Gulácsi L, Kiss Z T, Goldmann D A, Huskins W C
Hungarian Society for Quality Assurance in Health Care, Debrecen, Hungary.
J Hosp Infect. 2000 Jan;44(1):43-52. doi: 10.1053/jhin.1999.0655.
Assessment of healthcare quality is a major challenge in countries such as Hungary where there is limited experience with measurement of patient outcomes. We sought to develop the capacity for valid outcome measurement in Hungarian hospitals using surgical site infection (SSI) surveillance as a model and to identify areas for improvement by comparing SSI rates in Hungarian hospitals to benchmarks published by the United States Centers for Disease Control and Prevention's National Nosocomial Infection Surveillance (NNIS) System. We surveyed the incidence of SSI among 5126 patients undergoing 6006 procedures in 20 public hospitals in Hungary during 1996 using the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) protocol, a protocol consistent with the methods used by the NNIS System. Cholecystectomy, herniorrhaphy, appendectomy, and open reduction of fracture--four of the five most commonly performed procedures in Hungary in 1996--comprised 85% of the procedures analysed. Cumulative SSI rates for herniorrhaphy and appendectomy were comparable to NNIS System benchmarks. Cumulative SSI rates for cholecystectomy were significantly higher in Hungarian hospitals among risk categories that included open procedures. Nearly half of the hospitals had SSI rates for cholecystectomy that were high outliers (>90% percentile) compared to NNIS System benchmarks. Cumulative SSI rates for open reduction of fracture and mastectomy were significantly higher in Hungarian hospitals due to high rates in a few hospitals. The duration of surgery for all procedure types was substantially shorter in Hungarian hospitals compared with NNIS System hospitals. Future work should focus on optimizing prevention strategies for patients undergoing cholecystectomy, open reduction of fracture, and mastectomy. The effect of the utilization of open vs. laparoscopic cholecystectomy, short procedure duration, and procedure volume on SSI rates should be evaluated further. This programme expanded the capacity of Hungarian hospitals to perform surgical site infection surveillance and can serve as a model for hospitals in other countries with limited experience with outcome measurement.
在匈牙利等国家，医疗质量评估是一项重大挑战，因为在这些国家，患者预后测量经验有限。我们试图以手术部位感染（SSI）监测为模型，培养匈牙利医院有效进行预后测量的能力，并通过将匈牙利医院的SSI发生率与美国疾病控制与预防中心国家医院感染监测（NNIS）系统发布的基准进行比较，找出需要改进的领域。1996年，我们采用欧洲医院感染控制监测链接（HELICS）协议，对匈牙利20家公立医院中接受6006例手术的5126名患者的SSI发生率进行了调查，该协议与NNIS系统使用的方法一致。1996年匈牙利最常进行的五项手术中的四项——胆囊切除术、疝修补术、阑尾切除术和骨折切开复位术——占分析手术的85%。疝修补术和阑尾切除术的累积SSI发生率与NNIS系统基准相当。在包括开放手术在内的风险类别中，匈牙利医院胆囊切除术的累积SSI发生率显著更高。与NNIS系统基准相比，近一半的医院胆囊切除术的SSI发生率处于高异常值（>第90百分位数）。由于少数医院发生率较高，匈牙利医院骨折切开复位术和乳房切除术的累积SSI发生率显著更高。与NNIS系统的医院相比，匈牙利医院所有手术类型的手术时间都要短得多。未来的工作应侧重于优化胆囊切除术、骨折切开复位术和乳房切除术患者预防策略。应进一步评估开放与腹腔镜胆囊切除术的使用、短手术时间和手术量对SSI发生率的影响。该项目扩大了匈牙利医院进行手术部位感染监测的能力，并可作为其他预后测量经验有限国家的医院的一个范例。
