Impact of direct hand hygiene observations and feedback on hand hygiene compliance among nurses and doctors in medical and surgical wards: an eight-year observational study.

BACKGROUND: The improvement of hand hygiene compliance (HHC) is vital for preventing healthcare-associated infections (HAIs). AIM: To determine whether observation and feedback influences HHC among nurses and doctors in surgical and medical wards, and whether these actions impact HAI incidence. METHODS: In this longitudinal observational study, HHC and the incidence of HAIs were observed in six medical and seven surgical wards in a tertiary hospital in Finland from May 2013 to December 2020. Data of the observations of five hand hygiene (HH) moments were collected from the hospital HH and the HAI monitoring registries. For statistical analyses a multivariable logistic regression analysis and a Poisson regression model were used. FINDINGS: HH monitoring included 24,614 observations among nurses and 6396 observations among doctors. In medical wards, HHC rates increased 10.8%, from 86.2% to 95.5%, and HAI incidence decreased from 15.9 to 13.5 per 1000 patient-days (P < 0.0001). In surgical wards, HHC increased 32.7%, from 67.6% to 89.7%, and HAI incidence decreased from 13.7 to 12.0 per 1000 patient-days (P < 0.0001). The overall HHC increased significantly among nurses (17.8%) and doctors (65.8%). The HHC was better among nurses than doctors (in medical wards, OR: 3.36; 95% CI: 2.90-3.90; P < 0.001; and in surgical wards, OR: 9.85; 95% CI: 8.97-10.8; P < 0.001). CONCLUSION: Direct observations and feedback of HH increased HHC significantly among nurses and doctors over an eight-year period. During the same period, the incidence of HAIs significantly decreased in both medical and surgical wards.

Building-related symptoms are linked to the in vitro toxicity of indoor dust and airborne microbial propagules in schools: A cross-sectional study.

INTRODUCTION: Indoor microbial toxicity is suspected to cause some building-related symptoms, but supporting epidemiological data are lacking. OBJECTIVE: We examined whether the in vitro toxicity of indoor samples from school buildings was associated with work-related health symptoms (building-related symptoms, BRS). METHODS: Administrators of the Helsinki City Real Estate Department selected 15 schools for the study, and a questionnaire on symptoms connected to work was sent to the teachers in the selected schools for voluntary completion. The cellular toxicity of classroom samples was determined by testing substances extracted from wiped indoor dust and by testing microbial biomass that was cultured on fallout plates. Boar sperm cells were used as indicator cells, and motility loss was the indicator for toxic effects. The effects were expressed as the half maximal effective concentration (EC50) at which >50% of the exposed boar sperm cells were immobile compared to vehicle control. RESULTS: Completed symptom questionnaires were received from 232 teachers [median age, 43 years; 190 (82.3%) women] with a median time of 6 years working at their school. Samples from their classrooms were available and were assessed for cellular toxicity. The Poisson regression model showed that the impact of extracts of surface-wiped school classroom dust on teacher work-related BRS was 2.8-fold (95% CI: 1.6-4.9) higher in classrooms with a toxic threshold EC50 of 6µgml-1 versus classrooms with insignificant EC50 values (EC50 >50µgml-1); P<0.001. The number of symptoms that were alleviated during vacation was higher in school classrooms with high sperm toxicity compared to less toxic sites; the RR was 1.9 (95% CI: 1.1-3.3, P=0.03) for wiped dust extracts. CONCLUSIONS: Teachers working in classrooms where the samples showed high sperm toxicity had more BRS. The boar sperm cell motility inhibition assay appears promising as a tool for demonstrating the presence of indoor substances associated with BRS.

Early chest computed tomography in adult acute severe community-acquired pneumonia patients treated in the intensive care unit.

BACKGROUND: The value of early chest computed tomography (CT) was evaluated among severe community-acquired pneumonia (SCAP) patients. METHODS: The study population consisted of 65 of 457 SCAP patients with concomitant chest CT and radiograph performed within 48 h of ICU admission. Each image pair was re-evaluated by two radiologists. The type of pneumonia, the presence of pleural fluid and atelectasis were assessed. Therapeutic and diagnostic procedures induced by CT results were analysed together with clinical, microbiological and outcome data. RESULTS: Alveolar pneumonia was observed in 72.3% of patients by radiograph and in 75.4% of patients by CT. Pleural fluid was detected via chest radiograph and CT in 17 (26.2%) and 41 cases (63.1%), (P < 0.001) and atelectasis in 10 (15.4%) and 22 cases (33.8%), (P = 0.002), respectively. In 34 patients (52.3%), the CT revealed 38 new findings (58.5%) not shown in plain chest radiograph. Out of these 34 patients, therapeutic interventions or procedures were performed in 26 (76.5%). The number of infected lobes correlated negatively with the lowest PaO2 /FiO2 ratio (ρ = -0.326, P = 0.008) for chest CT scans. CONCLUSION: Compared with chest radiograph, chest CT generated new findings in nearly 60% of SCAP patients, leading to new procedures or changes in medical treatment in nearly 75% of those patients. Chest CT better describes the pulmonary involvement and severity of oxygenation disorder compared to a plain chest radiograph.

Kinetics of leukocyte CD11b and CD64 expression in severe sepsis and non-infectious critical care patients.

BACKGROUND: Leukocyte surface molecules may improve sepsis diagnostics. Our aim was to study whether monocyte and neutrophil CD11b and CD64 expression differs between patients with severe sepsis (including septic shock) and intensive care unit (ICU) controls, and also to investigate the expression kinetics in patient groups. METHODS: Monocyte and neutrophil CD11b and CD64 expression was analyzed in 27 patients with severe sepsis, 7 off-pump coronary artery bypass (OPCAB) patients, and 8 ICU patients without systemic inflammation in the beginning of the treatment using quantitative flow cytometry. Blood samples were collected within 48 h of the beginning of severe sepsis, at admission to the ICU for non-systemic inflammatory response syndrome patients, and on the day of surgery before the skin incision for OPCAB patients, and on 2 consecutive days for all patients. Ten healthy individuals served as controls. RESULTS: Monocyte and neutrophil CD11b and neutrophil CD64 expression was higher in severe sepsis patients compared with the other groups (P < 0.05). In severe sepsis, the expression decreased over time (P < 0.05). In OPCAB patients, the monocyte and neutrophil CD64 expression increased after surgery (P < 0.05). Neutrophil CD64 expression had the highest and statistically significant area under curves (AUC) values for identification of severe sepsis during 3 consecutive days, the highest AUC being 0.990 on D0. CONCLUSION: Neutrophil CD64 as well as neutrophil and monocyte CD11b expressions were highest in severe sepsis compared with non-infectious conditions, and thus analyses of their expression may be promising approach for sepsis diagnosis in ICU population.

Incidence of healthcare-associated infections in a tertiary care hospital: results from a three-year period of electronic surveillance.

BACKGROUND: Point prevalence surveillance is widely used to monitor healthcare-associated infections (HAIs). Incidence surveillance offers more accurate information than point prevalence surveillance, but is more time consuming. Electronic surveillance systems may allow for more widespread incidence surveillance. AIM: To determine the incidence of HAI in a tertiary care hospital in Finland over a three-year period from 2011 to 2013 using an automated electronic IS programme, linked to all of the hospital's electronic databases. METHODS: The programme identified cases of HAI prospectively from initiation of antibiotic treatment. All of the cases were verified manually after discharge. In order to evaluate the sensitivity of the electronic method for the identification of surgical site infections, the medical records of all patients who underwent cardiac surgery or total joint arthroplasty were evaluated retrospectively. FINDINGS: In total, 78,211 patients, covering 321,974 patient-days, were admitted to the wards during the study period, and 29,694 antibiotic treatment initiations were registered. After manual review, 5089 (17.1%) of these were found to be for HAIs. The total time needed to undertake the surveillance for the whole hospital (353 hospital beds) was 255 days, which is the approximate total annual working time for one nurse. Sensitivity evaluation showed that the number of surgical site infections identified by manual and electronic methods was identical. The three-year incidence of HAI was 15.8 per 1000 patient-days and 4.9% of all discharged patients. CONCLUSIONS: Continuous electronic incidence surveillance based on initiation of antibiotic treatment may be a practical means of measuring hospital-wide incidence of HAI, but this method still requires personnel resources.

Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia.

BACKGROUND: The role of viral infections in the etiology of severe community-acquired pneumonia (SCAP) was prospectively evaluated from 2008 to 2012 at a university-level intensive care unit. METHODS: Clinical data and microbiological tests were assessed: blood cultures, urine pneumococcal and legionella antigens, Mycoplasma pneumoniae and Chlamydia pneumoniae antibodies from paired serums, and respiratory virus detection by multiplex, real-time polymerase chain reaction (PCR) from nasopharyngeal swabs and lower tracheal specimens via intubation tube. RESULTS: Of 49 mechanically ventilated SCAP patients (21 men and 28 women; median age, 54 years), the etiology was identified in 45 cases (92%). There were 21 pure bacterial infections (43%), 5 probably pure viral infections (10%), and 19 mixed bacterial-viral infections (39%), resulting in viral etiology in 24 patients (49%). Of 26 viruses, 21 (81%) were detected from bronchial specimens and 5 (19%) from nasopharyngeal swabs. Rhinovirus (15 cases, 58%) and adenovirus (4 cases, 15%) were the most common viral findings. The bacterial-viral etiology group had the highest peak C-reactive protein levels (median, 356 [25th-75th percentiles, 294-416], P = .05), whereas patients with probably viral etiology had the lowest peak procalcitonin levels (1.7 [25th-75th percentiles, 1.6-1.7]). The clinical characteristics of pure bacterial and mixed bacterial-viral etiologies were comparable. Hospital stay was longest among the bacterial group (17 vs 14 days; P = .02). CONCLUSIONS: Viral findings were demonstrated in almost half of the SCAP patients. Clinical characteristics were similar between the pure bacterial and mixed bacterial-viral infections groups. The frequency of viral detection depends on the availability of PCR techniques and lower respiratory specimens.

Histological damage of colonic epithelium is associated with clinical severity and outcome in colectomized critically Ill patients.

BACKGROUND: Severe intestinal mucosal damage and organ failure has been associated in experimental models. Our purpose was to determine whether there is any association between histopathological findings and postoperative mortality among ICU patients undergoing emergency colectomies for various illnesses. METHODS: In a retrospective case control study, total colectomy specimens from 50 patients in a mixed ICU were analysed: 18 had sepsis, 11 vascular operations, and 21 Clostridium difficile colitis. Overall thickness, the width of epithelial defects, and presence of cryptal damage were assessed. Extent of necrosis and amount of neutrophils were separately evaluated in the layers of the colonic wall. Clinical features, including sequential organ failure assessment (SOFA) scores and survival, were registered. RESULTS: The histopathological findings for the three clinical entities were similar, except for the abundance of characteristic pseudomembranes in the Clostridium group. Mucosal height (maximum) showed a negative correlation with SOFA score on admission (ρ = -0.296, P = 0.037), and with preoperative blood lactate level (ρ = -0.316; P = 0.027). The nonsurvivors had wider enterocyte defects (60 vs. 40.8, P = 0.002) and more severe crypt damage (61 vs. 27 %; P = 0.024) than the survivors. CONCLUSIONS: The histopathological damage involves all layers of the colon wall among ICU patients being largely similar in sepsis, C. difficile infection, and ischemia after vascular operations. Mucosal epithelial damage is associated with clinical severity of the illness and mortality.

Risk factors for pneumonic and ulceroglandular tularaemia in Finland: a population-based case-control study.

Few population-based data are available on factors associated with pneumonic and ulceroglandular type B tularaemia. We conducted a case-control study during a large epidemic in 2000. Laboratory-confirmed case patients were identified through active surveillance and matched control subjects (age, sex, residency) from the national population information system. Data were collected using a self-administered questionnaire. A conditional logistic regression model addressing missing data with Bayesian full-likelihood modelling included 227 case patients and 415 control subjects; reported mosquito bites [adjusted odds ratio (aOR) 9·2, 95% confidence interval (CI) 4·4-22, population-attributable risk (PAR) 82%] and farming activities (aOR 4·3, 95% CI 2·5-7·2, PAR 32%) were independently associated with ulceroglandular tularaemia, whereas exposure to hay dust (aOR 6·6, 95% CI 1·9-25·4, PAR 48%) was associated with pneumonic tularaemia. Although the bulk of tularaemia type B disease burden is attributable to mosquito bites, risk factors for ulceroglandular and pneumonic forms of tularaemia are different, enabling targeting of prevention efforts accordingly.

Guillain-Barré syndrome and ulceroglandular tularemia.

Francisella tularensis is a small Gram-negative aerobic intracellular bacterium that should be considered as a possible pathogen in patients with fever, pharyngitis, and lymphadenopathia. Central nervous system manifestations have been rarely reported. We describe a patient who developed serious Guillain-Barré polyneuropathy as a rare complication of ulceroglandular tularemia.

Severe community-acquired pneumonia treated with ß-lactam-respiratory quinolone vs. ß-lactam-macrolide combination.

BACKGROUND: This study aimed to compare the outcome of patients with severe community-acquired pneumonia (SCAP) treated with the combination of either ß-lactam-quinolone (ßQ) or ß-lactam-macrolide (ßM) antibiotics. METHODS: We retrospectively studied a cohort of patients with SCAP treated from January 2000 to December 2010 at a mixed university-level intensive care unit (ICU). APACHE II score, SCAP severity assessed by IDSA/ATS score, first antibiotic treatment initiated during the initial 24 h of admission, ICU and hospital length of stay (LOS), and ICU, hospital, 30 and 60-day mortalities were assessed. RESULTS: Altogether, 210 patients with SCAP were analyzed, 104 in the ßQ arm and 106 in the ßM arm. Median APACHE II scores on admission were higher in the ßM group (22 vs. 18, P = 0.003). More patients in the ßQ group required mechanical ventilation (63.1% vs. 42.5%, P = 0.004) and fulfilled IDSA/ATS SCAP criteria (n = 87; 83.7%) than those in the ßM group (n = 73; 68.9%; P = 0.015). Thirty-day mortality was 16.3% in the ßQ group and 24.5% in the ßM group (P = 0.17), and with septic shock mortality was 19.6% and 32.6%, respectively (P = 0.16). On APACHE II and IDSA/ATS SCAP score adjusted multivariate logistic regression analysis, the ßM group had a slightly higher but not significant odds ratio (OR) for a 30-day mortality compared to the ßQ group (OR 1.4; 95% CI, 0.62-3.0; P = 0.44). CONCLUSION: Thirty-day mortality rate of SCAP patients did not differ whether they were treated with either ßQ or ßM combination.

Short-course antibiotics for prosthetic joint infections treated with prosthesis retention.

The purpose of the present study was to evaluate the significance of shortening the antibiotic treatment duration in prosthetic joint infections (PJI) treated with debridement, antibiotics and implant retention (DAIR). In April 2006 we shortened the total antibiotic treatment duration in total knee arthroplasty (TKA) PJIs from 6 months to 3 months and in total hip arthroplasty (THA) PJIs from 3 months to 2 months. All patients with TKA or THA PJI treated with DAIR between February 2001 and August 2009 were reviewed retrospectively. There were 132 patients treated with DAIR, of whom 86 (65%) completed the antibiotic therapy and were therefore eligible for comparison concerning the length of antibiotic treatment. There were 32 (37%) THA and 54 (63%) TKA PJIs in the comparison. The treatment succeeded in 34 (89.5%) patients treated with longer antibiotic treatment and in 42 (87.5%) of those treated with shorter antibiotic treatment (p 0.78). Our conclusion is that if the patient completes the antibiotic therapy, treatment duration of 3 months in TKA PJIs and 2 months in THA PJIs is as good as longer antibiotic treatment of 6 months or 3 months, respectively, in patients treated with DAIR.

Hospital and long-term outcomes of ICU-treated severe community- and hospital-acquired, and ventilator-associated pneumonia patients.

BACKGROUND: Our purpose was to analyse the association of pneumonia types with hospital and long-term outcomes of intensive care unit (ICU)-treated pneumonia patients. METHODS: The occurrence of pneumonia was retrospectively evaluated among prospectively registered patients admitted into a mixed university-level ICU during a 14-month period. Their age, severity of underlying disease, malignancy, immunosuppressive therapy and organ dysfunctions were recorded, as well as the length of hospital stay and short- and long-term mortalities. RESULTS: There were 117 severe community-acquired pneumonia (SCAP), 66 hospital-acquired pneumonia (HAP) and 25 ventilator-associated pneumonia (VAP) cases among the 817 patients admitted. ICU and hospital mortality did not differ between pneumonia groups. VAP and HAP patients had more malignant underlying diseases than SCAP patients (P < 0.001). HAP patients were older than SCAP and VAP patients (P = 0.023). The admission Acute Physiology and Chronic Health Evaluation II scores did not differ between the groups (P > 0.90). The patients with VAP had higher Sequential Organ Failure Assessment maximum scores compared with patients with SCAP and HAP (P < 0.001). In an adjusted multivariate logistic regression model, there were no significant differences in odds ratios for hospital mortality between the three pneumonia types. Mortality among the hospital survivors during the 12-month follow-up period was 18% (16/89) in the SCAP group, 35% (18/51) in the HAP group and 41% (7/17) in the VAP group (P = 0.023). CONCLUSION: The type of pneumonia (i.e. SCAP, HAP or VAP) had no significant association with hospital mortality, whereas the SCAP patients had the lowest 1-year mortality.

Point prevalence and risk factors for healthcare-associated infections in primary healthcare wards.

PURPOSE: The aim of this study was to document the point prevalence of healthcare-associated infections (HAIs) in the public primary healthcare wards, which treat both acute and long-term care patients. We also assessed the risk factors for HAI and the consumption of alcoholic hand rubs and antibiotics. METHODS: A cross-sectional study was performed in northern Finland in 2006 including all healthcare centers in the Oulu University Hospital district. RESULTS: There were 1,190 patients eligible for study in 44 public primary healthcare wards. The point prevalence of HAIs was 10.1%. The most common infections were urinary tract infections (30%), lower respiratory tract infections (27%), and skin and soft tissue infections (20%). The prevalence of HAIs did not depend on whether wards gave acute care, long-term care, or both acute and long-term care. In the multivariate analysis, the main risk factors for HAI were: more than three antibiotic prescriptions during the previous year, fully bedridden, renal disease, venous catheter, age over 80 years, previous hospitalization during the past six months, and implanted foreign material. A prophylactic antibiotic was a protecting factor. Antimicrobial treatment was given for 18% of the study population and another 18% received prophylactic antimicrobials. CONCLUSIONS: HAIs are common in Finnish primary healthcare wards and there is a need to improve everyday practices in the wards in order to reduce the number of HAIs. It is also important to reduce the inappropriate use of antibiotics.

Blood stream infections during chemotherapy-induced neutropenia in adult patients with acute myeloid leukemia: treatment cycle matters.

The purpose of this study was to assess the frequency of blood stream infections (BSIs) during neutropenia in different cycles of intensive chemotherapy treatment in acute myeloid leukemia (AML). The register data of 327 consecutive patients aged 16-66 years having de novo AML between September 1992 and December 2001 were prospectively gathered in five Finnish tertiary care leukemia centers. The patients had not received fluoroquinolone prophylaxis. Reported BSI rates were compared during neutropenia in four chemotherapy treatment cycles (C). There were 956 treatment episodes, with 456 (47.7%) positive blood cultures. BSI was monomicrobial in 327 episodes (71.7%) and polymicrobial in 129 (28.3%). The overall incidence rate (per 1,000 hospital days) for BSI was 13.2, varying from 6.8 in CI after idarubicin, conventional-dose cytarabine, and thioguanine to 15.6 in CII, 15.8 in CIII, and 17.6 in CIV. The distribution of monomicrobial gram-positive BSIs was as follows: CI, 71.7%; CII, 62.8%; CIII, 53.3%; CIV, 36.6%; and CI-IV together, 43.2%. The most common finding in the four different cycles was coagulase-negative staphylococci (38.3 to 30.6%). Viridans group streptococci were most commonly observed (in 20.4% of positive blood cultures) during CII after high-dose cytarabine and idarubicin treatments. The distribution of monomicrobial gram-negative BSIs was as follows: CI, 21.7%; CII, 36.3%; CIII, 45.7%; CIV, 46.9%; and CI-IV together, 37.9%. A great variation of incidence and types of microorganisms between AML chemotherapy cycles was found. It would be more reasonable to analyze chemotherapy cycle-based BSI results rather than the overall results.

Idarubicin inhibits the growth of bacteria and yeasts in an automated blood culture system.

The effect of anti-neoplastic agents on the growth of microorganisms was studied in vitro using aerobic BacT/Alert standard and FAN bottles as the culture media. A 50% longer incubation period to detect microbial growth compared to the control group was interpreted as growth inhibition. Idarubicin inhibited the growth of all of the five gram-positive cocci, one of five gram-negative rods and one of three yeast strains studied in the standard bottles but not in the FAN bottles. Candida glabrata was the most sensitive strain. Its growth was inhibited in the presence of idarubicin at a concentration of 1 micromol/l.

Expression of CD11b/CD18 adhesion molecules on circulating phagocytes-a novel aid to diagnose infection in patients with cancer.

GOALS OF WORK: No blood marker available to date is useful for distinguishing infection-related from neoplasm-related fever. We evaluated the expression of the peripheral blood phagocyte CD11b/CD18 adhesion molecule complex for this purpose. MATERIALS AND METHODS: Neutrophil and monocyte CD11b/CD18 expression was assessed in two cohorts of patients with advanced solid cancer (n = 120) and in healthy controls (n = 63). The cancer series included 89 patients with verified infection, 23 without infection, and eight with neoplastic fever. CD11b/CD18 expression was measured using flow cytometry, and serum C-reactive protein (CRP) concentration was determined with immunoturbidimetric assay. RESULTS: Cancer patients with infection had higher blood neutrophil and monocyte CD11b/CD18 expression levels than patients with neoplastic fever, those with advanced cancer without infection, or healthy controls (p < 0.01 for all analyses). High CD11b/CD18 values were measured exclusively in individuals diagnosed with infection. Receiver-operating characteristic area under the curve (AUC) for neutrophil and monocyte CD11b/CD18 expression for the discrimination of infection from neoplastic fever was 0.80 (95% CI, 0.70 to 0.88), which was superior (p = 0.039 and p = 0.049, respectively) to serum CRP on admission (AUC 0.51, 0.40 to 0.62). CONCLUSIONS: Peripheral blood phagocytic cell CD11b/CD18 expression is useful for making a differential diagnosis between infection and neoplasm-related fever in cancer patients.

Multi-detector computed tomography in critically ill patients.

BACKGROUND: There is a lack of studies showing the overall impact of multi-detector computed tomography (MDCT) on the treatment of critically ill patients in a general intensive care unit (ICU) setting. METHODS: A prospective observational study on the effects of MDCT on the treatment of patients in a 12-bed medical-surgical ICU in a university hospital providing tertiary care. RESULTS: During the 9-month study period, there were 343 admissions with ICU length of stay longer than 48 h. Of these patients, 64 (19%) had had inconclusive findings with other modalities of radiological imaging, and they underwent altogether 82 MDCT examinations. Fifty examinations (61%) resulted in a change of treatment. The changes included 22 surgical interventions, 16 percutaneous or paranasal interventions, 15 changes of antimicrobial therapy, three withdrawals of active treatment, and four other changes of treatment. Eight patients underwent two and one patient underwent three changes of treatment. Twenty examinations (24%) were regarded as otherwise necessary for clinical decision-making, although no change in the treatment was indicated. Twelve examinations (15%) failed to provide any additional information relevant to the patient's treatment. CONCLUSION: Sixty-one percent of the MDCT examinations led to a change of treatment, and 24% of them otherwise contributed to or supported clinical decision-making, suggesting that MDCT examination is helpful in the case of general ICU patients, with inconclusive findings with other imaging modalities.

Incidence of infections in patients with status epilepticus requiring intensive care and effect on resource utilization.

Data from a six-year period were retrospectively retrieved from medical records and an intensive care unit data management system to study the impact of infections on patients with status epilepticus. Out of 161 admitted patients, 33 had a community-acquired infection and 35 acquired an infection during their hospital stay, 10 while in a ward before admission to the intensive care unit and 25 while in an intensive care unit, giving an infection rate of 42% of all admissions (68 patients). The patients with intensive care unit-acquired infection had three times longer stays in the intensive care unit than those without any infection (P<0.001), and they utilized almost four times more nursing resources than those without infections (P<0.001). Furthermore, they were more often sedated with thiopentone infusion, either alone or in combination with other drugs, than the non-infectious patients (80% vs 20%, P <0.001). Both community- and hospital-acquired infections were related to longer intensive care unit stays (P<0.001). The hospital stay of patients with hospital-acquired infection was threefold compared to that of patients without infection (P<0.001), and these patients utilized almost three times more nursing resources than those without any infection (P<0.001). Patients with infections consumed 65.5% of the intensive care unit nursing resources of status epilepticus patients. In conclusion, the infection rate of status epilepticus patients was high and nosocomial infections were associated with more severe illness, treatment escalation, prolonged hospital stay and enhanced resource utilization.