外科患者手术后医院感染直接经济损失评价

目的 探讨外科患者手术后医院感染所造成的直接经济损失及特点，为医院感染管理部门决策提供科学依据。方法 选择2016年1月1日-2018年12月31日某三级甲等综合性医院外科手术后发生医院感染的100例患者为病例组，采用1：1配对病例对照研究方法，选择100例手术后未发生医院感染的患者为对照组，采用配对设计的秩和检验方法，比较两组患者直接经济损失及住院日数差异。结果 病例组与对照组比较，住院费用（中位数）增加19 866.3元（Z=-8.338，P<0.01），住院日数（中位数）增加8.0 d（Z=-6.857，P<0.01）；住院费用增加前三的手术为同种异体肾移植术、神经系统手术及泌尿系统手术，住院日数增加前三的手术为胆囊切除术、椎间盘破坏或切除术、泌尿系统手术，两组比较差异均有统计学意义（均P<0.05）；住院费用增加前三的感染为多部位感染、下呼吸道感染及腹腔内组织感染，住院日数增加前三的感染为多部位感染、深部切口感染及表浅切口感染，两组比较差异均有统计学意义（均P<0.05）。结论 外科患者手术后发生医院感染可导致巨大的直接经济损失，医院感染控制部门应采取有效的防控措施，减少外科多部位感染、下呼吸道感染及手术部位感染等感染的发生，减轻患者经济负担。

Direct economic loss due to postoperative healthcare-associated infection in surgical patients

Objective To explore the direct economic loss and characteristics of postoperative healthcare-associa-ted infection(HAI) in surgical patients, provide scientific basis for decision-making of HAI management department. Methods 100 patients who developed postoperative HAI in a tertiary first-class hospital from January 1, 2016 to December 31, 2018 were selected as case group, a 1:1 matched case-control study was conducted to select 100 patients who didn''t develop postoperative HAI were as control group, difference in direct economic loss and hospitalization days between two groups of patients was compared by rank sum test of paired design. Results Compared with control group, hospitalization expenses (median) increased by 19 866.3 Yuan (Z=-8.338, P<0.01) and length of hospital stay (median) increased by 8.0 days (Z=-6.857, P<0.01) in case group; the top three operations with increased hospitalization expenses were renal allograft, nervous system operation and urinary system operation; the top three operations with increased hospitalization days were cholecystectomy, intervertebral disc destruction or resection and urinary system operation, differences between two groups were both significant (both P<0.05); the top three infection with increased hospitalization expenses were multi-site infection, lower respiratory tract infection and intra-abdominal infection, the top three infection with increased hospitalization days were multi-site infection, deep incision infection and superficial incision infection, differences between two groups were both significant (both P<0.05). Conclusion HAI in surgical patients after operation can lead to huge direct economic loss, HAI control department should take effective prevention and control measures to reduce the occurrence of infection, such as surgical multi-site infection, lower respiratory tract infection and surgical site infection, so as to reduce the economic burden of patients.