血液病患者医院感染所致直接经济损失

目的分析血液病患者医院感染所致的直接经济损失。方法采用1∶1配对病例对照研究方法调查患者的医疗费用及住院时间,将医院感染患者再分为三组:单部位感染组、多部位感染组、多重耐药菌感染组,分析各组患者医院感染直接经济损失。结果病例组(医院感染患者)平均医疗费用为69 844.70元,对照组为35 077.13元,因医院感染导致患者的医疗费用平均增加34 767.57元,增加的医疗费用主要是药物费、检验费和输血费。不同感染类型患者平均医疗费用比较,差异具有统计学意义(P0.05),多重耐药菌感染组和多部位感染组患者的医疗费用均高于单部位感染组,多重耐药菌感染损失最高(平均医疗费用为121 949.02元)。直接经济损失因病种而异,直接经济损失居前3位的病种分别是伯基特淋巴瘤(BL)、急性早幼粒细胞白血病(APL)、急性髓系白血病(AML),直接经济损失分别为151 960.09、100 419.29、74 298.47元。病例组平均住院时间中位数为30 d,长于对照组的17 d(P0.05),不同感染类型患者平均住院时间比较,差异无统计学意义(P=0.620)。与对照组比较,不同血液病病种医院感染患者住院时间平均延长4～30 d。结论医院感染可增加血液病患者的医疗费用及住院时间,直接经济损失因感染类型及病种不同而存在差异,应加强多重耐药菌管理及专病管理,并积极采取有效的医院感染防控措施。

Direct economic loss due to healthcare associated infection in patients with hematological diseases

ObjectiveTo analyze direct economic loss due to healthcare associated infection(HAI) in patients with hematological diseases.MethodsA 1∶1 matched case control study was conducted to investigate medical expense and length of hospital stay of patients, patients with HAI were subdivided into three groups: single site infection group, multi site infection group, and multidrug resistant organism(MDRO) infection group, direct economic loss due to HAI in each group was analyzed.ResultsThe average medical expense of patients in case group (patients with HAI) was 69 844.70 Yuan, while that in control group was 35 077.13 Yuan, the average medical expense of patients increased by 34 767.57 Yuan due to HAI, the increased medical expenses were mainly fees for medicine, laboratory examination, and blood transfusion. The average medical expense of patients with different infection were significantly different (P<0.05), medical expense of patients in MDRO group and multi site infection group were both higher than patients in single site infection group, loss in MDRO infection group was the highest (average medical expense was 121 949.02 Yuan). Direct economic loss varied with different diseases, the top three diseases with direct economic loss were Bunkitt’s lymphoma, acute promyelocytic leukemia, and acute myeloid leukemia, direct economic losses were 151 960.09, 100 419.29, and 74 298.47 Yuan respectively. The median of average length of hospital stay in case group was 30 days, which was longer than 17 days in control group (P<0.05), there was no significant difference in the average length of hospital stay between patients with different types of infection (P=0.620). Compared with control group, the average length of hospital stay of HAI patients with different hematological diseases prolonged by 4-30 days.ConclusionHAI can increase medical expense and length of hospital stay of patients with hematological diseases, direct economic loss varies with different types of infection and diseases, management of MDRO and special disease should be strengthened, effective measures should be taken to prevent and control HAI.