Multistate point-prevalence survey of health care-associated infections.
Multistate point-prevalence survey of health care-associated infections.
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DOI：
10.1056/nejmoa1306801
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发表时间：
2014-03-27
期刊：
影响因子：
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通讯作者：
Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team
中科院分区：
文献类型：
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作者：
Magill SS;Edwards JR;Bamberg W;Beldavs ZG;Dumyati G;Kainer MA;Lynfield R;Maloney M;McAllister-Hollod L;Nadle J;Ray SM;Thompson DL;Wilson LE;Fridkin SK;Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team
目前，没有一个美国监测系统可以提供对急性护理患者人群中所有类型的医疗保健相关感染负担的估计。我们在10个地理位置不同的州进行了一项流行率调查，以确定急性护理医院中卫生保健相关感染的流行率，并对此类感染的国家负担进行更新估计。我们使用国家医疗保健安全网络标准定义了医疗保健相关感染。在参与调查的医院随机选择住院患者进行为期一天的调查。医院工作人员收集了人口统计学和有限的临床数据。经过培训的数据收集者回顾性地审查了医疗记录，以确定调查时活跃的卫生保健相关感染。调查数据和2010年全国住院患者样本数据，根据患者年龄和住院时间进行分层，用于估计2011年美国急性护理医院的医疗保健相关感染和此类感染的住院患者总数。在183家医院进行了调查。在11，282名患者中，452名患者有1种或多种医疗保健相关感染（4.0%; 95%置信区间，3.7至4.4）。在504例此类感染中，最常见的类型是肺炎（21.8%）、泌尿系部位感染（21.8%）和胃肠道感染（17.1%）。艰难梭菌是最常报告的病原体（造成12.1%的医疗保健相关感染）。器械相关感染（即，中心导管相关的血流感染、导管相关的尿路感染和呼吸机相关的肺炎）占此类感染的25.6%，这些感染传统上一直是预防卫生保健相关感染的计划的重点。我们估计，2011年美国急症护理医院有648，000名患者，721，800例医疗保健相关感染。这项多州卫生保健相关感染流行率调查的结果表明，公共卫生监测和预防活动应继续解决C。艰难感染。随着器械和手术相关感染的减少，应考虑扩大监测和预防活动，以包括其他医疗保健相关感染。
Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care–associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care–associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. We defined health care–associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care–associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care–associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011. Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care–associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care–associated infections). Device-associated infections (i.e., central-catheter–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care–associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care–associated infections in U.S. acute care hospitals in 2011. Results of this multistate prevalence survey of health care–associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care–associated infections.