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Epidemiology of nosocomial infections in veterans with spinal cord injury and disorder

Evans CT, LaVela SL, Parada JP, Priebe M, Sanford P, Weaver FM. Epidemiology of nosocomial infections in veterans with spinal cord injury and disorder. Poster session presented at: Society for Healthcare Epidemiology of America Annual Scientific Meeting; 2006 Mar 1; Chicago, IL.

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Background:Infection is the most common reason for emergency room visits and rehospitalizations in persons with spinal cord injury and disorder (SCIandD) and a common primary cause of death. Yet, the literature is limited on the epidemiology of nosocomial infections in this high risk population. Objectives:The purpose of this study was to describe the epidemiology of nosocomial infections (including assessment of infection sites) in veterans with SCIandD at a midwestern VA Spinal Cord Injury Center. Methods:A retrospective chart review was conducted on patients admitted at least once during a two-year period (October 1, 2001-September 30, 2003) to identify nosocomial infections. The incidence rate (IR) of nosocomial infections was defined by number of infections/total number of hospital days. Multivariate logistic regression analysis using Generalized Estimating Equations (GEE) was used to identify factors predictive of nosocomial infection occurrence.Results:226 patients had at least one admission with a mean length of stay (LOS) of 33.73 days (s.d. 57.89) during the study period. The majority of patients were male and white; the mean age, age at injury onset and duration of injury were 58, 37, and 21 years, respectively; level of injury was as follows: tetraplegia (47%), paraplegia (46%), unknown (7%). 668 nosocomial infections occurred during the study period in 18,517 total patient days in the hospital (IR = 36.1/1000 patient days). Almost half had at least one nosocomial infection. The average number of nosocomial infections per patient with an infection was 6.02/patient. The majority of nosocomial infections in veterans with SCIandD were from the urinary tract (25%; IR = 8.8/1000 patient days), bloodstream (18%; IR = 6.5/1000 patient days), and bone and joint (15%; IR = 5.6/1000 patient days). Persons with SCIandD that had at least one occurrence of a nosocomial infection were older (60 vs. 56years, p = 0.04) and had more comorbidities (mean of 1.19 vs. 0.70, p = 0.01). In-hospital mortality rate for those with and without infection was 12.6% and 5.2%. Multivariate analyses demonstrated that a patient was 24 times more likely to develop a nosocomial infection if their LOS was greater than 36 days compared to one hospitalized less than 7 days.Conclusions:Blood stream and urinary tract infections were two of the most common nosocomial infections found in this population, similar to what is found in the literature. The 3rd most common infections were bone and joint infections; though a prevalent problem in persons with SCIandD, the number of infections was still surprisingly high. The overall number of nosocomial infections in this population was higher than what has been found in the literature in other populations; this may be due to the long LOS seen in persons with SCIandD compared to other populations. These results indicate that there is significant room for improvement in reducing nosocomial infections in this population, which will ultimately lead to better outcomes.

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