Skip to main content Accesibility Help

Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit

  • Joseph M. Mylotte (a1) (a2) (a3), Robin Graham (a4) (a3), Lucinda Kahler (a1), B. Lauren Young (a4) (a3) and Susan Goodnough (a1)...

To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.


A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.

Study Population:

All patients admitted to the unit between January 1997 and July 1998.


Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).


There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), and Clostridium difficile diarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of ΔFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007).


Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.

Corresponding author
Infectious Diseases, Erie County Medical Center, 462 Grider St, Buffalo, NY 14215
Hide All
1. Nicolle, LE, Buffet, L, Alfieri, N, Tate, R. Nosocomial infections on a rehabilitation unit in an acute care hospital. Infect Control Hosp Epidemiol 1988;9:553558.
2. Henderson, E, Ledgerwood, D, Romance, L, Nicolle, L. Nosocomial infections in short-term rehabilitation patients: a two centre study. Sixth Annual Meeting of the Society for Healthcare Epidemiology of America. 1996; Washington, DC. Infect Control Hosp Epidemiol 1996;17(suppl):24. Abstract 52.
3. Mylotte, JM, Graham, R, Kahler, L, Young, L, Goodnough, S. Epidemiology of nosocomial infection and resistant organisms in patients admitted for the first time to an acute rehabilitation unit. Clin Infect Dis 2000;30:425432.
4. Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552557.
5. Knaus, WA, Wagner, DP, Draper, EA, Zimmerman, JE, Bergner, M, Bostos, PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:16191636.
6. Hamilton, BB, Granger, CV, Sherwin, FS, Zielezny, M, Tashman, JS. A uniform national data system for medical rehabilitation. In: Fuhrer, MJ, ed. Rehabilitation Outcomes: Analysis and Measurement. Baltimore, MD: Brooks; 1987.
7. Garner, JS, Jarvis, WR, Emori, TG, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
8. Gribble, MJ, Puterman, ML. Prophylaxis of urinary tract infection in persons with recent spinal cord injury: a prospective, randomized, double-blind, placebo-controlled study of trimethoprim-sulfamethoxazole. Am J Med 1993;95:141152.
9. Centers for Disease Control and Prevention. Public health focus: surveillance, prevention, and control of nosocomial infections. MMWR 1992;41:783787.
10. Heinemann, AW, Linacre, JM, Wright, BD, Hamilton, BB, Granger, C. Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil 1994;75:133143.
11. Pick, FC, Rose, M, Wang, D, Gardner, BP, Gillett, AP. The prevention of spread of methicillin resistant Staphylococcus aureus in a spinal injuries centre. Paraplegia 1994;32:732735.
12. Olona-Cabases, M, Tico-Falguera, N, Ramirez-Garceran, L, Del Valle-Ortiz, O, Castello-Verdu, T, Garcia-Fernandez, L. Methicillin-resistant Staphylococcus aureus: a four-year experience in a spinal cord injury unit in Spain. Spinal Cord 1996;34:315319.
13. Duerden, ME, Bergeron, J, Baker, RL, Braddom, RL. Controlling the spread of vancomycin-resistant enterococci with a rehabilitation cohort unit. Arch Phys Med Rehabil 1997;78:553555.
14. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as the source of infection. J Infect Dis 1992;166:561567.
15. Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459477.
16. Johnson, S, Gerding, DN. Clostridium difficile-assoaateti diarrhea. Clin Infect Dis 1998;26:10271036.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed