Nursing home-associated infections in Department of Veterans Affairs community living centers
Nursing home-associated infections in Department of Veterans Affairs community living centers
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DOI：
10.1016/j.ajic.2009.12.009
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发表时间：
2010-08-01
影响因子：
4.9
通讯作者：
Roselle, Gary
中科院分区：
文献类型：
--
作者：
Tsan, Linda;Langberg, Robert;Roselle, Gary
背景：人们对导致疗养院相关感染（NHAI）的因素知之甚少。我们对退伍军人事务部 133 个社区生活中心的居民进行了一项调查，以确定留置装置的使用、床位和治疗代码对 NHAI 的作用。方法：2007 年 11 月 14 日，使用美国疾病控制和预防中心对医疗保健相关感染的修改定义，对 NHAI 进行了基于网络的点患病率调查。结果：在 10,939 名居民中，575 人至少患有一种 NHAI。患病率为5.3%。尿路感染、皮肤感染、无症状菌尿和肺炎是最常见的 NHAI。共有 2687 名居民拥有一个或多个留置装置；其中 290 人也患有 NHAI，患病率为 10.8%。相比之下，没有留置装置的居民中 NHAI 的患病率为 3.5% (P < .0001)。留置导尿管、经皮胃造口管、经外周插入中心导管和耻骨上导尿管是最常用的装置。定点单位居民4027人，分散单位居民6912人。指定单位的设备使用率为 21.4%，分散单位为 26.4% (P < .0001)。指定单位的 NHAI 患病率为 4.5%，分散单位的 NHAI 患病率为 5.7% (P < .001)。不同治疗规范的 NHAI 率和设备使用率差异很大；然而，NHAI 发生率与设备使用率呈正相关。对长期住院和短期住院熟练护理住院医师数据的逐步逻辑回归分析显示，只有留置装置的存在，而不是住院时间或床位，会影响 NHAI 发生率。结论：发现留置装置的使用与 NHAI 发生率增加相关，但与床位位置或治疗代码无关。
Background: Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs.Methods: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007.Results: Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs.Conclusion: Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs.