| Background:The nosocomial infection is a world’s public health problem and the infection outbreak has a serious impact on medical security and social stability. The nosocomial infection is a world’s public health problem and the refractory and higher incidence and mortality rates make it to be a clinical problem demanding prompt solution in the work. The nosocomial infection not only can prolong patients’ hospitalization days increase patients’ mortality rate, bring great danger to patients’ health and safety, but also affect some high and new technology development, such as organ transplant and other difficult surgery. They often failed due to the nosocomial infection and result in a waste of medical resources and serious economic burden. Therefore, it is practical significant to conduct a prospective study on patients’ nosocomial infection monitoring and evaluation of economic burden, to find the influence factors of nosocomial infection and formulate and implement interventions to prevent nosocomial infection outbreak, and provide the scientific basis for department of public health and hospital managers in the formulation of relevant laws and regulations and the prevention regulation.Clinical studies have shown that, in recent years, the number of patients with chronic renal failure is increasing and hemodialysis patients are increasing year by year. Nosocomial infection is the most common complication and main cause of death in hemodialysis patients. An investigation of the incidence of nosocomial infection of various departments in the hospital showed that, department of hemodialysis had high prevalence of infection and the incidence can be as high as14.2%-49.2%. There have already broken out four events about nosocomial infection with hemodialysis patients in several hospitals from February2009to March2010, which caused serious social impact and drawn great attention of the ministry of health.Literature research indicated that domestic studies only focused on related factors of nosocomial infection in hemodialysis patients, most of which used retrospective investigation method. In Canada, some researchers paid attention to the cost-benefit analysis of nosocomial infection of hemodialysis patients and its prevention and control. There was yet no research that used the target monitoring method with the self-designed questionnaire to investigate the influencing factors of nosonomial infection of hemodialysis patients and evaluated the economic burden.In conclusion, the study focusing on nosocomial infection of hemodialysis patients, used the self-designed target monitoring questionnaire and the prospective monitoring method to research comprehensively and systematically various factors, including the nosocomial infection’s influencing factors, infection patterns and direct economic burden of hemodialysis patients. The study proposed and implemented the targeted intervention measures to reduce the incidence of nosocomial infection, which is of great practical significance to prevent nosocomial infection outbreak and has great value to application and research.Research Objectives:The objective of the study was to investigate the status of nosocomial infection of hemodialysis patients and its direct economic burden on a Three-level hospital by prospective target monitoring method, to find out the influencing factors and take intervention measures, to reduce the incidence of nosocomial infection and ensure the medical safety of hemodialysis patients, and to reduce the economic burden and shorten hospitalization days to improve patients’living quality. The specific objectives included:to investigate the current status, the characteristics, the site and pathogens distribution of nosocomial infection of hemodialysis patients; to analyze the correlation between the influencing factors and nosocomial infection; to study the direct economic burden and influencing factors, in order to improve the awareness of nosocomial infection prevention and reduce the waste of health resources, also to provide scientific basis for the administrative department of public health and hospital administrator to establish relevant laws, regulations and management rules.Research Methods:By cluster sampling, prospective target monitoring were taken on1184hemodialysis patients who suffered from uremia and were treated in department of hemodialysis on a Three-level hospital in Shandong Province from January1,2008to December31,2012. The questionnaire "The target monitoring investigation forms of hemodialysis patients","The nosocomial infection questionnaire of hemodialysis patients" and "The economic burden questionnaire of nosocomial infection of hemodialysis patients" of our own design were filled out by members of the research group. Various factors, including the general information of hemodialysis patients, the status of nosocomial infection, hospitalization expenses and hospitalization days were investigated. Chi-square test was used to analyze the relationship between the influencing factors and nosocomial infection. By logistic regression method, the significant influencing factors of nosocomial infection were included in multiple stepwise regression analysis. Patients with nosocomial infection were taken as case group and patients without nosocomial infection as control group, and hospitalization expenses and hospitalization days were investigated to analyze the direct economic loss of nosocomial infection. All the data were analyzed by Statistical Product and Service Solutions version19.0(SPSS19.0).Research Results:1. This study investigated1184patients,794male and390female patients aged between12and89years old, with an average age of (49.08±17.12),783patients were under60and401cases over60. 2. This study had investigated1184patients in department of hemodialysis from2008to2012,136patients and151cases suffered from nosocomial infection with an average infection rate of11.49%and an infection cases rate of12.75%. Both the infection rate and the infection case-rate of hemodialysis patients had shown a declining trend yearly from2008to2012. The infection rate dropped from17.05%in2008to6.14%in2012, and the infection case-rate from18.43%in2008to7.58%in2012.3. In151infected cases, the infection site was mostly the lower respiratory tract with61infection cases and41.50%infectious rate, followed by upper respiratory infection,32infected cases and21.19%infectious rate.26cases (17.22%) suffered from catheter-related infections,17cases (11.26%) from urinary tract infection.5cases (3.31%) from gastrointestinal infection and10cases from other infections.4. In all the patients of hospital mfection, a total of138pathogens were found.67Gram-negative bacteria (48.55%),60Gram-positive bacteria (43.48%),8fungi (5.80%) and3virus infections (2.7%). Neisseria meningitides were the most frequent finding in Gram-negative bacteria, streptococcus viridians in Gram-positive bacteria, Candida albicans in fungi and cytomegalovirus in virus infections.5. According to the Chi-square test, the nosocomial infection rate was associated with many factors including ages, hospitalization days, dialysis days, hemoglobin, body mass index, white blood cells (WBC), urine volume, catheter site, catheter detaining time, community-acquired infection and underlying diseases the difference in which was statistically significant (P<0.05). Whereas, there was no statistical significance between patients with different gender and season (P>0.05).6. The Chi-square test results showed that anemia, chronic glomerular nephritis, electrolyte disturbance and rheumatoid arthritis were influencing factors of nosocomial infection in hemodialysis patients (P<0.05). But there were no statistically significant differences on nosocomial infection rates of patients suffering from high blood pressure, diabetes, heart disease and diabetic nephropathy (P>0.05).7. The results of multiple regression analysis showed that age, number of underlying diseases, catheter site, catheter indwelling time and urine volume were significant determinants of nosocomial infection with hemodialysis patients and the difference was statistically significant (P<0.05).8. In infection group, the lowest total hospitalization expenses were4044yuan, the highest255086yuan and the median of total expenses were32269yuan. In control group, the lowest total hospitalization expenses were480yuan, the highest were163718yuan and the median of total expenses were14872yuan. The hospitalization expenses in infection group were higher than that in control group and the direct economic burden of nosocomial infection in hematodialysis patients was17397yuan.9. The various hospitalization expenses of infection group were all higher than those of control group and the difference was statistically significant (P<0.05). Among various hospitalization expenses, medicine fees (49.31%) was the highest, about49.31%, followed by therapy fees (33.14%) and laboratory fees (8.34%) and the treatment fees were the lowest.10. The total hospitalization expenses of infection group with different infection sites were higher than those of control group with a statistically significant difference (P<0.05). In comparison with single-site infection, the burden from multi-site infection was higher with30946yuan. In the single-site infection, the burden of urinary infection was highest, which took about23772yuan, followed by catheter-related infections, about10257yuan.11. The economic burden varied from age. The total hospitalization expenses of case group of different ages were higher than those of control group with statistical significance (PO.05). Patients between12-17years old had the highest economic burden, about74597yuan, then followed by patients more than60years old, about22319yuan.12. The hospitalization days were analyzed by Wilcoxon singned-rank test. The results showed that the median of hospitalization days of case group was41days and25days in control group. The difference was16days, which was statistically significant (P<0.05). It revealed that the hospitalization days of hemodialysis patient with nosocomial infection could be prolonged16days.13. The prolonged hospitalization days of patients with different infection sites were analyzed and the results showed that the hospitalization days of case group with different sites were longer than those of control group and the difference on the median of hospitalization days was statistically significant (P<0.05). The prolonged hospitalization days varied from infection sites. The prolong time of Multi-site infection had the most impact on the prolonged time which was35days.14. The prolonged hospitalization days of patients in different ages were analyzed. The results showed that the hospitalization days of case group were longer than those of control group, with a statistically significant difference on the median of hospitalization days (P<0.05). The difference of patients between12-17years old on prolonged hospitalization days was the longest and it was93days, then it was followed by patients more than60years old and the prolonged hospitalization days was20days.Conclusions and Recommendations:Although the average incidence of nosocomial infection in hemodialysis patients in the study was11.49%, lower than other relevant research results and the nosocomial infection rate of hemodialysis patients declined from2008to2012, hemodialysis patients were still at high risk of nosocomial infection due to their low immunity and long-term invasive operations. The influencing factors of nosocomial infection in hemodialysis patients include older age (higher than60years old), heavier underlying diseases, multi-site catheter, temporary catheter and extended catheter days. The occurrence of nosocomial infection can increase the hospitalization expenses, especially western medicine expenses and treatment expenses, and prolong the hospitalization days. The economic burden of multi-site infection is higher than that of a single site infection. The economic burden was different of hemodialysis patients in different age. Patients between12-17years old have the biggest economic burden, followed by elderly patients.Recommendations:(1) Try to arrange the patients in a single or a double room and avoid a crowded room if the condition allowed, in order preventing the spread of respiratory infection in the ward, otherwise it may reduce the incidence of respiratory tract infection in hemodialysis patients.(2) Maintain all kinds of catheter and perform strictly aseptic operation, continue to study and formulate measures to reducing the risk of catheter related infection and to provide evidences of evidence-based medicine, to achieve the goal of "zero infection".(3) Promote the detriment and economic burden of hospital infection to the general hospital administrators and medical personnel according to the results of the study, to enhance the consciousness of nosocomial infection prevention in medical staff, and to enforce consciously the rules and regulations of nosocomial infection management.(4) Reinforce the training of medical staff on nosocomial infection and continue to carry out strict hand hygiene work of medical personnel, and improve the compliance of hand washing, to avoid nosocomial cross infection and reduce the incidence of nosocomial infection.(5) Improve the nutritional status of hemodialysis patients, strengthen nutrition support therapy, increase the level of HB and the amount of WBC, ameliorate anemia and enhance the immunity of patients against infection.(6) Control and shorten the hospitalization days, dialysis days and catherter days in hemodialysis patients with the permission of patients’conditions, to reduce the incidence of nosocomial infection caused by longer hospitalization days. |
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