Healthcare-Associated Infections Are Associated with Insufficient Dietary Intake: An Observational Cross-Sectional Study

Abstract

BackgroundIndicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population.Methods and findingsDietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis.ConclusionMeasured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention.

Health care-associated infections – an overview

“…32,[141][142][143] The annual costs for HCAIs alone in the USA are between US$28 and US$45 billion, but with even this amount of spending, 90,000 lives are still lost per year: HCAIs are among the top five killers in the USA. 14,[144][145][146][147] The WHO advocates that effective hand hygiene is the single most important practice to prevent and control HCAIs, which form colonies with MDR microbes. 1,2,148,149 Several studies report that a simple and straightforward process, taking only a few seconds to clean hands with an alcohol-based hand rub helps prevent HCAIs and save lives, reduce morbidity, and minimize health care costs.…”

Health System Quality Improvement

“…3,[10][11][12] Malnutrition has negative impacts on patients and the health care system, leading to more complications, slowed recovery, and higher costs of care. Study results show that malnourished hospital patients, compared with their adequately nourished peers, are more likely to experience pressure ulcers, 13 postsurgical infections, 14,15 and falls 16 and are at greater risk for death. 17,18 These adverse outcomes contribute to the excessive financial burden on our health care system in the form of costly complications, longer hospital stays, and more frequent readmissions.…”

Health care costs matter: a review of nutrition economics – is there a role for nutritional support to reduce the cost of medical health care?

“…26,[35][36][37] Survival (or mortality) is the one of the most frequently measured variables related to nutrition. 10,28,29 One large new study showed that, to save a life, the numberneeded-to-treat (the average number of patients who need to be treated to prevent one additional bad outcome) with ONS was just 20.3.…”