Mertens R, Van den Berg J M, Veerman-Brenzikofer M L, Kurz X, Jans B, Klazinga N
Institute of Hygiene and Epidemiology, Brussels, Belgium.
Infect Control Hosp Epidemiol. 1994 Sep;15(9):574-8. doi: 10.1086/646984.
To explore the potential benefit of comparing results from two national surveillance networks.
Two prospective multicenter cohort studies of surgical wound infections (SWI).
Thirty-five and 62 acute-care hospitals in The Netherlands (NL) and Belgium (B), respectively, from October 1, 1991, to June 30, 1992.
The participation was equivalent in the two countries: 27% (NL) and 28% (B) of all acute-care hospitals. Marked differences emerged between the Dutch and Belgian crude infection rates and the specific rates by wound class and other risk factors. Because the case-mix in the countries is quite different, comparisons can be made only by specific surgical category. The results for inguinal hernia repair and for appendectomy are compared as an example. In herniorrhaphies, the difference in infection rate (0.4% [NL] versus 1.2% [B]) is not explained by differences in the distribution of risk factors. The shorter hospital stay in The Netherlands (4 days [NL] versus 6 days [B]), the more effective postdischarge surveillance in Belgium, and the fact that more than two thirds of the detected infections occurred after the first postoperative week probably can account for most of the difference. There was a striking difference in prophylaxis use (3.7% [NL] versus 41.9% [B]). In appendectomies, the Dutch patient population shows on average a higher risk profile, and surgery is urgent much more often in The Netherlands (78.3%) than in Belgium (49.2%). The infection rate is higher in The Netherlands, especially among the patients without prophylaxis, which again is employed less frequently there.
We conclude that international comparisons yield interesting insights regarding quality of care, reaching beyond the field of nosocomial infection prevention. This is an argument in favor of more harmonization between surveillance networks.
探讨比较两个国家监测网络结果的潜在益处。
两项关于手术伤口感染（SWI）的前瞻性多中心队列研究。
分别于1991年10月1日至1992年6月30日期间，荷兰（NL）的35家及比利时（B）的62家急性护理医院。
两国的参与情况相当：占所有急性护理医院的27%（荷兰）和28%（比利时）。荷兰和比利时的粗感染率以及按伤口类别和其他风险因素划分的特定感染率存在显著差异。由于两国的病例组合差异很大，只能按特定手术类别进行比较。以腹股沟疝修补术和阑尾切除术的结果为例进行比较。在疝修补术中，感染率的差异（0.4%[荷兰]对1.2%[比利时]）无法用风险因素分布的差异来解释。荷兰的住院时间较短（4天[荷兰]对6天[比利时]），比利时出院后监测更有效，而且超过三分之二的检测到的感染发生在术后第一周之后，这些可能是造成差异的主要原因。预防措施的使用存在显著差异（3.7%[荷兰]对41.9%[比利时]）。在阑尾切除术中，荷兰患者群体平均风险特征更高，而且荷兰的手术急诊情况（78.3%）比比利时（49.2%）更为频繁。荷兰的感染率更高，尤其是在未采取预防措施的患者中，而且荷兰预防措施的使用频率更低。
我们得出结论，国际比较能产生有关医疗质量的有趣见解，超出了医院感染预防领域。这支持了监测网络之间加强协调统一。
