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在重症监护病房中,教育干预措施预防导管相关血流感染是否具有成本效益?

Are educational interventions to prevent catheter-related bloodstream infections in intensive care unit cost-effective?

机构信息

Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.

Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.

出版信息

J Hosp Infect. 2014 Jan;86(1):47-52. doi: 10.1016/j.jhin.2013.09.004. Epub 2013 Sep 21.

Abstract

BACKGROUND

There is increasing interest in evidence-based educational interventions in central venous catheter care. It is unclear how effective these are at reducing the risk of bloodstream infections from the use of intravascular catheters (catheter-BSIs) and the associated costs and health benefits.

AIM

To estimate the additional costs and health benefits from introducing such interventions and the costs associated with catheter-BSIs.

METHODS

A comprehensive epidemiological and economic review was performed to develop the parameters for an economic model to assess the cost-effectiveness of introducing an educational intervention compared with clinical practice without the intervention. The model follows the clinical pathway of cohorts of patients from their admission to an intensive care unit (ICU), where some may acquire catheter-BSI, and estimates the associated costs, mortality and life expectancy.

FINDINGS

The additional cost per catheter-BSI episode was £3940. The results of this model demonstrate that introducing an additional educational intervention to prevent catheter-BSI improved patient life expectancy and reduced overall costs.

CONCLUSION

Introducing evidence-based education is likely to reduce the incidence of catheter-BSI and the model results suggest that the cost of introducing the interventions will be outweighed by savings related to reduced ICU bed occupancy costs.

摘要

背景

人们对基于证据的中心静脉导管护理教育干预措施越来越感兴趣。目前尚不清楚这些措施在降低血管内导管相关血流感染(导管相关 BSIs)的风险方面的有效性,以及相关的成本和健康效益。

目的

估计引入这些干预措施的额外成本和健康效益,以及与导管相关 BSIs 相关的成本。

方法

进行了全面的流行病学和经济审查,以制定经济模型的参数,以评估与不进行干预的临床实践相比,引入教育干预措施的成本效益。该模型遵循患者队列从入住重症监护病房(ICU)到 ICU 出院的临床路径,其中一些患者可能会发生导管相关 BSIs,并估计相关的成本、死亡率和预期寿命。

发现

每例导管相关 BSIs 发作的额外成本为 3940 英镑。该模型的结果表明,引入额外的教育干预措施来预防导管相关 BSIs 可以提高患者的预期寿命并降低总体成本。

结论

引入基于证据的教育措施可能会降低导管相关 BSIs 的发生率,并且模型结果表明,引入干预措施的成本将被 ICU 床位占用成本降低带来的节省所抵消。

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