Horstman Molly J, Li Yu-Fang, Almenoff Peter L, Freyberg Ron W, Trautner Barbara W
1Center for Innovations in Quality,Effectiveness, and Safety (IQuESt);Michael E. DeBakey VA Medical Center,Houston,Texas.
5Operational Analytics and Reporting,Office of Informatics and Analytics,Veterans Health Administration,Department of Veterans Affairs,Washington, DC.
Infect Control Hosp Epidemiol. 2015 Jun;36(6):710-6. doi: 10.1017/ice.2015.42. Epub 2015 Mar 18.
To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator
Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care
Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections
We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance.
A total of 7.9 million bed days were included. From 2011 to 2013, CAUTI decreased whether measured by device days (2.32 to 1.64, P=.001) or bed days (4.21 to 3.02, P=.006). CLABSI decreased when measured by bed days (1.67 to 1.19, P=.04). VAP rates and device utilization ratios for CAUTI, CLABSI, and VAP were not statistically different across time. Infection rates calculated with device days were strongly correlated with infection rates calculated with bed days (r=0.79-0.94, P<.001). Hospital relative performance measured by ordered rank was also strongly correlated for both denominators (r=0.82-0.96, P<.001).
These findings suggest that device days and bed days are equally effective adjustment metrics for comparing healthcare-associated infection rates between hospitals in the setting of stable device utilization.
以设备使用天数和住院天数为分母，研究其对导尿管相关尿路感染（CAUTI）、中心静脉导管相关血流感染（CLABSI）和呼吸机相关性肺炎（VAP）的感染率及医院排名的影响
2010年10月至2013年7月的回顾性调查
提供急性医疗和外科护理的退伍军人健康管理局医疗中心
入住120家报告有医疗相关感染的退伍军人健康管理局医疗中心的患者
我们研究了以设备使用天数和住院天数为分母在各医疗中心CAUTI、CLABSI和VAP的感染率与医院排名之间的重要性。使用Pearson相关性评估以设备使用天数和住院天数为分母之间的关系，并通过方差分析评估感染率和设备使用率的变化。
共纳入790万个住院天数。从2011年到2013年，无论以设备使用天数衡量（从2.32降至1.64，P = 0.001）还是以住院天数衡量（从4.21降至3.02，P = 0.006），CAUTI均有所下降。以住院天数衡量时，CLABSI有所下降（从1.67降至1.19，P = 0.04）。CAUTI、CLABSI和VAP的VAP率及设备使用率在不同时间无统计学差异。以设备使用天数计算的感染率与以住院天数计算的感染率密切相关（r = 0.79 - 0.94，P < 0.001）。两种分母衡量的医院相对表现排名也密切相关（r = 0.82 - 0.96，P < 0.001）。
这些发现表明，在设备使用稳定的情况下，设备使用天数和住院天数是比较医院间医疗相关感染率的同等有效的调整指标。
