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埃塞俄比亚阿姆哈拉州教学医院医院获得性感染的危险因素:一项匹配病例对照研究。

Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study.

作者信息

Yallew Walelegn Worku, Kumie Abera, Yehuala Feleke Moges

机构信息

Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

出版信息

PLoS One. 2017 Jul 18;12(7):e0181145. doi: 10.1371/journal.pone.0181145. eCollection 2017.

Abstract

BACKGROUND

Hospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia.

METHOD

A matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis.

RESULT

The median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03-0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17-4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively.

CONCLUSION

Health providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.

摘要

背景

医院获得性感染影响着全球数亿人。它是患者安全方面的一个重大全球性问题。了解潜在风险因素对于认识当地情况很重要。埃塞俄比亚阿姆哈拉州教学医院开展了一项匹配病例对照研究设计,这在该研究地区尚属首次,旨在确定风险因素。

方法

采用年龄和医院类型匹配的病例对照研究设计。该研究在贡德尔大学和费莱格 - 希沃特医学教学医院进行。病例为符合美国疾病控制与预防中心(CDC)医院获得性感染定义标准的患者,对照为在研究期间入住病房超过48小时但未发生感染的住院患者。每1例病例选取4名对照。在545名患者中,109例为病例,436例为对照。使用STATA 13进行条件逻辑回归分析数据。

结果

病例组和对照组的中位住院时间分别为7天和8天。病房内有医疗废物容器的患者发生医院获得性感染的几率降低82%(比值比[AOR]为0.18;95%置信区间[CI]为0.03 - 0.98)。免疫缺陷患者发生医院获得性感染的几率比非免疫缺陷患者高2.34倍(95% CI为1.17 - 4.69)。自入院后接受抗菌药物治疗、使用中心血管导管和接受手术的患者发生医院获得性感染的几率分别高8.63倍、6.91倍和2.35倍。

结论

医疗服务提供者和管理人员应考虑在所有病房提供和配备医疗保健材料及设施,对患者使用外部设备遵循适当的安全医疗程序,并关注免疫功能低下患者以预防和控制医院获得性感染。

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