Epidemiology and Impact of Healthcare-Associated Infections in Trauma Patients: A National Data Analysis

Background: Traumatic injuries are a leading cause of death and morbidity. Despite their comprising a small (<5%) segment of all hospitalizations, the length of stay (LOS) is above average; and the cost of care for the more than 20 million trauma inpatients nears $30 billion per year. Adding insult to injury, risk factors for health-care-associated infections (HAI), including invasive devices and comprised integrity, may be particularly pronounced in this population, potentially exacerbating the clinical and economic burden. Our aim was to determine the distribution, determinants, and burden of HAI after traumatic injury using LOS as a surrogate for health-care-related expense. Patients and Methods: This retrospective cohort study used the Trauma Quality Improvement Project (TQIP) database (2013-2016). Patients 16 to 89 years of age were included. Those who developed at least one of the following were counted as cases: Catheter-related central blood stream infection, catheter-related urinary tract infection, ventilator-associated pneumonia, surgical site infection, osteomyelitis, and severe sepsis. Outcomes included the hospital LOS, intensive care unit (ICU) days, and ventilator days. Uni-variable and propensity-matched analyses were conducted to determine differences among patients with and without an HAI. Results: Of 806,066 patients, 5.6% (n = 44,844) developed an HAI. A higher proportion of patients with HAI had co-morbid risk factors of chronicity and history of blood transfusion and rated higher on the Abbreviated Injury Scale than those without HAI. After matching, those with HAI also had significantly longer (3 x ) overall LOS, ICU LOS, and prolonged mechanical ventilation (p < 0.05). Conclusions: This updated epidemiology study of trauma patients showed the HAI burden to be higher than past estimates and disproportionate of all patient estimates. The associated economic burden of a longer ICU stay with a tripling of the LOS and longer mechanical ventilation demands responsible administrative policies and support for infection prevention programs and interventions.