Outcomes of Healthcare Associated Infection in Intensive Care Units of A Tertiary Care Hospital

Muhammad Rizwan; Aamer Ikram; Muhammad Qaiser Alam Khan; Zahid Farooq Baig; Muhammad Abid; Ayesha Bashir

doi:10.51253/pafmj.v75iSUPPL-6.8284

Authors

Muhammad Rizwan Department of Pathology, Army Cardiac Centre Lahore Pakistan
Aamer Ikram Department of Microbiology, National Institutes of Health Islamabad, Pakistan
Muhammad Qaiser Alam Khan Department of Pathology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan
Zahid Farooq Baig Department of Nephrology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan
Muhammad Abid Department of Pathology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan
Ayesha Bashir Department of Pathology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-6.8284

Keywords:

Healthcare associated infection, health care costs, intensive care units, length of stay.

Abstract

Objectives: To determine the extra costs, excess length of stay and mortality attributable to healthcare associated infection among critically ill patients.

Study Design: Prospective longitudinal study

Place and Duration of Study: Surgical, Medical and Cardiac Intensive Care Units of Combined Military Hospital, Lahore between January 2021 and December 2021.

Methodology: Successive 339 adult patients, having Simplified Acute Physiology Score II < 70, remained admitted to the intensive care units for a minimum of 48 hours were included. Patients were followed up for healthcare associated infections and related parameters on daily basis. Patients with and without healthcare associated infection were compared for mean age, gender, severity of disease score, length of stay, mortality and mean overall expenditures.

Results: Out of 339 total patients, 103(30.4%) acquired infection during their stay in intensive care unit. The patients with healthcare associated infections had 12 days longer mean overall length of stay, 21.9% higher mortality rate and $4340 extra overall cost per patient comparatively to patients without healthcare associated infection.

Conclusion: In this study, patients with healthcare associated infection experienced remarkable prolongation of hospitalization, higher attributable mortality and an increased use of healthcare costs. These outcomes indicate the necessity of implementation of efficient and flawless infection control program.

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References

1. Magill SS, O’Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, et al. Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med. 2018 Nov 01; 379(18): 1732-44.

2. Suetens C, Latour K, Karki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in the acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018 Nov 15; 23(46): 1800516.

3. Karki T, Plachouras D, Cassini A, Suetens C. Burden of healthcare-associated infections in European acute care hospitals. Wien Med Wochenschr. 2019 Feb; 169(Suppl 1): 3-5.

4. Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011 Jan 15; 377(9761): 228-41.

5. Arif S, Sadeeqa S, Saleem Z, Latif S, Sharif M. The burden of healthcare-associated infections among pediatrics: a repeated point prevalence survey from Pakistan. Hosp Pract (1995). 2021 Feb; 49(1): 34-40.

6. Fact sheet on HCAI endemic burden worldwide. Clean care is safer care. World Health Organization 2011. Available at: http://www.who.int/gpsc/country_work/burden_hcai/en/ Accessed June 01, 2021.

7. Rahmqvist M, Samuelsson A, Bastami S, Rutberg H. Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements. Am J Infect Control. 2016 May 1; 44(5): 500-6.

8. Septimus E, Yokoe DS, Weinstein RA, Perl TM, Maragakis LL, Berenholtz SM. Maintaining the momentum of change: the role of the 2014 updates to the compendium in preventing healthcare-associated infections. Infect Control Hosp Epidemiol. 2014 Sep; 35 Suppl 2: S6-9.

9. Forrester JD, Maggio PM, Tennakoon L. Cost of health care-associated infections in the United States. J Patient Saf. 2021 Apr 13; doi: 10.1097/PTS.0000000000000845.

10. Rosenthal VD, Guzman S, Migone O, Crnich CJ. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: A prospective, matched analysis. Am J Infect Control. 2003 Dec; 31(8): 475-80.

11. Centers for disease control and prevention. Bloodstream infection event (Central line-associated bloodstream infection and non-central line-associated bloodstream infection). Available ahttp://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed June 05, 2021.

12. Centers for disease control and prevention. Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU] event. Available at http://www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf. Accessed June 05, 2021.

13. Centers for disease control and prevention. Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI] and other urinary system infection [USI]) events. Available at http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf. Accessed June 05, 2021.

14. Centers for disease control and prevention. Surgical site infection (SSI) event. Available at http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent

15. Anderson DJ, Kirkland KB, Kaye KS, Thacker PA, Kanafani ZA, Auten G, et al. Underresourced hospital infection control and prevention programs: Penny wise, Pound foolish. Infect Control Hosp Epidemiol. 2007; 28: 767-773.

16. Rizvi MF, Hasan Y, Memon AR, Abdullah M, Rizvi MF, Saleem S, et al. Pattern of nosocomial infection in two intensive care units of a tertiary care hospital in Karachi. J Coll Physicians Surg Pak. 2007 Mar; 17(3): 136-9.

17. Shaikh JM, Devrajani BR, Ali Shah SZ, Akhund T, Bibi I. Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital. J Ayub Med Coll Abottabad. 2008 Oct-Dec; 20(4): 37-40.

18. Choudhuri AH, Chakravarty M, Uppal R. Epidemiology and characteristics of nosocomial infections in critically ill patients in a tertiary care Intensive Care Unit of Northern India. Saudi J Anaesth. 2017 Oct-Dec; 11(4): 402-7.

19. Duszynska W, Rosenthal VD, Szczesny A, Zajaczkowska K, Fulek M, Tomaszewski J. Device associated-health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017). BMC Infect Dis. 2020 Oct 16; 20(1): 761.

20. Salmanov A, Litus V, Vdovychenko S, Litus O, Davtian L, Ubogov S, et al. Healthcare-associated infections in intensive care units. Wiad Lek. 2019; 72(5cz2): 963-9.

21. Soleymani F, Palangi HS, Asiabar AS, Keshtkar A, Mohammadi M, Sari AA, et al. Costs of hospital-acquired infection for patients hospitalized in intensive care unit of an Iranian referral hospital. Med J Islam Repub Iran. 2018 Aug 6; 32: 67.

22. Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, et al. International nosocomial infection control consortium (INICC) report, data summary of 45 countries for 2012-2017. Device associated module. Am J Infect Control. 2020 Apr; 48(4): 423-32.

23. Al-Abdely HM, Alshehri AD, Rosenthal VD, Banjar W, Mohammed YK, Assiri AM, et al. Device-associated infection rates in Intensive Care Units of five cities of the Kingdom of Saudi Arabia: International Nosocomial Infection Control Consortium (INICC) findings. Can J Infect Control. 2017; 32(1): 31-36.

24. Kanj S, Kanafani Z, Sidani N, Alamuddin L, Zahreddine N, Rosenthal V. International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital. J Glob Infect Dis. 2012 Jan; 4(1): 15-21.

25. Kothari A, Sagar V, Ahluwalia V, Pillai BS, Madan M. Costs associated with hospital-acquired bacteraemia in an Indian hospital: a case-control study. J Hosp Infect. 2009 Feb; 71(2): 143-8.

26. Kaye KS, Marchaim D, Chen TY, Baures T, Anderson DJ, Choi Y, et al. Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J Am Geriatr Soc. 2014 Feb; 62(2): 306-11.