Risk factors for Healthcare Associated Infections (HAI) or sepsis in trauma patients: An integrative literature review

Ms  Xue Ying (Debbie)  Tan1, Dr  Kaye Rolls1,2, Dr Taneal Wiseman1, Dr  Vasiliki  Betihavas1,3
1Susan Wakil School of Nursing and Midwifery , Camperdown, Australia, 2AVATAR Griffith University, Menzies Institute , Gold Coast, Australia, 3SWSLHD Campbelltown Hospital , Campbelltown , Australia

Background: HAI and sepsis pose a threat to patient safety.  Patients presenting following a traumatic injury have an increased susceptibility to HAI and sepsis leading to unfavourable morbidity and mortality outcomes.
Aim: The aim of this integrative literature review was to explore the evidence to identify risk factors that predict HAI or sepsis in patients following admission for traumatic injury.
Methods: Medline and Scopus were electronically searched from 2007 to 2018 and key journals were hand-searched. Ancestry searching was also performed. Study criteria included: (1) quantitative studies, qualitative and mixed-methods papers, (2) sample populations of patients admitted to hospital following traumatic injury who developed at least one HAI over the course of their hospitalisation and (3) articles that were written in English. Each study was evaluated independently by two authors using the Critical Appraisal Skills Program checklists. Data extraction was completed by one author.
Findings: 7 articles (1 case control and 6 cohort studies) of ‘fair-moderate’ to ‘good’ quality were included in final review. Patient factors included (1) age (OR 1.29, 1.15-1.43), (2) deranged physiology (OR 1.66, 1.50-1.84), (3) frailty (p = 0.005, OR 1.46, 95% CI 2.28-38.78), (4) aspiration (p = 0.004, OR 33.86, 95% CI 3.10-370.07) and (5) oral colonization (p = 0.02, OR 9.41, 95% CI 2.28-38.78). System factors included major surgical intervention (OR 1.71, 1.46-2.00) and ICU admission (OR 10.75, 8.19-14.11).
Conclusions: Findings were inconclusive due to limited good quality studies. There is an overt focus on patient-related risk factors rather than healthcare providers or system factors. Furthermore, studies identified did not reflect contemporary infection prevention strategies, in particular the impact of early implementation of care bundles in Emergency Departments.
Implications: Patient outcomes in relation to HAI and sepsis must be improved.  Research into provider and system factors is urgently needed.

Dr Vasiliki Betihavas is a Senior Lecturer in Primary Health Care with over twenty years’ clinical nursing expertise in critical care. Her research focus includes developing risk prediction models and preventing readmission to hospital.  She has a passion for improving patient outcomes.