National nosocomial infection surveillance system-based study in Iran: additional hospital stay attributable to nosocomial infections

BACKGROUND: Nosocomial infection is a serious health and financial problem. The purpose of this study was to determine the extra hospital stay attributable to nosocomial infections for patients undergoing surgery. METHOD: All patients undergoing surgery admitted from March 1, 1999, to February 28, 2000, to the 38-bed general surgery ward within a university hospital in Shiraz, Iran, were included in this study. The study was planned as a pairwise-matched case-control study nested in cohort design. A case was defined as any patient with 1 of 4 of the following nosocomial infections: urinary tract infection; surgical site infection; bloodstream infection; or pneumonia, whereby definitions for the nosocomial infections were on the basis of National Nosocomial Infection Surveillance system definitions. For each patient, an appropriate match was selected, which resulted in 69 pairs of study patients. RESULTS: The total incidence of nosocomial infection during the study period was 17.59%. The mean extra length of hospitalization as a result of all major kinds of nosocomial infections was 6.62 days total, which was obtained using 4.4, 5.33, 8.73, and 9.2 extra days for urinary tract infection, pneumonia, surgical site infection, and bloodstream infection, respectively. CONCLUSION: Nosocomial infections add considerable costs to the health care system in Iran. Therefore, the development of strategies and concepts to reduce the incidence of nosocomial infections is cost-effective and warranted, and an appropriate surveillance system on the basis of international criteria is the cornerstone for this task.