Abstract
Background
Nosocomial infections, which arise during patient treatment in healthcare facilities and are absent at admission, occur more frequently in Intensive Care Units (ICUs) and high-care settings than in general wards. Consequently, patients in ICUs or high-care units face a higher risk of acquiring these infections compared to those in general wards.
Purpose
This study aimed to quantitatively analyse the impact of patient and environmental risk factors on the incidence of nosocomial infections in ICU and high-care patient populations.
Methods
This retrospective study utilized secondary data from the IPC (Infection, Prevention and Control) program, examining 514 patients admitted to ICU and high-care units between August 2022 and August 2023. Using random sampling, 213 patients of various ages (from 13 years and older) and both genders were selected for inferential statistical analysis with STATA/MP version 18.0 and SPSS version 29.
The study's analysis included descriptive statistics on patient population frequencies and nosocomial infection incidence. Multivariate analyses, using logistic regression, chi-square tests, and Cox regression, examined significant associations between risk factors and environmental factors. The results confirmed a higher incidence of nosocomial infections in ICU and high-care settings, identified significant associations with patient and environmental risk factors, and demonstrated the impact of these infections on patient outcomes, indicating an increased burden of disease.
Results
Descriptive Analysis: The study found an overall infection incidence rate of 11%. ICU patients had 25.14 infections per 1000 patient days, compared to 14.19 for the rest of the hospital. Klebsiella pneumoniae accounted for 57.3% of infections, followed by Pseudomonas aeruginosa (22.5%) and Escherichia coli (16%). Candida Auris led to the longest hospital stays (83 days), followed by Serratia marcescens (81 days) and Pseudomonas aeruginosa (76 days).
Survival Analysis: Older age, multiple risk factors, ventilation, and medical ICU admission were linked to a higher mortality risk. Pseudomonas aeruginosa, Serratia marcescens, and Candida
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Auris were significantly associated with increased mortality risk. Prolonged hospital stay, having more than one infection type, undergoing a surgical procedure, having multiple infections or infection sites increases the risk of death. Peripheral lines and tracheostomy tubes were associated with a lower risk of mortality. Appropriate antibiotic use reduced death risk by 11%.
Multivariate Analysis: Invasive ventilation increased the risk of Klebsiella pneumoniae, Serratia marcescens, Acinetobacter baumannii and Escherichia coli. Peripheral IV lines were associated with an increased risk of Candida Auris, Escherichia coli and Clostridioides difficile. Tracheostomy tubes are associated with Candida Auris, Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter baumannii, Candida parapsilosis, Escherichia coli, Enterobacter cloacae and Clostridioides difficile. Klebsiella pneumoniae, Candida auris, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Serratia marcescens and Clostridioides difficile resulted in prolonged hospital stay. Based on the study’s prediction model, 21 patients who were discharged were at a higher risk of death but had survived and 40 patients who had demised were at a lower risk of death.
Conclusion
The strengths and weaknesses of the study are discussed. Lastly, the study recommendations are discussed to highlight current improvements and advancements in reducing the burden of nosocomial infections and the spread within healthcare facilities.
Keywords: nosocomial infections, cox survival analysis, logistic regression, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Candida Auris, immunosenescence