Prevention of Nosocomial Infections and Cost-Effectiveness Analysis

描述（由申请人提供）：医疗相关感染（HAI）是发病率和死亡率的主要来源，尽管它们通常是可以预防的。大多数HAI与侵入性器械相关，并且不成比例地发生在入住重症监护室（ICU）的老年患者中。据估计，医院每年的HAI费用为65亿美元。虽然HAI的影响可能会远远超出出院范围，尤其是在老年人中，但很少有关于HAI导致的长期健康或经济结果的研究。30多年前，疾病控制和预防中心（CDC）利用调查和病历审查进行了一项开创性的全国性研究，其中感染控制人员的水平和感染预防，监测和控制（IPSC）干预措施的强度与HAI率有关。然而，这项研究尚未更新。虽然目前有一些准则，但建议不一致，而且没有得到很好的遵守。尽管HAI率不断上升，并且需要评估当前IPSC流程的影响，但在其临床有效性和成本效益方面的知识仍存在差距。其目的是：1）描述目前全国ICU中感染控制人员的水平和IPSC干预的强度; 2）确定当前感染控制人员和IPSC干预的强度之间的关联，以及老年ICU患者中HAI和短期生存的概率; 3）估计老年患者中HAI的长期结果;和4）确定ICU有效感染控制人员配置和IPSC干预的成本效益。我们修改了CDC研究中使用的调查，以反映当前的IPSC流程（即，人员配置和10项IPSC干预措施）。这项新的调查经过试验性测试，结果证明是可靠和有效的。为了满足目标1，我们建议在第一阶段的数据收集中使用此调查，在参加CDC国家医疗安全网络（NHSN）的感染控制专业人员的样本中，以确定当前的IPSC流程。为了达到目标2，在数据收集的第二阶段，我们将从第一阶段的受访者中随机选择一个分层的子样本，并获得标准化的HAI数据，83个ICU的管理数据和老年患者的医疗保险文件（n ~ 80，000）。对于目标3，我们将在既往研究（R 01 HS 11978）的基础上，使用NHSN方案对一组经鉴定患有和不患有HAI的老年患者（n = 39，314）进行随访。我们将使用5年的医疗保险数据跟踪这一队列。所有数据将用于目标4。提出的分析策略包括多变量计量经济学方法，旨在尽量减少潜在的偏见和解决聚类的数据。研究结果将为感染控制专业人员和临床医生的实践提供信息，使他们能够根据当前的证据进行实践，这将改善患者的预后并降低HAI率。

DESCRIPTION (provided by applicant): Healthcare associated infections (HAI) are a major source of morbidity and mortality despite the fact that they are often preventable. Most HAI are associated with an invasive device and disproportionately occur in elderly patients admitted to intensive care units (ICU). The annual cost of HAI to hospitals has been estimated to be $6.5 billion. While effects of HAI are likely to extend well beyond hospital discharge, especially in the elderly, there has been little study of the long term health or economic outcomes attributable to HAI. Over 30 years ago, using a survey and medical record reviews, the Centers for Disease Control and Prevention (CDC) conducted a seminal national study in which level of infection control staffing and intensity of infection prevention, surveillance, and control (IPSC) interventions were linked to HAI rates. However, this study has not been updated. While a number of current guidelines exist, recommendations are inconsistent and poorly followed. Despite rising HAI rates and the need to assess the impact of current IPSC processes, there is a gap in the knowledge regarding both their clinical effectiveness and cost-effectiveness. The aims are to: 1) Describe the level of infection control staffing and intensity of IPSC interventions currently in place in ICU across the nation; 2) Determine associations between current infection control staffing and intensity of IPSC interventions, and probability HAI and short term survival in elderly ICU patients; 3) Estimate the long term outcomes attributable to HAI in elderly patients; and 4) Determine the cost-effectiveness of effective infection control staffing and IPSC interventions in ICU. We have revised the survey used in the CDC study to reflect current IPSC processes (i.e., staffing and ten IPSC interventions). The new survey was pilot tested and found to be reliable and valid. To meet Aim 1, we propose to use this survey during Phase I of data collection in a sample of infection control professionals who participate in the CDC's National Healthcare Safety Network (NHSN) to determine current IPSC processes. To meet Aim 2, in Phase II of data collection, we will randomly select a stratified sub-sample from Phase I respondents and obtain standardized HAI data, administrative data in 83 ICU, and Medicare files for elderly patients (n ~ 80,000). For Aim 3, we will build upon a previous study (R01HS11978) and follow a cohort of elderly patients (n = 39,314) identified with and without HAI using the NHSN protocols. We will follow this cohort using 5-years of Medicare data. All data will be used for Aim 4. The analytic strategies proposed include multivariate econometric methods designed to minimize potential bias and address clustering of data. Results will inform the practice of infection control professionals and bedside clinicians, allowing them to base their practices on current evidence, which should improve patient outcomes and reduce HAI rates.