Descriptive analysis of healthcare-associated infections other than bloodstream, respiratory, urinary tract, or surgical site infections
Descriptive analysis of healthcare-associated infections other than bloodstream, respiratory, urinary tract, or surgical site infections
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对血液、呼吸道、泌尿道或手术部位感染以外的医疗保健相关感染的描述性分析
DOI：
10.1086/668423
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Rutala WA
中科院分区：
文献类型：
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作者：
Kanamori H;Weber DJ;Sickbert-Bennett EE;Brown V;Kaku M;Rutala WA
据估计，医疗相关感染（HAI）每年在美国医院造成约170万例感染和99，000例死亡。1疾病控制和预防中心（CDC）和国家医疗安全网络（NHSN）已经制定了HAI的标准化监测定义，包括手术部位感染（SSI），肺炎，血流感染（BSI）和尿路感染（UTI）。2除了这”四大”感染类型之外，所有HAI都被归类为”其他”HAI类型。在估计的人工流产总数中，（1，195，142）和与HAI相关的死亡（98，987），其他类型的HAI分别占美国医院重症监护室（ICU）外成人和儿童死亡的22%（263，810）和11%（11，062），1这表明其他HAI是美国医疗机构的重大负担。NHSN报告重点关注器械相关HAI的监测数据，如中心静脉导管相关BSI、呼吸机相关肺炎和导管相关UTI。3.北卡罗来纳州大学（University of North Carolina）医院根据CDC标准对所有HAI进行了全面的全院监测。2，4来自NHSN医院的数据表明，在三级护理医院发现的HAI中，约有50%未包括在已发表的NHSN报告中。5总体而言，2010年，1，264例HAI中有208例（16.5%）被归类为其他类型的HAI。在这篇文章中，我们分析了医院的数据，以便（1）调查趋势，并根据CDC标准将HAI分类为”其他”，（2）通过选定的变量（例如，服务，护士站和病原体）分析其他HAI。我们希望这些数据对有兴趣参与全面努力减少所有HAI而不仅仅是器械相关感染的感染预防专家有用。这项研究是在拥有800张床位的三级医疗机构ESTA医院进行的，有11年的数据（2001-2011）。由5名感染预防专家和2名全职教职员工按照CDC标准2对所有涉及CDC定义的感染的HAI进行全面的全院监测。所有监测数据均输入电子数据库。本研究已获得美国查佩尔山机构审查委员会的批准。从2001年到2011年，共有19，357例HAI在医院被确定，如下：BSI，4，989（25.8%）; UTI，4，791（24.8%）;呼吸道感染，3，389（17.5%）; SSI，3，986（20.6%）;和其他，2，202（11.4%）。确定的其他5种主要HAI类型如下：胃肠道系统感染，1，061例（48.2%）;皮肤和软组织感染，610例（27.7%）;心血管系统感染，295例（13.4%）;耳、鼻、咽喉和口腔感染，118例（5.4%）;颅内感染，70例（3.2%;表1）。此外，我们确定了以下感染类型：生殖道感染，18例（0.8%）;骨或关节感染，15例（0.7%）;全身感染，14例（0.6%）;其他感染，1例（< 0.1%）。总体而言，其他感染发生在以下病房：外科，877（39.8%）;内科，609（27.7%）;小儿外科，310（14.1%）;小儿内科，224（10.2%）;康复，67（3.0%）;妇产科，54（2.5%）;和杂项，61（2.8%）。1，057例（48.0%）发生在ICU，1，041例（47.3%）发生在非ICU环境，104例（4.7%）发生在门诊环境。表1显示了5类主要其他类型HAI和相关病原体的特定感染。消化道感染1,061例，其中胃肠炎843例（79.5%），腹膜炎135例（12.7%）.
It is estimated that healthcare-associated infections (HAIs) account for approximately 1.7 million infections and 99,000 deaths in US hospitals each year. 1 The Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN) have developed standardized surveillance definitions of HAIs including surgical site infection (SSI), pneumonia, bloodstream infection (BSI), and urinary tract infection (UTI). 2 All HAIs except for these" big four" infection types are categorized as" other" types of HAI. Of the estimated numbers of total HAIs (1,195,142) and deaths associated with HAI (98,987) in US hospitals among adults and children outside of intensive care units (ICUs), other types of HAI accounted for 22%(263,810) and 11%(11,062) of deaths, respectively, 1 which suggests that other HAIs represent a substantial burden in US healthcare facilities. NHSN reports have focused on surveillance data for device-associated HAI such as central line-associated BSI, ventilator-associated pneumonia, and catheter-associated UTI. 3 The University of North Carolina (UNC) Hospitals have conducted comprehensive hospital-wide surveillance for all HAIs according to CDC criteria. 2, 4 Data from UNC Hospitals suggest that approximately 50% of HAIs identified in a tertiary care hospital are not included in published NHSN reports. 5 Overall, 208 (16.5%) of a total of 1,264 HAIs were classified as other types of HAI at UNC Hospitals in 2010. In this article, we analyze the UNC Hospitals data in order to (1) investigate trends and break down HAI categorized as" other" according to the CDC criteria and (2) analyze other HAIs by selected variables (eg, service, nurse station, and pathogen). We expect these data to be useful to infection preventionists who are interested in engaging in comprehensive efforts to reduce all HAIs and not just device-associated infections. This study was conducted at UNC Hospitals, an 800-bed tertiary care facility, with 11 years of data (2001-2011). Comprehensive hospital-wide surveillance for all HAIs that involved all CDC-defined infections was performed in accordance with CDC criteria2 by 5 infection preventionists and 2 full-time faculty members. All surveillance data were entered into an electronic database. This study was approved by the Institutional Review Board of UNC Chapel Hill. A total of 19,357 HAIs were identified at UNC Hospitals from 2001 to 2011, as follows: BSI, 4,989 (25.8%); UTI, 4,791 (24.8%); respiratory tract infection, 3,389 (17.5%); SSI, 3,986 (20.6%); and other, 2,202 (11.4%). The 5 major other types of HAI that were identified were as follows: gastrointestinal system infection, 1,061 (48.2%); skin and soft tissue infection, 610 (27.7%); cardiovascular system infection, 295 (13.4%); ear, nose, throat, and mouth infection, 118 (5.4%); and intracranial infection, 70 (3.2%; Table 1). Additionally, we identified the following infection types: reproductive tract infection, 18 (0.8%); bone or joint infection, 15 (0.7%); systemic infection, 14 (0.6%); and miscellaneous, 1 (< 0.1%). Overall, other infections occurred in the following wards: surgery, 877 (39.8%); medicine, 609 (27.7%); pediatric surgery, 310 (14.1%); pediatric medicine, 224 (10.2%); rehabilitation, 67 (3.0%); gynecology-obstetrics, 54 (2.5%); and miscellaneous, 61 (2.8%). Infection occurred in an ICU in 1,057 cases (48.0%), in a non-ICU setting in 1,041 cases (47.3%), and in an outpatient setting in 104 cases (4.7%). Specific infections in the 5 categories of major other types of HAI and associated pathogens are shown in Table 1. Of the 1,061 gastrointestinal system infections, gastroenteritis and peritonitis accounted for 843 (79.5%) and 135 (12.7 …