Heudorf U, Schulte D
Abteilung Medizinische Dienste und Hygiene, Amt für Gesundheit, Breite Gasse 28, 60313 Frankfurt am Main.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2009 Jul;52(7):732-43. doi: 10.1007/s00103-009-0869-6.
In Germany, surveillance of nosocomial infections is obligatory by law in hospitals, but not in long-term care facilities. In long-term care facilities, neither X-ray nor laboratory facilities are available; therefore, special criteria for infection surveillance in these facilities were developed by Mc Geer et al. (1991), based only on observations of the medical staff and foregoing laboratory methods. The practicability of these criteria was assessed in a long-term care facility with an electronic medical documentation system. In a retirement home in Frankfurt/Main, Germany, the residents' symptoms according to McGeer et al. were recorded from January, 1 to June 31, 2006. The study included 278 residents, 45,710 resident days, including 4413 "urinary catheter days" und 6009 "gastric tube days". Based on the symptoms documented in the electronic medical documentation system, the respective diagnoses were obtained. Data on gastrointestinal, bronchial, urinary, and eye infections are reported here, including number of cases as well as incidences per 1000 resident days. The overall incidence rate was 5.07/1000 resident days, including 1.9 gastrointestinal infections, 0.95 bronchitis/pneumonia, and 0.44 urinary infections. Incidence of urinary infections in residents with an indwelling urinary catheter was 2.26/1000 catheter days compared to 0.242/1000 days for those without a catheter. Urinary catheter, however, was not only a risk factor for urinary infections (OR 9.4, 95CI 3.4-25.8) but also for bronchial infections (OR 3.0, 95CI 1.3-6.8), and eye infections (OR 1.6, 95CI 0.4-5.8). Gastric tubes were associated with bronchial infections (OR 3.7; CI 1.7-7.9), eye infections (OR 5.4, CI 1.9-15.2), and urinary infections (OR 2.7, 95CI 0.9-8.2). Urinary or fecal incontinence were not associated with any infections, and age (>80 years) was negatively associated with urinary infections (OR 0.35, significant) and bronchial infections (OR 0.51, significant). Compared with published studies, the incidence rates were comparable. The practicability of the criteria of McGeer et al. could be confirmed - with only slight modification - in a long-term care facility with electronic medical documentation.
在德国，法律规定医院必须对医院感染进行监测，但长期护理机构则无需如此。在长期护理机构中，既没有X光设备也没有实验室设施；因此，Mc Geer等人（1991年）仅基于医务人员的观察和先前的实验室方法，为这些机构制定了感染监测的特殊标准。在一个配备电子医疗记录系统的长期护理机构中评估了这些标准的实用性。在德国美因河畔法兰克福的一家养老院，记录了2006年1月1日至6月31日期间居民符合McGeer等人标准的症状。该研究包括278名居民，共45710个居民日，其中包括4413个“导尿日”和6009个“胃管日”。根据电子医疗记录系统中记录的症状得出相应诊断。这里报告了胃肠道、支气管、泌尿系统和眼部感染的数据，包括病例数以及每1000个居民日的发病率。总体发病率为5.07/1000居民日，其中包括1.9例胃肠道感染、0.95例支气管炎/肺炎和0.44例泌尿系统感染。留置导尿管的居民泌尿系统感染发病率为2.26/1000导尿日，而未留置导尿管的居民发病率为0.242/1000日。然而，导尿管不仅是泌尿系统感染的危险因素（比值比9.4，95%置信区间3.4 - 25.8），也是支气管感染的危险因素（比值比3.0，95%置信区间1.3 - 6.8）和眼部感染的危险因素（比值比1.6，95%置信区间0.4 - 5.8）。胃管与支气管感染（比值比3.7；置信区间1.7 - 7.9）、眼部感染（比值比5.4，置信区间1.9 - 15.2）和泌尿系统感染（比值比2.7，95%置信区间0.9 - 8.2）有关。尿失禁或大便失禁与任何感染均无关联，年龄（>80岁）与泌尿系统感染（比值比0.35，具有显著性）和支气管感染（比值比0.51，具有显著性）呈负相关。与已发表的研究相比，发病率相当。McGeer等人的标准在配备电子医疗记录的长期护理机构中经过轻微修改后其实用性得到了证实。
