Taylor G D, McKenzie M, Kirkland T, Buchanan-Chell M, Wiens R
University of Alberta, University of Alberta Hospital, Edmonton, Alberta.
Can J Infect Dis. 2000 Jan;11(1):34-7. doi: 10.1155/2000/869091.
To assess the impact of the health care restructuring, which occurred in Alberta in 1995, on the occurrence of nosocomial blood stream infection and risk factors for these infections at the University of Alberta Hospital.
Changes in patient population, hospital bed numbers, admissions and hospital days for 1993 and 1994 (1993/94) were compared with those for 1996 and 1997(1996/97). Central venous catheter (CVC) use in intensive care units (ICU), days of total parenteral nutrition (TPN) and hemodialysis were compared for the two time periods. Prospectively collected data obtained by monitoring blood culture results on nosocomial blood stream infections in 1993/94 were compared with those obtained in 1996/97.
Hospital bed number fell by 10% between 1993/94 and 1996/97. Annual admissions fell by 19% and patient days by 17%. Some services markedly increased patient days (neurosurgery 49%, nephrology 30%, orthopedic surgery 24%), and others markedly reduced patient days (obstetrics and gynecology 99%, ophthalmology 100%, adult medicine 41%, general paediatrics 38%). ICU use of CVCs increased by 41%, TPN days increased by 25% and hemodialysis runs increased by 9%. Annual nosocomial blood stream infections increased by 31% and the annual rate per 10,000 patient days increased by 60%. TPN-related blood stream infection rates and ICU CVC infection rates did not change from 1993/94 to 1996/97.
Hospital restructuring has been associated with a 31% increase in nosocomial blood stream infection number and a 60% increase in rate. The increase has been associated with a change in patient populations and increases in risk factors for blood stream infection.
评估1995年在艾伯塔省发生的医疗保健结构调整对艾伯塔大学医院医院血流感染发生率及这些感染的危险因素的影响。
将1993年和1994年（1993/94）的患者人群、病床数量、入院人数和住院天数的变化与1996年和1997年（1996/97）的进行比较。比较两个时间段重症监护病房（ICU）中心静脉导管（CVC）的使用情况、全胃肠外营养（TPN）天数和血液透析情况。将1993/94年通过监测医院血流感染血培养结果前瞻性收集的数据与1996/97年获得的数据进行比较。
1993/94年至1996/97年期间，病床数量减少了10%。年入院人数下降了19%，患者住院天数下降了17%。一些科室的患者住院天数显著增加（神经外科增加49%，肾病科增加30%，骨科手术增加24%），而其他科室则显著减少（妇产科减少99%，眼科减少100%，成人医学减少41%，普通儿科减少38%）。ICU中CVC的使用增加了41%，TPN天数增加了25%，血液透析次数增加了9%。医院血流感染年发生率增加了31%，每10000患者住院天数的年发生率增加了60%。1993/94年至1996/97年，TPN相关血流感染率和ICU中CVC感染率没有变化。
医院结构调整与医院血流感染数量增加31%以及感染率增加60%有关。这种增加与患者人群的变化以及血流感染危险因素的增加有关。
