Stay and Cost among Patients with Acute Myocardial Infarction Related Cardiogenic Shock Complicated with Nosocomial Infections: Analysis of National Inpatient Sample Data

In-hospital mortality of patients with cardiogenic shock complicating ST-elevation myocardial infarction (STEMI-CS) ranges from 30% to 50%. The impact of nosocomial infection(NI) is not well addressed in these patients. We queried the 2005-2014 Nationwide Inpatient Sample database to identify patients with STEMI-CS. Incidence of hospital-mortality, acute kidney injury (AKI), length of stay (LOS), cost of hospitalization and NI such as bloodstream infections due to central venous catheters (BI), bacteremia, ventilator-associated pneumonia (VAP), and clostridium difficile (CDI) infection among patients with and without mechanical circulatory support (MCS) use (intra-aortic balloon pump [IABP], Impella/TandemHeart [PVAD], and extra corporeal membrane oxygenation [ECMO]) were analyzed. We identified 172486 cases of STEMI-CS, of which 53% required MCS. Among STEMI-CS cases 6104 (3.5%) developed NI and 3977 cases required MCS. The rates of NI were increased among patients with MCS (p<0.001, Table 1) with the highest rates encountered among patients with combinations of MCS. BI and CDI were higher in patients requiring ECMO whereas bacteremia and VAP were higher among patients requiring combined MCS (Table 1). Patients with STEMI-CS requiring MCS had higher rates of mortality, AKI, LOS and cost. However, among STEMI-CS patients the occurrence of NI was associated with lower incidence of in-hospital mortality in the subgroups of those requiring MCS, IABP, PVADs and combined MCS but no effect on mortality among those requiring ECMO(Table2). Patients with or without need for MCS and NI had significantly higher rates of AKI, longer LOS and costs (Table 2). NI are more frequent among patients with STEMI-CS requiring MCS and are associated with increased rates of AKI, LOS, and costs, but do not affect in-hospital mortality.

INCIDENCE OF NOSOCOMIAL INFECTIONS AND ITS CLINICAL IMPLICATION IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK WITH PERCUTANEOUS MECHANICAL CIRCULATORY SUPPORT DEVICES

The impact of nosocomial infections(NI) in patients with STEMI and cardiogenic shock (STEMI-CS) is not well addressed. Using the 2005-2014 Nationwide Inpatient Sample database patients with STEMI-CS were identified. Incidence of mortality, acute kidney injury (AKI), length of stay (LOS), cost, and

Nosocomial infections in surgical intensive care unit: A retrospective single-center study.

Aims:This study aims to study the incidence, microbiological and antibiotic sensitivity and resistance profile and impact on intensive care units (ICUs) stay and mortality of nosocomial infections in patients admitted to surgical ICU of our hospital.Methods:A retrospective analysis of all patients admitted, over the course of 1 year, in the surgical ICU was undertaken. All patients who developed nosocomial infections were included in the study. Incidence, sites, common organisms of nosocomial infection were identified. The antibiotic sensitivity pattern of the microorganisms which were cultured was identified. This group of patients with nosocomial infections was matched with group of patients without nosocomial infections with respect to age, gender, and clinical diagnosis and the impact of nosocomial infections on ICU stay, and mortality was studied.Results:Of 1051 patients admitted to the ICU during the study, 350 patients developed nosocomial infections and were included in the study group. Of the remaining patients, 350 patients matching the patients in the study group were included in the control group. The prevalence of nosocomial infections in our study was 33.30%. Skin and soft tissue infections (36.30%), including postoperative wound infections were the most common nosocomial infection, followed by respiratory infections (24.46%) and genitourinary infections (23.40%). The most common organisms causing nosocomial infections were Escherichia coli (26.59%) and Acinetobacter species (18.08%). About 40% of all Gram-negative organisms isolated were multidrug resistant. The average length of stay in ICU was 14.4 days for patients with nosocomial infections and 5.4 days (P < 0.05) for matched patients without nosocomial infections. The mortality in patients with nosocomial infections was 25.14% while that in patients without nosocomial infections was 10.57% (P < 0.05). Overall ICU mortality was 14.27%.Conclusions:Nosocomial infections in surgical ICU patients significantly increase ICU length of stay and mortality.

Clinical applications of bacterial glycoproteins

ABSTRACTThere is an ongoing race between bacterial evolution and medical advances. Pathogens have the advantages of short generation times and horizontal gene transfer that enable rapid adaptation to new host environments and therapeutics that currently outpaces clinical research. Antibiotic resistance, the growing impact of nosocomial infections, cancer-causing bacteria, the risk of zoonosis, and the possibility of biowarfare all emphasize the increasingly urgent need for medical research focussed on bacterial pathogens. Bacterial glycoproteins are promising targets for alternative therapeutic intervention since they are often surface exposed, involved in host-pathogen interactions, required for virulence, and contain distinctive glycan structures. The potential exists to exploit these unique structures to improve clinical prevention, diagnosis, and treatment strategies. Translation of the potential in this field to actual clinical impact is an exciting prospect for fighting infectious diseases.

White Coat: A Friend or a Foe

Copyright: © 2012 Dalal BD. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Long time debate is going on for a topic of dress code for doctors in hospital. White coats are symbol of medical profession for ages. In last several years, positive and negative aspects of white coat came to light. On a one side patients and doctors prefer white coat as representation of the profession while problem of transmitting pathogen and increasing nosocomial infections (NI) have created evidence against it. NI accounted for 1.7 million infections in 2002, which resulted in 99,000 deaths in the United States, and it is estimated to cost $6.7 billion per year [1]. With such a significant impact of NIs, it is understandable that preventing them is a desirable outcome; house delegates of AMA discussed this issue in 2009 and recommended to have more research. In contrast, healthcare personnel in the United Kingdom abide by a “bare below the elbows” policy (that is, short sleeves, no wrist watch, no jewelry and avoidance of neckties) when in patient care areas, in hopes that this will decrease the incidence of NI. Although the United Kingdom has implemented these changes, no studies have looked at the effect of physician’s white coats or the bare below the elbows policy on NI rates.

Impact of nosocomial infections on clinical outcome and resource consumption in critically ill patients

Nosocomial infections still present a major problem in intensive care units (ICUs), accounting for prolonged ICU and hospital stays and worsened outcomes. There exist differences in the literature regarding the impact of nosocomial infections on attributable mortality and resource consumption. The aim of this study was to observe these effects in a large cohort of critically ill patients. Thirty-four Austrian ICUs participated in the study by documenting all nosocomial infections from 1 June to 30 November 2003 according to the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. Of 2,392 patients with a length-of-stay (LOS) >2 days, 683 (28.6%) developed at least one nosocomial infection. The most common infection was pneumonia (n = 456), followed by central venous catheter (CVC) infections (n = 101). Risk-adjusted mortality rates (standardized mortality ratios) were significantly increased for infected patients [0.91 (0.83-0.99) vs. 0.68 (0.61-0.74)]. Significant attributable risk-adjusted mortality was found for patients with pneumonia, combined infections (both 32%) and CVC-related infections (26%). LOS in the ICU increased significantly for all infections. We conclude that significant attributable mortality for several nosocomial infections exists in a large cohort of critically ill patients, with the highest impact occurring in those with microbiologically diagnosed pneumonia and combined infections. All infections were associated with an increased resource consumption. Effective infection control measures could improve both clinical outcome and proper and effective use of ICU resources.

Valutazione dei costi delle infezioni nosocomiali da Escherichia coli

The reduction of nosocomial infections represents a major challenge for large hospitals in order to pursue efficiency. Despite in Europe 7.7% of admitted patients are infected during their hospital stay — in Italy this rate is thought to be close to 6.8% —, the need to reduce the economic impact of nosocomial infections is still considered a major issue for hospital management. In order to quantify the resource uptake due to nosocomial infections, we performed a case-control retrospective observational study. In 2007, 63 patients who developed E. coli-type nosocomial infections were selected and compared with 126 patients admitted to a large University Hospital in Rome. We also performed a cross-sectional analysis merging administrative and clinical databases to estimate the incremental costs for diagnostic tests, antibiotics consumption and length of stay due to the infection with respect to the resource uptake of the non-infected controls. The costs to treat the infected patients resulted in a 3.5-fold increase with respect to the non-infected patients. This incremental cost was higher (i.e. a 4.6-fold increase) in the case of antibiotic resistance production (ESBL, extended-spectrum beta-lactamases). A Montecarlo analysis showed how, in terms of monetary values, the difference between infected and non-infected patients was in the range of €11,875–13,560 per patient. The range was €14,049–15,733 in the case of ESBL production.

Nursing intervention on the impact of nosocomial infection in burn Patients

Objective Study of nursing intervention on the impact of nosocomial infection in burn patients.Methods Will be in January 2005 ～ January 2009 of 244 cases of hospitalized bum patients were randomly divided into test group and control group 122 patients, two groups of patients were treated with conventional treatment and care, the test group on this basis, the implementation of nursing intervention, comparison two groups of patients with hospital infection rates.Results Two groups of hospital infection rates are as follows: control group, 19.67%, 6.55% in experimental group and control group and experimental group, by the χ~2 test Pvalue of 0.01, with statistical significance. Conclusion Nursing intervention can effectively control the nosocomial infection rate of burn patients, thereby reducing the patient's hospital stay, reduce the financial burden of patients, it is worth promoting. Key words: Nursing intervention; Burn patients; Hospital Infection

Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania

The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections. This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidence-based infection control measures. A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05) The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined.

Prospective evaluation of a multi-factorial prevention strategy on the impact of nosocomial infection in very-low-birthweight infants

The aim of this study was to examine the impact of a multi-factorial intervention on nosocomial infection in very-low-birthweight infants. Consecutive infants with a birth weight less than 1500 g, born between February 2002 and February 2003, were included in this prospective study. The first six-month period (control) included surveillance of current practice. The intervention began in the seventh month and included: (i) changes to handwashing solutions with hand hygiene education; (ii) standardization of intravascular device (IV) insertion with specialized packs; (iii) changes to skin antiseptic solutions (2% aqueous chlorhexidine and 1% chlorhexidine in ethanol); and (iv) mandatory removal or replacement of peripheral IV after 48 hours and removal once enteral intake was > 120 mL/kg/day. Demographic data and details of every device were collected prospectively. Bloodstream infections (BSIs), length of stay (LOS), length of ventilation (LOV) and death were recorded and the rate of nosocomial BSI was calculated. Overall, 174 newborns required 1359 devices. The two cohorts were similar for birth weight and gestation. There was a reduction in nosocomial BSIs from 21% to 9% (control vs. intervention) (P = 0.05, confidence intervals 0.19-1.0). There was no significant difference in LOS, LOV, or mortality. Four infants had complications from 2% chlorhexidine. In conclusion, implementation of the multi-factorial prevention strategy reduced nosocomial BSIs. Alternative antiseptic solutions are needed to reduce the complications caused by 2% aqueous chlorhexidine.

Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients.

Nosocomial infections have been shown to be associated with increased attributable mortality, length of hospital stay, and health care costs in studies mainly conducted in western populations. However, the health care system in Taiwan differs from the typical situation in western countries, with longer hospitalization times and lower daily costs. The purpose of this study was to understand the economic and clinical impacts of nosocomial infections in Taiwan. Between June 1, 2001 and December 31, 2001, every hospitalized patient (age >/= 16 years) with nosocomial infections (case group) and matched control patients without nosocomial infections of the same age, gender, underlying medical illness, clinical diagnosis at admission and disease severity (control group) were recruited. Demographic characteristics, length of hospitalization, costs and final outcomes of both groups were collected for analysis. A total of 482 patient-pairs with median age of 68 years were studied. The median length of hospital stay was 40 days for the case group and 22 days for the control group (p < 0.0001). The median hospital cost for the case group was 363,425 New Taiwan Dollars (NTD) and 165,965 NTD for the control group (p < 0.0001). The median additional hospital stay for patients with nosocomial infection was 15 days, which amounted to 127,354 NTD. The extra hospital costs were not only associated with accommodation but also fees for materials, and costs relating to pharmacy, laboratory tests and diet. Patients with nosocomial infections were more likely to have shock, organ failure and death (all p < 0.0001). Additional hospital stay and costs were not related to various infection sites and bacterial pathogens causing nosocomial infections; however, medical costs attributable to nosocomial fungal infection were higher than that of bacterial infections. Nosocomial infections have a significant impact on the length of hospital stay and medical care cost. Extra costs of nosocomial infections resulted not only from prolongation of hospital stay, but also other medical costs. Infection control for preventing nosocomial infections may play an important role in reducing medical costs, hospital stay, and mortality in hospitalized patients.

Practices and an assessment of health care workers' perceptions of compliance with infection control knowledge of nosocomial infections

The impact of nosocomial infections, including associated mortality, morbidity, and attributable cost is well documented. Infection control practices, such as handwashing and use of gloves and gowns, have proven to be effective. Because many nosocomial infections result from cross transmission, primarily via the hands of health care workers (HCWs), handwashing remains the single most important means to prevent the transmission of nosocomial pathogens. Although most HCWs are aware of the rationale for infection control practices, compliance is generally poor. HCWs have cited various reasons for noncompliance, including insufficient time, inaccessible supplies, and lack of knowledge. Little is known about the factors that motivate HCWs to comply with infection control practices. The purpose of this study was 3-fold. First, it was to assess HCWs’ perceptions of adherence to infection control practices including isolation guidelines and hand hygiene using an antiseptic soap or an alcoholbased hand sanitizer product. Additionally, we sought to measure motivational factors for compliance. Last, we sought to assess beliefs regarding the etiology and prevention of nosocomial infections.