Impact of an infection control service in a university psychiatric hospital: significantly lowering healthcare-associated infections during 18 years of surveillance
Impact of an infection control service in a university psychiatric hospital: significantly lowering healthcare-associated infections during 18 years of surveillance
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DOI：
10.1016/j.jhin.2020.07.018
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发表时间：
2020-10-01
影响因子：
6.9
通讯作者：
Widmer, A. F.
中科院分区：
文献类型：
--
作者：
Buechler, A. C.;Sommerstein, R.;Widmer, A. F.
背景：医疗保健相关感染（HAI）导致高发病率和死亡率。HAI在精神病医院的数据是稀缺的，并不是来自长期surveillance.Aim：为了评估的影响，感染控制服务的流行HAI在精神病医院超过18年的时间。1999年，瑞士巴塞尔大学精神病医院开始提供专业感染控制服务，有一名兼职感染控制护士，医院流行病学家和行政支持除了监测多重耐药病原体的发病率外，还在2001年至2018年期间进行了8项使用疾病控制和预防中心（CDC）概述的定义的流行率研究。对于主要结局，拟合Poisson回归模型以确认HAI病例，标准化风险患者作为模型偏移。总的来说，医院感染的预测患病率从3.7%下降到3.7%，（95%置信区间（CI）2.2-5.3%）（95% CI 0.2-1.8%）在2018年引入感染控制服务后（发病率比率（IRR）每年下降0.93，95% CI 0.87-0.98，P=0.007）。实施感染控制服务可能导致HAI的长期显著减少，即使是在照顾HAI风险低的患者的机构中，比如精神病院。此外，流行病和集群迅速得到控制。应将急性护理医院的感染控制服务扩大到精神病院，以降低HAI的发生率，并在出现多重耐药病原体时应对新的挑战。(C)2020由Elsevier Ltd代表The Healthcare Infection Society发布。
Background: Healthcare-associated infections (HAIs) lead to high morbidity and mortality. Data for HAIs in psychiatric hospitals are scarce, and are not derived from long-term surveillance.Aim: To assess the impact of an infection control service on the prevalence of HAIs in a psychiatric hospital over an 18-year period.Methods: In 1999, a professional infection control service was initiated at the University Psychiatric Hospital in Basel, Switzerland, with a part-time infection control nurse, a hospital epidemiologist, and administrative support. In addition to monitoring rates of multi-drug-resistant pathogens, eight prevalence studies using definitions outlined by the Centers for Disease Control and Prevention (CDC) were conducted between 2001 and 2018. For the primary outcome, a Poisson regression model was fitted to confirm cases of HAIs, standardized for patients at risk as a model offset.Findings: Overall, the predicted prevalence of nosocomial infections decreased from 3.7% (95% confidence interval (CI) 2.2-5.3%) in 2001 to 1.0% (95% CI 0.2-1.8%) in 2018 after introduction of an infection control service (incidence ratio rate (IRR) for yearly decrease of 0.93, 95% CI 0.87-0.98, P=0.007).Conclusions: Implementation of an infection control service may lead to a significant longterm decrease in HAIs, even in an institution caring for patients with low risk for HAIs, such as in psychiatric hospitals. In addition, epidemics and clusters were rapidly contained. Infection control services from acute-care hospitals should be expanded to psychiatric institutions, in order to decrease the incidence of HAIs and meet new challenges in times of emergence of multi-drug-resistant pathogens. (C) 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.