Objective To investigate the current status of nosocomial infections in patients with hyperosmolar hyperglycemic state (HHS) and their nursing-related influencing factors, and to provide evidence for developing targeted intervention strategies.

Methods A retrospective study was conducted on 356 HHS patients admitted to Diqing Tibetan Autonomous Prefecture People's Hospital from January 2020 to December 2024. Data on demographics, disease characteristics, treatment, and nursing care were collected. Nosocomial infections were assessed according to the Diagnostic Criteria for Nosocomial Infections (Trial). Univariate analysis and multivariate stepwise Logistic regression (with stratified inclusion of three nursing levels: basic, specialized, and systemic) were used to analyze the influencing factors of infection.

Results Among the 356 patients, 101 developed nosocomial infections, with an infection rate of 28.37%. The main infection sites were the respiratory tract (45.54%) and the urinary system (27.72%). Multivariate analysis showed that poor skin care quality at the basic nursing level (OR = 1.889 95% CI: 1.151-3.113, P = 0.01), insufficient blood glucose monitoring (OR = 2.892, 95% CI: 1.733-4.832, P ＜ 0.01) and nonstandard catheter care (OR = 2.451, 95% CI: 1.460-4.113, P = 0.001) at the specialized nursing level , as well as insufficient nurse-to-patient ratio (OR = 2.009, 95% CI: 1.231-3.292, P ＜ 0.01) and poor multidisciplinary collaboration (OR = 1.889, 95% CI: 1.151-3.113, P = 0.01) at the systemic nursing level were all independent risk factors for nosocomial infections. Model fit improved with the stepwise inclusion of nursing levels (Nagelkerke R² increased from 0.356 to 0.535).

Conclusions The incidence of nosocomial infections in HHS patients is relatively high and is influenced by multiple nursing factors, including skin care quality, blood glucose monitoring, catheter care, nurse-to-patient ratio, and multidisciplinary collaboration.