Assessing the impact of healthcare-associated infections in patients discharged from a University Hospital in Southeastern Brazil (Hospital das Clinicas da Faculdade de Medicina de Botucatu)

Abstract

Nosocomial infections are defined as those acquired after hospital admission that manifested during the hospitalization or after discharge. Recently, the concept was expanded to cover infections resulting from the care provided in non-hospital settings (healthcare-associated infections, HAI). HAIs are a major public health problem worldwide, with the greatest impact in developing countries. Despite its inclusion in the agenda of the Ministry of Health for nearly three decades, there are little data on the magnitude of HAIs in Brazil. Less is known about the full impact of HAIs. Recent studies focused on mortality, prolongation of stay, and cost of hospitalization. Some analyze the potential for infection prevention. However, few studies aimed at estimating the social burden of HAIs. Recently, a study conducted in the U.S. showed that patients discharged after diagnosis of HAIs had an increased risk of readmission. The identification of trends like this in Brazil is of great importance for the Unified Health System. Obviously, given the complex system of reference/counter-referral, as well as the transit of persons between primary (e.g., Basic Units of health, Family Health Program ), secondary and tertiary care services, addressing the impact of HAIs is a major challenge. Our project aims to identify the impact of HAIs among subjects discharged from the "Hospital das Clínicas da Faculdade de Medicina de Botucatu" ( 450 beds ) . We intend to follow a prospective matched cohort of 136 subjects diagnosed with HAIs during hospitalization and 136 controls without this diagnosis, for a total of 12 weeks after discharge. Outcomes of interest will be the rate of readmission, the number of outpatient visits, the degree of autonomy and the need for absence from work, the impact on family routine, and the quality of life. Weekly interviews will be conducted by telephone using a standardized questionnaire to identify the factors mentioned above. For individuals living in Botucatu, we will apply a cross-culturally validated questionnaire for assessing the quality of life ( SF36 ) in the fourth and eighth weeks post-discharge. The results will be analyzed using multivariate logistic models and/or survival analysis. (AU)