Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-01T00:30:31.586Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit

Published online by Cambridge University Press:  02 January 2015

Joseph M. Mylotte ,
Robin Graham ,
Lucinda Kahler ,
B. Lauren Young  and
Susan Goodnough
Joseph M. Mylotte*
Affiliation:
Department of Medicine, University at Buffalo, Buffalo, New York Department of Microbiology, University at Buffalo, Buffalo, New York School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
Robin Graham
Affiliation:
Office of Research Development, Department of Family Medicine, University at Buffalo, Buffalo, New York School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
Lucinda Kahler
Affiliation:
Department of Medicine, University at Buffalo, Buffalo, New York
B. Lauren Young
Affiliation:
Office of Research Development, Department of Family Medicine, University at Buffalo, Buffalo, New York School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
Susan Goodnough
Affiliation:
Department of Medicine, University at Buffalo, Buffalo, New York
*
Infectious Diseases, Erie County Medical Center, 462 Grider St, Buffalo, NY 14215
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.

Setting:

A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.

Study Population:

All patients admitted to the unit between January 1997 and July 1998.

Design:

Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).

Results:

There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), and Clostridium difficile diarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of ΔFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007).

Conclusions:

Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 2 , February 2001 , pp. 83 - 87
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nicolle, LE, Buffet, L, Alfieri, N, Tate, R. Nosocomial infections on a rehabilitation unit in an acute care hospital. Infect Control Hosp Epidemiol 1988;9:553–558.CrossRefGoogle Scholar
2. Henderson, E, Ledgerwood, D, Romance, L, Nicolle, L. Nosocomial infections in short-term rehabilitation patients: a two centre study. Sixth Annual Meeting of the Society for Healthcare Epidemiology of America. 1996; Washington, DC. Infect Control Hosp Epidemiol 1996;17(suppl):24. Abstract 52.Google Scholar
3. 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.CrossRefGoogle Scholar
4. Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.CrossRefGoogle ScholarPubMed
5. Knaus, WA, Wagner, DP, Draper, EA, Zimmerman, JE, Bergner, M, Bostos, PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–1636.Google Scholar
6. Hamilton, BB, Granger, CV, Sherwin, FS, Zielezny, M, Tashman, JS. A uniform national data system for medical rehabilitation. In: Fuhrer, MJ, ed. Rehabilitation Outcomes: Analysis and Measurement. Baltimore, MD: Brooks; 1987.Google Scholar
7. Garner, JS, Jarvis, WR, Emori, TG, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
8. Gribble, MJ, Puterman, ML. Prophylaxis of urinary tract infection in persons with recent spinal cord injury: a prospective, randomized, double-blind, placebo-controlled study of trimethoprim-sulfamethoxazole. Am J Med 1993;95:141–152.Google Scholar
9. Centers for Disease Control and Prevention. Public health focus: surveillance, prevention, and control of nosocomial infections. MMWR 1992;41:783–787.Google Scholar
10. Heinemann, AW, Linacre, JM, Wright, BD, Hamilton, BB, Granger, C. Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil 1994;75:133–143.Google Scholar
11. Pick, FC, Rose, M, Wang, D, Gardner, BP, Gillett, AP. The prevention of spread of methicillin resistant Staphylococcus aureus in a spinal injuries centre. Paraplegia 1994;32:732–735.Google Scholar
12. Olona-Cabases, M, Tico-Falguera, N, Ramirez-Garceran, L, Del Valle-Ortiz, O, Castello-Verdu, T, Garcia-Fernandez, L. Methicillin-resistant Staphylococcus aureus: a four-year experience in a spinal cord injury unit in Spain. Spinal Cord 1996;34:315–319.Google Scholar
13. Duerden, ME, Bergeron, J, Baker, RL, Braddom, RL. Controlling the spread of vancomycin-resistant enterococci with a rehabilitation cohort unit. Arch Phys Med Rehabil 1997;78:553–555.Google Scholar
14. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as the source of infection. J Infect Dis 1992;166:561–567.Google Scholar
15. Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
16. Johnson, S, Gerding, DN. Clostridium difficile-assoaateti diarrhea. Clin Infect Dis 1998;26:1027–1036.Google Scholar