Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and "Other" Types of Infection
Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and "Other" Types of Infection
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DOI：
10.1017/ice.2015.142
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发表时间：
2015-10-01
影响因子：
4.5
通讯作者：
Rutala, William A.
中科院分区：
文献类型：
--
作者：
Kanamori, Hajime;Weber, David J.;Rutala, William A.
目标。有针对性的监测侧重于器械相关感染和手术部位感染（ssi），通常仅限于高风险地区的医疗保健相关感染（HAIs）。所有HAIs的纵向趋势，包括其他类型的HAIs，以及重症监护病房（icu）以外的HAIs仍不清楚。我们在12年期间（2001-2012年）使用全院范围的综合监测检查了所有HAIs的发生率。这项回顾性观察性研究是在北卡罗来纳大学（UNC）医院进行的，这是一家三级医疗学术机构。通过全院范围的综合监测，确定了所有HAIs，包括5例主要感染，14个特定感染点（根据CDC标准定义）。采用广义线性模型检验不同感染类型的发病率随时间的差异。HAIs共16579例，其中icu内6397例，icu外10182例。在医院范围内（每1000个病人日感染-3.4例）、在icu（每1000个病人日感染-8.4例）和在非icu环境（每1000个病人日感染-1.9例）的总体HAIs发生率显著下降。血液感染、尿路感染和肺炎的发生率在全院范围内显著下降，但SSI和下呼吸道感染的发生率保持不变。艰难梭菌感染（CDI）的发生率明显升高。结果估计包括预防了700例hai，挽救了40人的生命，节省了超过1000万美元的费用。在12年的时间里，我们成功地降低了总体的艾滋病感染率。我们的数据强调了在icu之外、非器械相关HAIs和CDI进行监测和感染预防干预的必要性。
OBJECTIVE. Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001-2012).METHODS. This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.RESULTS. A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (-3.4 infections per 1,000 patient days), in ICUs (-8.4 infections per 1,000 patient days), and in non-ICU settings (-1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.CONCLUSIONS. We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non-device-associated HAIs, and for CDI.