Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs
Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs
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DOI：
10.1086/657912
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发表时间：
2011-02-01
影响因子：
4.5
通讯作者：
Brennan, Patrick J.
中科院分区：
文献类型：
--
作者：
Umscheid, Craig A.;Mitchell, Matthew D.;Brennan, Patrick J.
目标。为了评估美国医院中“合理可预防”的医疗保健相关感染(HAI)的比例以及相关的死亡率和成本。方法：为了评估导管相关血流感染(CABSI)、导管相关尿路感染(CAUTI)、手术部位感染(SSI)和呼吸机相关肺炎(VAP)的可预防性，我们使用了一项由联邦政府赞助的减少HAI干预措施的系统性综述。可预防的范围包括过去10年发表的美国“中等”到“良好”质量的研究报告的最低和最高风险降低。我们使用最新公布的国家数据来确定禽流感的年度发病率和相关死亡率。为了估计HAIS的增量成本，我们进行了一项系统的回顾，其中包括对美国普通患者群体的研究成本。为了计算每年可预防的感染和死亡人数的范围以及每年的成本，我们将感染、死亡率和成本数字乘以每个HAI的可预防范围。结果：多达65%-70%的CABSI和CAUTI病例以及55%的VAP和SSI病例可能是可以通过当前的循证策略预防的。CAUTI可能是最可预防的HAI。CABSI的可预防死亡人数最多，其次是VAP。CABSI也具有最高的成本影响；可预防的VAP、CAUTI和SSI病例造成的成本可能较低。结论：我们的研究结果表明，目前的循证预防策略可能无法100%预防HAI；然而，全面实施此类策略可以预防数十万HAI，拯救数万人的生命和数十亿美元。感染控制猪瘟2011；32(2)：101-114
OBJECTIVE. To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs.METHODS. To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of "moderate" to "good" quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI.RESULTS. As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less.CONCLUSIONS. Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars. Infect Control Hosp Epidemiol 2011; 32(2):101-114