构建医院感染质量指标评价体系对医院感染控制的作用

目的 探讨构建医院感染质量指标评价体系对医院感染的影响。方法 选取某三级甲等综合医院2017年1月-2018年12月的所有住院患者为研究对象，比较实施医院感染质量指标评价体系干预前（2017年1-12月）与干预后（2018年1-12月）医院感染过程、结果指标的差异。结果 干预前后同期住院患者数分别为106 558、111 904例，分别发生医院感染1 803、1 526例次，医院感染例次发病率从1.69%下降至1.36%，差异有统计学意义（χ²=38.040，P<0.001）；干预后多重耐药菌（MDRO）医院感染例次发病率、呼吸机相关肺炎（VAP）发病率及导尿管相关泌尿道感染（CAUTI）发病率较干预前下降，差异均有统计学意义（均P<0.05）。干预后，MDRO检出率、住院患者抗菌药物使用率、导尿管使用率、医院感染病例漏报率较干预前下降，VAP的预防率、MDRO感染防控措施执行率、治疗性抗菌药物使用前病原学送检率高于干预前，差异均有统计学意义（均P<0.05）。结论 构建医院感染质量指标评价体系能促进感染控制措施的落实，降低医院感染发病率。

Effect of constructing evaluation system of healthcare-associated infection quality indicators on controlling healthcare-associated infection

Objective To explore the effect of constructing the evaluation system of healthcare-associated infection(HAI) quality indicators on controlling HAI. Methods All inpatients who were hospitalized in a tertiary first-class hospital from January 2017 to December 2018 were selected as the research objects, differences in process and outcome indicators of HAI before (January-December 2017) and after intervention (January-December 2018) were compared. Results The numbers of inpatients during the same period before and after intervention were 106 558 and 111 094 respectively, HAI cases were 1 803 and 1 526 respectively, case incidence of HAI decreased from 1.69% to 1.36%, difference was statistically significant(χ²=38.040, P<0.001); compared with before intervention, case incidence of multidrug-resistant organism (MDRO) HAI, ventilator-associated pneumonia (VAP) and catheter-related urinary tract infection (CAUTI) all decreased significantly after the intervention, differences were all statistically significant (all P<0.05). After intervention, isolation rate of MDRO, utilization rate of antimicrobial agents, utilization rate of urinary catheter, and missing report rate of HAI were lower than before intervention, prevention rate of VAP, implementation rate of MDRO infection prevention and control measures, as well as pathogen detection rate before therapeutic antimicrobial use were all higher than before intervention, differences were all statistica-lly significant (all P<0.05). Conclusion Constructing the evaluation system of HAI quality indicators can promote the implementation of infection control measures and reduce the incidence of HAI.