Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
Antimicrob Resist Infect Control. 2022 Nov 9;11(1):135. doi: 10.1186/s13756-022-01175-y.
Infection prevention and control (IPC) measures in Japan are facilitated by a financial incentive process at the national level, where facilities are categorized into three groups (Tier 1, Tier 2, or no financial incentive). However, its impact on IPC at the facility level using a validated tool has not been measured.
A nationwide cross-sectional study was conducted from August 2019 to January 2020 to evaluate the situation of IPC programs in Japan, using the global IPC Assessment Framework (IPCAF) developed by the World Health Organization. Combined with the information on the national financial incentive system, the demographics of facilities and each IPCAF item were descriptively analyzed. IPCAF scores were analyzed according to the facility level of care and the national financial incentive system for IPC facility status, using Dunn-Bonferroni and Mann-Whitney U tests.
Fifty-nine facilities in Japan responded to the IPCAF survey: 34 private facilities (57.6%) and 25 public facilities (42.4%). Of these, 11 (18.6%), 29 (49.2%), and 19 (32.3%) were primary, secondary, and tertiary care facilities, respectively. According to the national financial incentive system for IPC, 45 (76.3%), 11 (18.6%), and three (5.1%) facilities were categorized as Tier 1, Tier 2, and no financial incentive system, respectively. Based on the IPCAF total score, more than half of the facilities were categorized as "Advanced" (n = 31, 55.3%), followed by "Intermediate" (n = 21, 37.5%). The IPCAF total score increased as the facility level of care increased, while no statistically significant difference was identified between the secondary and tertiary care facilities (p = 0.79). There was a significant difference between Tier 1 and Tier 2 for all core components and total scores. Core components 5 (multimodal strategies for implementation of IPC interventions) and 6 (monitoring/audit of IPC and feedback) were characteristically low in Japan with a median score of 65.0 (interquartile range 40.0-85.0) and 67.5 (interquartile range 52.5-87.5), respectively.
The national financial incentive system was associated with IPC programs at facility level in Japan. The current financial incentive system does not emphasize the multimodal strategy or cover monitoring/audit, and an additional systematic approach may be required to further promote IPC for more practical healthcare-associated infection prevention.
日本的感染预防和控制（IPC）措施通过国家层面的财务激励机制得以推进，该机制将医疗机构分为三个等级（1 级、2 级或无财务激励）。然而，利用经过验证的工具衡量其对医疗机构层面 IPC 的影响尚未得到评估。
2019 年 8 月至 2020 年 1 月，我们开展了一项全国性的横断面研究，使用世界卫生组织（WHO）制定的全球 IPC 评估框架（IPCAF），评估日本 IPC 项目的情况。结合国家财务激励系统的相关信息，对医疗机构的人口统计学特征和每个 IPCAF 项目进行描述性分析。根据医疗机构的护理水平和国家 IPC 财务激励系统，对 IPCAF 评分进行分析，采用 Dunn-Bonferroni 和 Mann-Whitney U 检验。
日本共有 59 家医疗机构对 IPCAF 调查做出了回应：34 家私立机构（57.6%）和 25 家公立机构（42.4%）。其中，11 家（18.6%）、29 家（49.2%）和 19 家（32.3%）分别为一级、二级和三级医疗机构。根据国家 IPC 财务激励系统，45 家（76.3%）、11 家（18.6%）和 3 家（5.1%）医疗机构分别被归类为 1 级、2 级和无财务激励系统。根据 IPCAF 总分，超过一半的医疗机构被归类为“先进”（n=31，55.3%），其次是“中级”（n=21，37.5%）。IPC 评估框架总分随医疗机构护理水平的提高而增加，而二级和三级医疗机构之间的差异无统计学意义（p=0.79）。1 级和 2 级之间在所有核心组成部分和总分上均存在显著差异。日本核心组成部分 5（实施 IPC 干预的多模式策略）和 6（IPC 监测/审核和反馈）的得分特别低，中位数分别为 65.0（四分位距 40.0-85.0）和 67.5（四分位距 52.5-87.5）。
国家财务激励系统与日本医疗机构层面的 IPC 项目相关。现行的财务激励系统不强调多模式策略，也不涵盖监测/审核，可能需要采取额外的系统方法来进一步促进 IPC，以更有效地预防与医疗保健相关的感染。
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