Engelhart S T, Hanses-Derendorf L, Exner M, Kramer M H
Institute of Hygiene and Public Health, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
J Hosp Infect. 2005 May;60(1):46-50. doi: 10.1016/j.jhin.2004.09.037.
We undertook a prospective surveillance study in order to determine the incidence of healthcare-associated infections (HCAIs) in German nursing home residents. All people residing for more than one day in a 103-bed nursing home for the elderly in Bonn, Germany between December 1998 and November 1999 were included. Active surveillance was based on previously published consensus definitions. Rates for HCAIs and urinary tract infections (UTIs) were calculated based on resident-days and device-utilization days, respectively. The overall incidence of HCAIs was 6.0 per 1000 resident-days, with respiratory tract infections, gastroenteritis, skin/soft tissue infections and UTIs representing 94% of all HCAIs (2.2, 1.2, 1.2 and 1.0 infections per 1000 resident-days, respectively). Residents with pneumonia were more likely to die than residents with other HCAIs (RR=5.09; 95%CI 1.87-13.89; P=0.011). We conclude that HCAIs are a serious health problem in German nursing home residents. Standardized surveillance in nursing homes is important to assess the effectiveness of infection control standards, and should be based on consensus definitions in order to allow for meaningful interfacility comparisons. In Germany, the implementation of a hospital reimbursement system based on diagnosis-related groups is likely further to increase the proportion of vulnerable populations in long-term-care facilities.
我们开展了一项前瞻性监测研究，以确定德国养老院居民中医疗保健相关感染（HCAIs）的发生率。纳入了1998年12月至1999年11月期间在德国波恩一家拥有103张床位的老年养老院居住超过一天的所有人。主动监测基于先前发表的共识定义。HCAIs和尿路感染（UTIs）的发生率分别根据居民日数和设备使用日数计算。HCAIs的总体发生率为每1000居民日6.0例，其中呼吸道感染、胃肠炎、皮肤/软组织感染和UTIs占所有HCAIs的94%（分别为每1000居民日2.2、1.2、1.2和1.0例感染）。肺炎患者比其他HCAIs患者更有可能死亡（RR = 5.09；95%CI 1.87 - 13.89；P = 0.011）。我们得出结论，HCAIs是德国养老院居民中的一个严重健康问题。养老院的标准化监测对于评估感染控制标准的有效性很重要，并且应该基于共识定义，以便进行有意义的机构间比较。在德国，基于诊断相关组的医院报销系统的实施可能会进一步增加长期护理机构中弱势群体的比例。
