Bearman Gonzalo, Doll Michelle, Cooper Kaila, Stevens Michael P
Virginia Commowealth University Hospital Infection Prevention Program, North Hospital, 2nd Floor, Room 2-073, 1300 East Marshall Street, Richmond, VA, 23298-0019, USA.
Curr Infect Dis Rep. 2019 Feb 2;21(1):2. doi: 10.1007/s11908-019-0660-2.
To summarize the extent to which hospital-acquired infections (HAIs) are preventable and to assess expectations, challenges, and barriers to improve patient outcomes.
HAIs cause significant morbidity and mortality. Getting to zero HAIs is a commonly stated goal yet leads to unrealistic expectations. The extent to which all HAIs can be prevented remains debatable and is subject to multiple considerations and barriers. Current infection prevention science is inexact and evolving. Evidence-based infection prevention practices are often incompletely implemented and at times controversial. Highly sensitive surveillance results in overdiagnosis, calling into question the real incidence of HAIs. Perceived reductions in HAIs by gaming the system lead to false conclusions about preventability and may cause harm. Successful HAI reduction programs require executive oversight yet keeping hospital leaders engaged in infection prevention is a challenge given competing priorities. Medicine is not a physical science with precisely defined laws; thus, infection prevention interventions are subject to variable outcomes. Perhaps up to 55-70% of HAIs are potentially preventable. This is subject to a law of diminishing returns as the preventable proportion of HAIs may reduce over time with improvements in patient safety. As the principle tenet of medicine is first do no harm, infection prevention programs should relentlessly pursue reliable, sustainable, and practical strategies for heightened patient safety.
总结医院获得性感染（HAIs）的可预防程度，并评估改善患者预后的期望、挑战和障碍。
医院获得性感染会导致严重的发病率和死亡率。实现零医院获得性感染是一个常见的目标，但会导致不切实际的期望。所有医院获得性感染能否被预防仍存在争议，且受到多种因素和障碍的影响。当前的感染预防科学并不精确且仍在不断发展。基于证据的感染预防措施往往未得到充分实施，有时还存在争议。高度敏感的监测会导致过度诊断，这使得医院获得性感染的实际发病率受到质疑。通过操纵系统来降低医院获得性感染的假象会导致关于可预防性的错误结论，并可能造成危害。成功的医院获得性感染减少计划需要行政监督，但鉴于存在相互竞争的优先事项，让医院领导参与感染预防工作是一项挑战。医学并非一门有精确界定定律的物理科学；因此，感染预防干预措施的结果存在变数。也许高达55% - 70%的医院获得性感染是有可能预防的。随着患者安全状况的改善，医院获得性感染的可预防比例可能会随着时间的推移而降低，这遵循收益递减规律。由于医学的首要原则是不造成伤害，感染预防计划应不懈地追求可靠、可持续和实用的策略，以提高患者安全。
