Stone Patricia W, Horan Teresa C, Shih Huai-Che, Mooney-Kane Cathy, Larson Elaine
Columbia University School of Nursing, New York, NY 10032, USA.
Am J Infect Control. 2007 Apr;35(3):145-9. doi: 10.1016/j.ajic.2006.11.001.
Many states have or are in process of legislating hospitals to report health care-associated infections (HAI). The purpose of this article is to compare two methods currently in use by different states: 1) selected infections due to medical care Patient Safety Indicator (PSI-7); and 2) Centers for Disease and Prevention Control (CDC) protocols for central line-associated bloodstream infections (CLA-BSI).
Data came from a multihospital study. Site coordinators provided lists of elderly Medicare patients admitted in an enrolled intensive care unit in 2002 cross referenced with patient specific data on CLA-BSI following CDC protocols. PSI-7 was identified using Medicare data and the Agency for Healthcare Research and Quality PSI software version 2.1.
The full sample comprised records from 14,637 patients from 41 intensive care units in 24 hospitals. Patients were excluded if they did not meet the PSI-7 denominator criteria. In a sample of 9,948 patients, both methods identified infections in 89 (0.89%) patients. The methods had little concordance with only 8 patients identified using both methods.
Inconsistencies that we identified in this study are concerning given the fact that reports of HAI generated by different methods vary widely. Mandatory reporting mechanisms should be standardized and their accuracy confirmed.
许多州已经或正在立法要求医院报告医疗保健相关感染（HAI）。本文的目的是比较不同州目前使用的两种方法：1）因医疗护理导致的特定感染患者安全指标（PSI-7）；2）疾病预防控制中心（CDC）关于中心静脉导管相关血流感染（CLA-BSI）的协议。
数据来自一项多医院研究。现场协调员提供了2002年在参与研究的重症监护病房入院的老年医疗保险患者名单，并根据CDC协议与CLA-BSI的患者特定数据进行交叉引用。使用医疗保险数据和医疗保健研究与质量机构PSI软件版本2.1识别PSI-7。
完整样本包括来自24家医院41个重症监护病房的14637名患者的记录。不符合PSI-7分母标准的患者被排除。在9948名患者的样本中，两种方法均在89名（0.89%）患者中识别出感染。两种方法的一致性很低，仅8名患者通过两种方法都被识别出感染。
鉴于不同方法产生的HAI报告差异很大，我们在本研究中发现的不一致令人担忧。强制报告机制应标准化并确认其准确性。
