The Economic Losses Caused By Nosocomial Infections And Precautionary Countermeasures To Them

Nosocomial infection (NI), which belongs to the field of medical infections, refers to any infective disease in hospital. Hospital gives birth to NI that does harm to patients'heath and lives, decreases quality of medical service and turnover of beds, hinders implement of advanced technologies, prolongs the hospitalized time and increases the expenditure of patients. All of these bring a great economic loss to patients, hospitals and nation. This issue has become a prominent public health problem. At present, some researchers has attached importance to study on economic loss of NI, however, their study only put focus on economic loss of NI in specialized hospitals or some specialties in comprehensive hospitals. Studies which employ case-control (1:1) methods on economic loss of NI in comprehensive hospitals have seldom been reported. As a result, author performed the study as below. There are few reports seen in the literature on investigations and analysis on economic losses caused by nosocomial infection in general hospitals. So a case-control study was adopted based on the related points to investigate, analyze and study the causes of economic losses as well as to approach its solving strategies.Objectives:By performing quantitative analysis and assessment on direct economic loss of NI in hospitalized patients, meanings and important points of supervision and control on NI in hospitalized patients were clarified, countermeasures to NI were purposed so that importance of management of NI in health constitution and medical staff were attached, controlling conceptions on NI were increased, incidence of NI was decreased, bitterness and economic burden were alleviated, health expenditure was decreased, evidences to support decision of medical management constitution and leaders were preferred, and hospital may gain more social and economic benefits.Methods: Case-control method was employed in this study on basis of former retrospective studies and comparison was performed strictly on ratio of 1:1. This study performed retrospective investigations, analysis and assessments on economic loss of NI of hospitalized patients in Long nan Hospital, Da qing City during January to December in 2004. 87 comparisons were selected which included leaving-hospital NI cases and identified controls. Unified tables were designed to search hospitalized records of these two groups using electronic case system and search results were filled in the tables. The identification and diagnosing criteria were based on"diagnosing criteria for nosocomial infection"published in 2001 by health ministry. Health expenditure investigated in this study included medicine expenditure, examination expenditure, treatment expenditure, etc. Database was written to store and analyze the data. Statistical Methods: Medians were used to describe average level and quartiles were used to describe variations for hospitalized expenditure and time belongs to leaning data. Nonparametric test (Wilcoxon Signed Ranks Test) was used to compare diversity between groups using SPSS 12.0 software.Results:17371 hospitalized patients leaved hospital Long nan during January to December in 2004. In these patients, 290 were infected. 87 comparisons were selected according to criteria. In these comparisons, 48 were males, 55.2%; 39 were females, 44.8%. The average age in case group was 55.1±17.9 yrs and the average age in controlled group was 55.0±17.1 yrs. The total expenditure of case group was 12955 RMB yuans. The average expenditure in this group was 8251 higher than the compared group. The average expenditure of case group was 2.7 times of controlled group. The total expenditure in case group was 12955 RMB yuans, average expenditure was 8251 RMB yuans. groups was statistically significant(Z=5.765,P﹤0.001). This result was higher than the result reported in present study which reported the average expenditure of NI patients was 2615-6753 RMB yuans. All kinds of expenditures in NI group were 2.03-3.13 times of the controlled group. Medicine expenditure was 3235RMB yuans (P<0.01) by average and was the highest in the economic loss which was 39.2% of the total economic loss. The total hospitalized time by average in NI group was 20 days which was higher significantly than 12 days in controlled group. NI prolonged 8 days to the hospitalized time. The diversity between the two groups was statistically significant (Z=5.917, P≤0.001). This results approached nearly to the results of Chen Jinhua's study which reported 12.3 days by average. The average hospitalized time in NI of different parts of body was 1.48-4.50 times of the controlled group. The diversities between the two groups in all parts were statistically significant (P≤0.05) except for skull-inner and cut infections. The average economic loss in NI of different parts of body was 1.70-4.36 times of the controlled group. The loss varied by different infected part. The loss of underside air way infection was the highest which was 12660 RMB yuans by average followed by the loss of upper air way infection which was 2900 RMB yuans. The average hospitalized expenditure in NI of different systems of body was 2.48-6.15 times of the controlled group. The diversities between the two groups in all systems were statistically significant (P<0.05). The loss of neurosurgery NI was the highest which was 53203 RBM yuans (P<0.05) followed by the loss of NI in nerve department which was 13555 RMB yuans (P<0.001). The diversities between the two groups were statistically significant. The proportion of medicine expenditure in the direct economic loss was the highest which was 46%, increasing 24310 by average. The all kinds of expenditures of NI in nerve department were higher than the controlled group significantly (P<0.05). This loss was 1.47-2.62 times of the controlled group. All kinds of economic loss of the cardiovascular NI cases were 2.06-6.09 times of the controlled group. The all kinds of expenditures of NI in nerve department were higher than the controlled group significantly (P<0.05) except for that in treatment expenditure. The medicine expenditure was the highest in the loss of air way NI. The loss of upper and underside air way NI were 730 RMB yuans and 7615 RMB yuans respectively. The diversity between the two groups was statistically significant (P<0.05).Conclusions:NI brings a great economic loss to patients and prolongs hospitalized time. The prolonged hospitalized time decrease the turnover of beds and was the main reason for the excessive hospitalized expenditure. In the view of infection, prolonged hospitalized time increase the chances of multi-infection and dwelling of medicine-tolerant bacterium. As a result, health management constitutions should strengthen supervision of NI, all the health constitutions should attached importance to employing the staff to special in controlling NI. The related legislations such as"the management of Nosocomial infection"and"the technique norms of sterilization"should be abided by. Effective precaution and supervision on NI should be performed. Procedure of treatment and hands'cleaning should be regulated. Antibiotic medicine shouldn't be used absurdly. The qualities of once-used health ware should be supervised more strictly. Medical wastes should be classified, carried to be treated safely. Professional safeguard should be strengthened to decrease the incidence of NI. In practices, managers of hospitals should clarify the key groups, key parts, key departments according to the practical situations and attach importance to precaution and supervision to create more social and economical benefits using limited managing resources of NI.