Macartney K K, Gorelick M H, Manning M L, Hodinka R L, Bell L M
Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, and University of Pennsylvania School of Medicine, USA.
Pediatrics. 2000 Sep;106(3):520-6. doi: 10.1542/peds.106.3.520.
To determine the cost-effectiveness and cost-benefit of an infection control program to reduce nosocomial respiratory syncytial virus (RSV) transmission in a large pediatric hospital.
RSV nosocomial infection (NI) was studied for 8 years, before and after intervention with a targeted infection control program. The cost-effectiveness of the intervention was calculated, and cost-benefit was estimated by a case-control comparison.
Children's Hospital of Philadelphia, a 304-bed pediatric hospital.
All inpatients with RSV infection, both community- and hospital-acquired.
Consisted of early recognition of patients with respiratory symptoms, confirmation of RSV infection by laboratory testing, establishing cohorts of patients and nursing staff, gown and glove barrier precautions, and monitoring and education of staff.
The incidence density of RSV NI before and after the intervention was calculated as the rate per 1000 patient days-at-risk for infection. Intervention costs included laboratory testing, isolation, and administration of the program. The cost of RSV NI was estimated by comparing hospital charges for 30 cases and matched uninfected controls.
A total of 148 patients acquired NI (88 before and 60 after the intervention). The Mantel-Haenszel stratified relative risk for NI in the period before the infection control program, compared with the postintervention period, was.61 (95% confidence interval:.53-.69). By applying the preintervention stratum-specific rates of infection to the days-at-risk in the postintervention period, an estimated 100 NIs would have been expected, which in comparison to the 60 NIs observed, yielded an estimated program effectiveness of 10 RSV NIs prevented per season. The total cost of the program per season was $15 627 or $1,563/NI prevented. In comparison, the mean cost to the hospital was $9,419/case of RSV NI, resulting in a cost-benefit ratio of 1:6.
A targeted infection control intervention was cost-effective in reducing the rate of RSV NI. For every dollar spent on the program, approximately $6 was saved.
确定一项感染控制计划在一家大型儿科医院降低医院获得性呼吸道合胞病毒（RSV）传播的成本效益和成本效益比。
在采用针对性感染控制计划进行干预前后，对RSV医院感染（NI）进行了8年的研究。计算干预措施的成本效益，并通过病例对照比较估算成本效益比。
费城儿童医院，一家拥有304张床位的儿科医院。
所有RSV感染的住院患者，包括社区获得性和医院获得性感染。
包括早期识别有呼吸道症状的患者、通过实验室检测确认RSV感染、建立患者和护理人员队列、穿隔离衣和戴手套的屏障预防措施以及对工作人员的监测和教育。
干预前后RSV NI的发病密度计算为每1000个感染风险患者日的发生率。干预成本包括实验室检测、隔离和该计划的管理费用。通过比较30例RSV NI病例和匹配的未感染对照的医院收费来估算RSV NI的成本。
共有148例患者发生NI（干预前88例，干预后60例）。与干预后时期相比，感染控制计划实施前NI的Mantel-Haenszel分层相对风险为0.61（95%置信区间：0.53-0.69）。通过将干预前各层特定感染率应用于干预后时期的感染风险日数，预计会有100例NI，与观察到的60例NI相比，该计划估计每季节可预防10例RSV NI。该计划每季节的总成本为15627美元，即每预防一例NI花费1563美元。相比之下，医院每例RSV NI的平均成本为9419美元，成本效益比为1:6。
针对性的感染控制干预措施在降低RSV NI发生率方面具有成本效益。该计划每花费1美元，大约可节省6美元。
