Analysis Of Hospital Infection And The Role Of Upper Arm And Calf Circumferences In Nutrition Assessment For Patients With Hospital Infection

The hospital infection rates are different in diseases, treatment methods, people and nutritional status of patients according to reports in the literature. Most studies about hospital infection focused on infection rate, infection, infection department, diseases, infections, and control of hospital infection and reduce the infection rate of research methods. The hospital infection patients are prone to poor nutrition, which would further aggravate the hospital infection. Although BMI is recognized as a gold standard in evaluating the nutritional status in patients, it is unable to measure the height and weight and calculate BMI to nutrition assessment for patients in bed. Few studies evaluated the nutritional status of specific patients by the calf and upper arm circumferences. But there was no research evaluated the nutritional status of hospital infection patients in bed by the calf and upper arm circumferences. This study aims to this point.Purposes1. To discuss the hospital infection in department distribution, disease distribution, risk factors, the infection site distribution and other basic situation.2. To investigate the hospital infection in patients with the correlation of human body measurement and laboratory indexes.3. To analyze of upper arm and calf circumferences in diagnosis of malnutrition in patients with hospital infection in bed by ROC curve.MethodsA total of 765 hospital infections cases (male 391, female 343) in according with the hospital infection diagnostic criteria in Traditional Chinese Medicine Hospital of Guangdong Province in November 2013 to October 2014 were selected. The general and clinical data were collected, including research indicators:1. Basic information:department, gender, age, primary diseases, admission time, admitting time, inducing factors, whether the use of antibiotics, courtyard area.2. The human body measurements:patient’s height, weight, upper arm circumference, calf circumference, body mass index were standard measured by uniform training nutritionist.3. Biochemical examination:The nurses in different departments collected blood according to the standard requirements and the red blood cells, hemoglobin, total protein, albumin, creatinine and urea nitrogen were measured.4. Screening nutritional risk using NSR 2002 by nutritionist.Data were inputted by Excel 2010. SPSS 19.0 statistical software were adopted to data statistical analysis and graphics. Independent sample t-test was used to compare related indicators between malnutrition and nutrition group. Pearson correlation test was used to analyze the correlation of the upper arm, calf circumferences and related indicators. P<0.05 were used to behave statistical significance. The statistically significant index were selected to draw the receiver-operating characteristic curve (ROC) by MedCalc16.2.0. The area under the ROC curve (AUC) was calculated. The best cutoff point was selected according to Youden index (sensitivity+specificity-1).Results1. The top five departments in hospital infection were neurology (149,20.30%), ICU (144,19.62%), oncology (67,9.13%),geriatrics (65,8.86%) and gynaecology(51, 6.95%).2. Male (391) and female (343) accounted for 46.73% and 53.27%, respectively. Elderly patients accounted for big part of hospital infection.3. The cases were 222(30.25%) in the first week after admission nosocomial infection, 271(36.92%) in the second week,185(25.20%) in the third week and 56(7.63%) after more than 28 days.4. The top five primary disease was stroke (175,23.84%), tumor (141,19.21%), respiratory system disease (92,12.53%), renal disease (55,7.49%), diseases of the cardiovascular system (54,7.36%).5.33 cases had two infection sites and 3 cases had three infection sites. The top six of 771 infection sites were lung infection (391,50.71%), urinary tract infection (146, 18.94%), blood infection (73,9.47%), upper respiratory tract infection (61,7.91%), mouth infection (26,3.37%), gastrointestinal tract infection (24,3.11%).6. There are many susceptible factors in some patients with hospital infection at the same time. Susceptible factors were drug (98,8.44%), malnutrition (285,24.55%), disease (420,36.18%), invasive operation (358,30.84%).7.308 cases can measure height and weight and calculate BMI because they were not in the bed.426 cases can only measure the upper arm circumference and crus surrounds because they can’t stand up. The upper arm and calf circumferences in malnutrition patients (BMI<18.5) were smaller in patients with normal nutrition (BMI≥18.5) (P<0.05).The rest of the laboratory indexes were no statistically significant difference (P>0.05).8. There were no between different gender group of nosocomial infection patients in upper arm circumference, calf circumference, BMI, urea nitrogen on admission, prealbumin on admission and albumin, red blood cells, creatinine, urea nitrogen, prealbumin in infection but were statistical difference in age, height, weight, albumin creatinine, hemoglobin, red protein hemoglobin on admission.9. The differences were statistical between the elderly and the young and middle-age group in calf circumference and albumin on admission, but no statistical in the rest anthropometric and laboratory indexes. The correlation was high between calf circumference and BMI (r=0.673).10. The AUC of upper arm circumference and calf circumference was 0.939、0.883 in the young and middle-age group. There was no significant difference between diagnosis of malnutrition in upper arm circumference and calf circumference (P=0.1849).The optimal point of tangency of upper arm circumference was 24.00cm (sensitivity:100%, specificity:76%) in the young and middle-age patients with hospital infection. The optimal point of tangency of calf circumference was 30.50cm (sensitivity:90%, specificity:79%) in the young and middle-age patients with hospital infection.11. The AUC of upper arm circumference and calf circumference was 0.860% 0.869 in elderly group. There was no significant difference between diagnosis of malnutrition in upper arm circumference and calf circumference (P=0.8487).The optimal point of tangency of upper arm circumference was 23.00cm (sensitivity:79%, specificity:80%) in elderly patients with hospital infection. The optimal point of tangency of calf circumference was 28.50cm (sensitivity:88%, specificity:75%) in elderly patients with hospital infection.Conclusions1. The male and elderly hospital infection patients were more than female and the young and middle-aged patients, most hospital infection occurred after a week later on admission.2. The top five departments in hospital infection were neurology, ICU, oncology, geriatrics and gynaecology. The top five primary disease was stroke, tumor respiratory system disease, renal disease and diseases of the cardiovascular system3. The top six infection sites were lung infection, urinary tract infection, blood infection, upper respiratory tract infection, mouth infection, gastrointestinal tract infection.4. Susceptible factors were drug, malnutrition, disease, invasive operation.5. Upper arm circumference and crus surrounds can both replace BMI diagnosis of nutritional status in the young and middle-aged patients with hospital infection. The optimal point of tangency of upper arm circumference was 24.00cm. The optimal point of tangency of calf circumference was 30.50cm.6. Upper arm circumference and crus surrounds can both replace BMI diagnosis of nutritional status in elderly patients with hospital infection. The optimal point of tangency of upper arm circumference was 23.00cm. The optimal point of tangency of calf circumference was 28.50cm.