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Epidemiology of Hospital-Acquired Infections in Veterans With Spinal Cord Injury and Disorder

Published online by Cambridge University Press:  02 January 2015

Charlesnika T. Evans ,
Sherri L. LaVela ,
Frances M. Weaver ,
Michael Priebe ,
Paul Sandford ,
Pamela Niemiec ,
Scott Miskevics  and
Jorge P. Parada
Charlesnika T. Evans*
Affiliation:
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, Chicago
Sherri L. LaVela
Affiliation:
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, Chicago Center for Research on Health and Aging, University of Illinois at Chicago, Chicago
Frances M. Weaver
Affiliation:
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, Chicago Department of Neurology and Institute for Health Services and Policy Research, Northwestern University, Chicago
Michael Priebe
Affiliation:
Mayo Clinic, Rochester, Minnesota
Paul Sandford
Affiliation:
Department of Physical Medicine and Rehabilitation, Clement J. Zablocki Veterans Affairs Medical Center, Medical College of Wisconsin, Milwaukee
Pamela Niemiec
Affiliation:
Infection Control Section, Edward Hines Jr. Veterans Affairs Hospital, Hines, Chicago
Scott Miskevics
Affiliation:
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, Chicago
Jorge P. Parada
Affiliation:
Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, Chicago Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
*
Edward J. Hines Jr. Veterans Affairs Hospital, (151H), Fifth Avenue and Roosevelt Road, P.O. Box 5000, Room D302, Hines, IL 60141 ([email protected])
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Abstract

Objective.

To describe the epidemiology of hospital-acquired infections (HAIs) in veterans with spinal cord injury and disorder (SCI&D).

Design.

Retrospective medical record review.

Setting.

Midwestern Department of Veterans Affairs spinal cord injury center.

Participants.

A total of 226 patients with SCI&D hospitalized at least once during a 2-year period (October 1, 2001, through September 30, 2003).

Results.

A total of 549 hospitalizations were included in the analysis (mean duration of hospitalization, 33.7 days); an HAI occurred during 182 (33.2%) of these hospitalizations. A total of 657 HAIs occurred during 18,517 patient-days in the hospital (incidence rate, 35.5 HAIs per 1,000 patient-days). Almost half of the 226 patients had at least 1 HAI; the mean number of HAIs among these patients was 6.0 HAIs per patient. The most common HAIs were urinary tract infection (164 [25.0%] of the 657 HAIs; incidence rate, 8.9 cases per 1,000 patient-days), bloodstream infection (111 [16.9%]; incidence rate, 6.0 cases per 1,000 patient-days), and bone and joint infection (103 [15.7%]; incidence rate, 5.6 cases per 1,000 patient-days). The most common culture isolates were gram-positive bacteria (1,082 [45.6%] of 2,307 isolates), including Staphylococcus aureus, and gram-negative bacteria (1,033 [43.6%] of isolates), including Pseudomonas aeruginosa. Multivariate regression demonstrated that predictors of HAI were longer length of hospital stay (P = .002), community-acquired infection (P = .007), and use of a urinary invasive device (P = .01) or respiratory invasive device (P = .04).

Conclusions.

The overall incidence of HAIs in persons with SCI&D was higher than that reported for other populations, confirming the increased risk of HAI in persons with spinal cord injury. The increased risk associated with longer length of stay and with community-acquired infection suggests that strategies are needed to reduce the duration of hospitalization and to effectively treat community-acquired infection, to decrease infection rates. There is significant room for improvement in reducing the incidence of HAIs in this population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 3 , March 2008 , pp. 234 - 242
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.National SCI Statistical Center. Spinal Cord Injury Facts and Figures at a Glance. June 2006. National Institute on Disability and Rehabilitation Research, Washington, DC. Available at: http://www.spinalcord.uab.edu. Accessed October 11, 2007.Google Scholar
2.Montgomerie, JZ. Infections in patients with spinal cord injuries. Clin Infect Dis 1997;25:1285–1290.Google Scholar
3.DeVivo, M, Stover, S. Long term survival and causes of death. In: Stover, SL, DeLisa, JA, Whiteneck, GG, eds. Spinal Cord Injury Clinical Outcomes From the Model Systems. Gaithersburg, MD: Aspen Publishers; 1995:289–313.Google Scholar
4.DeVivo, MJ, Krause, JS, Lammertse, DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80:1411–1419.Google Scholar
5.Vincent, J. Nosocomial infections in adult intensive-care units. Lancet 2003;361:2068–2077.Google Scholar
6.LaVela, SL, Evans, CT, Miskevics, S, Parada, JP, Priebe, M, Weaver, FM. Long-term outcomes from nosocomial infections in persons with spinal cord injuries and disorders. Am J Infect Control 2007;35:393–400.Google Scholar
7.Pittet, D, Theivent, B, Wenzel, RP, Li, N, Gurman, G, Suter, PM. Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 1993;19:265–272.Google Scholar
8.Gross, PA, DeMauro, , van Antwerpen, C, Wallenstein, S, Chiang, S. Number of comorbidities as a predictor of nosocomial infection acquisition. Infect Control Hosp Epidemiol 1988;9:497–500.Google Scholar
9.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.Google Scholar
10.Chotani, RA, Roghmann, M, Perl, TM. Nosocomial infections. In: Nelson, KE, Williams, CM, Graham, NMH, eds. Infectious Disease Epidemiology: Theory and Practice. Gaithersburg, MD: Aspen Publishers; 2001:357–407.Google Scholar
11.McGowan, JE. The impact of changing pathogens of serious infections in hospitalized patients. Clin Infect Dis 2000;31(suppl 4):S124–S130.Google Scholar
12.Mylotte, JM, Graham, R, Kahler, L, Young, L, Goodnough, S. Epidemiology of nosocomial infection and resistant organisms in patients admitted for the first time to an acute rehabilitation unit. Clin Infect Dis 2000;30:425–432.Google Scholar
13.US Department of Health and Human Services. Healthy People 2010 with Understanding and Improving Health and Objectives for Improving Health. 2 vols. 2nd ed. Washington, DC: US Government Printing Office;2000.Google Scholar
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–40.CrossRefGoogle ScholarPubMed
15.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TC. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
16.Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.Google Scholar
17.Graves, N, Weinhold, D, Tong, E, et al.Effect of healthcare-acquired infection on length of hospital stay and cost. Infect Control Hosp Epidemiol 2007;28:280–292.Google Scholar
18.Gastmeier, P. Nosocomial infection surveillance and control policies. Curr Opin Infect Dis 2004;17:295–301.Google Scholar
19.Chen, Y, Chou, Y, Chou, P. Impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infect Control Hosp Epidemiol 2005;26:281–287.Google Scholar
20.Nicolle, LE, Buffet, L, Alfien, N, Tate, R. Nosocomial infections on a rehabilitation unit in an acute care hospital. Infect Control Hosp Epidemiol 1988;9:553–558.Google Scholar
21.Josephson, A, Karanfil, L, Alonso, H, Watson, A, Blight, J. Risk-specific nosocomial infection rates. Am J Med 1991;91(suppl 3b):131S–137S.Google Scholar
22.Urrea, M, Pons, M, Serra, M, Latorre, C, Palomeque, A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003;22:490–494.Google Scholar
23.Nash, MS. Known and plausible modulators of depressed immune functions following spinal cord injuries. J Spinal Cord Med 2000;23:111–120.Google Scholar
24.Frost, FS, Pien, LC. The immune system and inflammatory response in persons with SCI. In: Lin, VW, Cardenas, DD, Cutter, NC, et al., eds. Spinal Cord Medicine: Principles and Practice. New York, NY: Demos Medical Publishing Inc; 2003:213–220.Google Scholar
25.Darouiche, RO. Infection and spinal cord injury. In: Lin, VW, Cardenas, DD, Cutter, NC, et al., eds. Spinal Cord Medicine: Principles and Practice. New York, NY: Demos Medical Publishing Inc; 2003:201–207.Google Scholar
26.Lew, DP, Waldvogel, FA. Osteomyelitis. Lancet 2004;364:369–379.Google Scholar
27.Ronald, A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med 2002;113:14S–19S.Google Scholar
28.Bennett, CJ, Young, MN, Darrington, H. Differences in urinary tract infections in male and female spinal cord injury patients on intermittent catheterization. Paraplegia 1995;33:69–72.Google Scholar
29.Hamamci, N, Dursun, E, Akbas, E, Aktepe, OC, Cake, A. A quantitative study of genital skin flora and urinary colonization in spinal cord injured patients. Spinal Cord 1998;36:617–620.Google Scholar
30.Banerjee, SN, Emori, TG, Culver, DH, et al.Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Am J Med 1991;91:86S–89S.Google Scholar
31.Pien, EC, Hume, KE, Pien, FD. Gastrostomy tube infections in a community hospital. Am J Infect Control 1996;24:353–358.Google Scholar
32.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar