Birnbaum D, Schulzer M, Mathias R G, Kelly M, Chow A W
Department of Medicine, University of British Columbia, Vancouver, Canada.
Infect Control Hosp Epidemiol. 1990 Sep;11(9):465-72. doi: 10.1086/646213.
The impact of recently recommended hospital infection control guidelines on Canadian acute-care hospitals is unknown. A confidential cross-sectional mailed survey of all acute-care Canadian hospitals was conducted to determine rates of receipt and adoption of published guidelines for Universal Precautions (UP) or Body Substance Isolation (BSI), rationale for adoption and knowledge of costs and benefits. Five hundred and seventy-nine of 943 sites (61%) responded (exceeding 80% in urban centers); 94% among hospitals with at least 300 beds and 57% among those under 300 beds. Seventy-four percent of responders claimed adoption of UP (65%) or BSI (9%), staff protection being their primary motivation. Adoption of either UP or BSI was associated with size (p less than .001), increasing progressively from 45% in the smallest group (less than 25 beds) to 84% in the largest (greater than or equal to 500 beds). Many hospitals introduced modifications and some substituted names other than UP or BSI in adopting a new strategy. In practice, UP and BSI now mean different things in different hospitals, and the distinction between them has become blurred. Furthermore, only 5% claiming adoption of a new strategy adopted all of the fundamental policies expected under UP or BSI. Receipt of guidelines was also correlated with size: one-third of hospitals under 200 beds had not received key publications defining UP and BSI. Only 19% claiming adoption of a new strategy indicated knowledge of cost implications. These results suggest a need for closer collaboration among hospitals and government agencies in developing uniform infection control policies, and for systematic evaluation of the cost and effectiveness of new strategies.
最近推荐的医院感染控制指南对加拿大急症护理医院的影响尚不清楚。我们对加拿大所有急症护理医院进行了一次保密的横断面邮寄调查，以确定已发布的通用预防措施（UP）或体液隔离（BSI）指南的接收率和采用率、采用的理由以及对成本和效益的了解情况。943个机构中有579个（61%）做出了回应（城市中心超过80%）；床位至少300张的医院中有94%做出了回应，床位不足300张的医院中有57%做出了回应。74%的回应者声称采用了UP（65%）或BSI（9%），员工保护是他们的主要动机。采用UP或BSI与医院规模有关（p值小于0.001），采用率从最小规模组（床位少于25张）的45%逐步上升到最大规模组（床位大于或等于500张）的84%。许多医院进行了修改，一些医院在采用新策略时使用了UP或BSI以外的名称。实际上，UP和BSI在不同医院的含义不同，它们之间的区别已经变得模糊。此外，在声称采用新策略的医院中，只有5%采用了UP或BSI预期的所有基本政策。指南的接收情况也与医院规模相关：200张床位以下的医院中有三分之一没有收到定义UP和BSI的关键出版物。在声称采用新策略的医院中，只有19%表示了解成本影响。这些结果表明，医院和政府机构在制定统一的感染控制政策方面需要更密切的合作，并且需要对新策略的成本和有效性进行系统评估。
