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Modeling the epidemiologic and economic impacts of nosocomial infection prevention strategies.

机译：对医院感染预防策略的流行病学和经济影响进行建模。

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摘要

It is estimated that more than 1.7 million nosocomial infections and 98,000 deaths occur annually in the U.S. Nosocomial infections are associated with a longer length of stay (LOS), which is in-turn associated with higher costs and is a risk factor for additional infections. Infection prevention measures may allow a significant number of cases to be averted, although consensus has not been reached about the ultimate epidemiologic and economic value of prevention strategies. A multifaceted program of nosocomial infection prevention evaluating the surveillance test attributes, target population, and intervention implementation has potential to both improve patient outcomes and reduce healthcare costs. I developed models to evaluate and estimate the impact of these infection control interventions. First, testing adult hospital inpatients has the potential to prevent transmission of MRSA among patients. However, policy makers and hospital administrators must consider the diagnostic test used in a screening program. Increasing the number of anatomic sites tested with surveillance cultures does not appear to have as great an impact as decreasing turnaround time on the economic value of a MRSA testing strategy. Second, weekly surveillance of neonates in the neonatal intensive care unit (NICU) and isolation of those who test positive is a technique that hospitals could use to decrease the incidence on nosocomial infections, selecting neonates as a target population where MRSA infections have substantial morbidity. Hospitals with moderate to high adherence to isolation protocols have the potential to prevent adverse clinical outcomes and mortality among NICU populations. Third, routine dispensing of home-based preoperative chlorhexidine bathing kits has the potential to prevent post-operative surgical site infections (SSIs). Our model suggests that preoperative bathing would have substantial economic value throughout a wide range of intervention implementation scenarios: patient compliance levels, cloth efficacies, costs, and SSI-attributable LOS, supporting the distribution of chlorhexidine cloths preoperatively. The public health significance is that decision makers can use the models described here to benchmark the test characteristics, potential target populations, and intervention implementation strategies to utilize in local infection prevention programs. A comprehensive approach including the interventions modeled here may help move towards the elimination of healthcare acquired infections.
机译：据估计，美国每年发生超过170万例医院感染和98,000例死亡。医院感染与住院时间更长（LOS）有关，而住院时间又与更高的花费有关，并且是发生其他感染的危险因素。尽管尚未就预防策略的最终流行病学和经济价值达成共识，但预防感染的措施可避免很多病例。评估监视测试属性，目标人群和干预措施的医院感染预防的多方面计划，有可能改善患者预后并降低医疗保健成本。我开发了模型来评估和估计这些感染控制干预措施的影响。首先，对成年住院患者进行测试可能会阻止MRSA在患者之间传播。但是，政策制定者和医院管理者必须考虑筛查程序中使用的诊断测试。用监视文化进行测试的解剖部位数量的增加似乎没有像减少周转时间那样对MRSA测试策略的经济价值产生太大的影响。其次，每周在新生儿重症监护病房（NICU）进行新生儿监测并隔离那些呈阳性的人是医院可以用来降低院内感染发生率的一种技术，选择新生儿作为MRSA感染具有高发病率的目标人群。中度到高度遵守隔离方案的医院有可能预防NICU人群的不良临床结果和死亡率。第三，常规分配的家庭术前洗必泰洗浴套件具有预防术后手术部位感染（SSI）的潜力。我们的模型表明，术前洗澡将在一系列干预实施方案中具有重大的经济价值：患者的依从性水平，布的功效，成本以及SSI引起的LOS，从而支持术前洗必泰布的分布。公共卫生的意义在于，决策者可以使用此处描述的模型来对测试特征，潜在目标人群以及干预措施实施策略进行基准测试，以用于本地感染预防计划。包括此处建模的干预措施在内的综合方法可能有助于消除医疗保健后天感染。

著录项

  • 作者

    Bailey, Rachel Rubin.;

  • 作者单位

    University of Pittsburgh.;

  • 授予单位 University of Pittsburgh.;
  • 学科 Epidemiology.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 103 p.
  • 总页数 103
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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