实施感染控制方案在降低自发性脑出血病人经济费用中的研究

目的比较自发性脑出血病人因医院感染导致的直接经济损失与实施感染防控方案后的成本与效益、效果。方法以2019年1月1日至2019年12月31日出院病人中第一诊断为自发性脑出血病人为对照组，实施感染控制方案后的2020年1月1日至2020年12月31日出院的自发性脑出血病人为观察组，比较感染控制措施实施前后的脑出血病人医院感染发生风险的变化。同时将2年中发生医院感染的脑出血病人为感染组，在未发生医院感染的脑出血病人中按1:1匹配对照组（非感染组），比较2组住院时间与各项住院费用的差异。结果2019年和2020年自发性脑出血出院病人分别为215例和189例，自发性脑出血病人中发生医院感染例数分别为25例和11例。2020年医院感染发生率明显低于2019年（P < 0.01）。结合2年的脑出血病人中发生医院感染共匹配出27对满足要求的病例对照，感染组和非感染组病人的住院时间中位数分别为26 d和17 d，感染组的脑出血病人住院时间较非感染组延长（P < 0.01）；感染组病人的住院总费用中位数为79 889.03元，非感染组为18 662.37元，住院总费用直接经济损失为61 226.66元（P < 0.05）；感染组药品费、检查费用、化验费用、诊查费用、床位费、手术费、治疗费和护理费均高于对照组（P < 0.05）。结论对于自发性脑出血病人发生医院感染造成的住院时间的延长和住院费用的显著增加，实施感染控制方案能取得良好的效益与效果。

Study on reducing the economic cost of patients with spontaneous intracerebral hemorrhage by implementing infection control program

ObjectiveTo compare the direct economic loss caused by nosocomial infection in patients with spontaneous intracerebral hemorrhage and the cost, benefit and effect after implementing the infection prevention and control program.MethodsThe patients with first diagnosed spontaneous intracerebral hemorrhage among the patients discharged from January 1, 2019 to December 31, 2019 were set as the control group, and the patients with spontaneous intracerebral hemorrhage discharged from January 1, 2020 to December 31, 2020 after implementing the infection control program were set as the observation group.The changes in the risk of nosocomial infection in patients with intracerebral hemorrhage was compared before and after implementing the infection control program.At the same time, patients with spontaneous intracerebral hemorrhage with nosocomial infection in the past two years were selected as the infection group, and patients without nosocomial infection were selected as the control group (non-infection group) according to the 1:1 matching method.The differences of hospitalization time and various hospitalization costs between the two groups were compared.ResultsIn 2019 and 2020, there were 215 and 189 patients with spontaneous intracerebral hemorrhage, respectively, and there were 25 and 11 patients with nosocomial infection, respectively.The incidence of nosocomial infection in 2020 was significantly lower than that in 2019(P < 0.01).Combined with the occurrence of nosocomial infection in patients with intracerebral hemorrhage for 2 years, a total of 27 pairs of case controls meeting the requirements were matched.The median hospitalization time of patients in the infection group and non-infection group was 26 days and 17 days, respectively, which was extended in the non-infection group(P < 0.01).The median hospitalization costs were 79 889.03 yuan and 18 662.37 yuan in the infection group and non-infection group, respectively, and the direct economic loss of the total hospitalization cost was 61 226.66 yuan(P < 0.05).The cost of medicine, examination, laboratory test, diagnosis, bed, surgery, treatment and nursing in the infection group were higher than those in the control group(P < 0.05).ConclusionsNosocomial infection in patients with spontaneous intracerebral hemorrhage causes the prolongation of hospitalization time and significant increase of hospitalization costs.The implementation of infection control program can achieve good benefits and effects.