手术部位感染致直接经济损失1∶1病例对照研究

目的从卫生经济学角度探讨手术部位感染（SSI）的直接经济损失,为卫生行政部门制订决策提供依据。方法调取2008年3月-2010年2月某院乳腺、胃、结肠和直肠SSI病例,采用病例对照研究的方法,按照条件相似的原则1∶1配对,SSI者为SSI组,对照组为同期手术未发生SSI的患者,比较SSI组与对照组住院费用和住院日数差异,评价SSI的经济损失。结果共调查手术病例1 523例,发生SSI 75例,SSI发病率4.92%。按配对原则获得有效配对69对,经配对样本的秩和检验,SSI组与对照组的住院费用比较,差异有统计学意义（Z=6.586,P＜0.001）,SSI组患者住院费用中位数比对照组高6 828.60元,SSI组各项费用均高于对照组;SSI组患者住院日数中位数比对照组延长10 d,两组差异有统计学意义（Z=5.939,P＜0.001）。结论SSI延长患者住院日数,增加医疗费用的支出,同时降低病床周转率,影响经济收入和医疗质量。

Prevalence rates of healthcare associated infection in a provincial tumor hospital from 2012 to 2014

ObjectiveTo investigate the status and change trend of healthcare associated infection (HAI) in a tumor hospital, so as to provide reference for formulating scientific control measures of HAI and strengthening management of HAI.MethodsAccording to the requirement of the National HAI Surveillance Network, on September 19, 2012, August 20, 2013 and August 13,2014, survey on HAI prevalence rates among all hospitalized patients in this hospital were carried out, data were analyzed statistically.ResultsThe prevalence rates of HAI from 2012 to 2014 were 6.93%,8.82%, and 8.10% respectively;lower respiratory tract was the main infection site in three years, accounting for 30.00%, 53.85%, and 47.44% respectively;followed by upper respiratory tract, abdominal (pelvic) tissue, superficial incision, and urinary tract. Gram negative bacilli were the main pathogens causing HAI, accounting for 71.43%, 66.67%,and 72.97% respectively, the detection rate of Escherichia coli was the highest. Antimicrobial usage rates in 2012-2014 were 18.23%,13.64%, and 17.70% respectively;pathogenic detection rates in patients receiving therapeutic antimicrobial use were 74.51%,57.14%,and 55.68% respectively（χ2=15.122,P=0.001）. Antimicrobial usage rates in type Ⅰ incisional operation were 0.78%, 6.25%, and 8.33% respectively.ConclusionSurvey of HAI prevalence rate is helpful for realizing the current situation of HAI and deficiency of prevention and control of HAI, taking targeted measures, and reducing incidence of HAI.