The Economic Evaluation Of Target Monitoring Of ICU And The Interventional Research On KAP Of Nosocomial Infection Among ICU Medical Staff In Xinjiang

? Objective ? The study is to investigate infection knowledge,attitude and behavior status of ICU medical staff in Grade III,Class A hospital in Xinjiang,analysis the knowledge,attitude practice behavior(KAP)influence factors of ICU medical staff.Through the study,we also explore practical and effective comprehensive intervention measures by carrying out research on the infection knowledge and hand hygiene behavior in some ICU hospital.We will have a comparison study on infection status and risk factors between grade III,class A hospital and comprehensive hospital ICU patients.Based on the study,hospital infection to provide scientific basis for health administrative departments and hospital administrators.?Methods?(1)By using cluster sampling method to conduct questionnaire survey,1033 medical staffs from 12 Grade III,Class A hospitals in Xinjiang were selected to investigate on knowledge situation of hospital infection influencing factors,and the relationship among knowledge,attitude and behavior.The intermediary effect method was used to analyze and four quadrant method to determine the key medical staffs of education and training.(2)During the intervention and evaluation period,ICU medical staffs from Grade III,Class A hospitals in Xinjiang were taken as intervention group.According to the research object and exclusion criteria,88 ICU medical staffs in the intervention group,and 108 ICU medical staffs in the control group were taken into the intervention study.Then in accordance with the hospital manage daily training supervisor mode,comprehensive intervention measures were implemented on the ICU medical staffs for three months.In the end,the effect of the intervention was evaluated by comparing the knowledge,attitude,behavior and the hand hygiene execution differences between the experimental group and the control group before and after the intervention in the ICU medical staffs.(3)Adopting themethod of targeted monitoring,we had collected infection status and risk factors of comprehensive ICU patients from two different types Grade III,Class A hospitals.(4)In direct economic loss of study,the infected patients(patient group)and patients without infected(contrast group)were matched at the rate of 1:1 to compare hospitalization expense and hospitalization time differences in two types of hospital.?Results?(1)The infection knowledge of ICU medical staffs in Xinjiang hospital showed good recognition attitude that the correct answer rate was between72.21% and 82.38% for each question;about hospital infection,93.32% of medical staff has relatively positive attitude;the behavior of hand hygiene compliance was only 46.76%,which is far below the national requirements.In the case of the master the hospital infection knowledge,there was statistically significant(P<0.05)among the different age,working years,hospital,education experience,professional degree;in the case of ICU medical staff attitude to the hospital infection,there was also statistically significant(P<0.05)among the different working years,hospital,profession,education experience,and professional degree.In the case of ICU medical staff hand hygiene behavior,eight factors all have statistically significant(P<0.05).The hierarchical regression model showed that after taking the attitude of hospital infection into the equation,R2 increases from 0.596 to 0.596,and the relevant degree between the variable of the hospital infection knowledge and behavior of hospital infection decreases from 0.135 to 0.073.F test for the ?R2 value was 158.390,P =0.001,which showed that the medical staff of the hospital infection behavior can be affected by the hospital infection knowledge and the attitude to hospital infection.The attitude of hospital infection meet the requirement of the mediation effect condition on the hospital infection knowledge and the behavior of hospital infection,which can play an important role in the mediation variables.In the four quadrant analysis,26.91% of people was in the first(?)quadrant with 80.58% of those,holding positive attitude on hospital infection,need to give them full play to play their model role;19.85% in the ? quadrant,and they did not have a good command of infection knowledge,but a better behavior;35.91% in the ? quadrant with both lack of infection knowledge and poor behavior,and they were the key object to carry out intervention training;17.33% in the ? quadrant with 30.73% of them,having the right hospital infection positive attitude,means that although they had mastered thecorrect knowledge,their the surface improvement phenomenon fails to reach the expected effect,and need to strengthen training intervention.(2)The intervention results,using comprehensive intervention measures,on related infection knowledge of ICU medical staff,the hand hygiene compliance and correctness were as follows: As for the intervention group,there was statistically significant(P<0.05)on the showing score and each dimension scores before and after the intervention: before the intervention,hand hygiene compliance of the intervention group was 58.48% in the middle of intervention75.71%,and in the later period of intervention 72.83%;There was also statistically significant(P<0.05)on the hand hygiene correctness: before the intervention,the correctness of hand hygiene was70.41%,in the middle of intervention 100.00%,and in the later period of intervention97.83%.However,as for the contrast group,there was no statistically significant on the showing score and each dimension scores before and after the intervention: before the intervention,hand hygiene compliance of the intervention group was 65.07%,in the middle of intervention 68.26%,and in the later period of intervention 67.18%;There also was not statistically significant(P<0.05)on the hand hygiene correctness before the intervention,the correctness of hand hygiene was 77.49%,in the middle of intervention 80.20%,and in the later period of intervention 79.89%.The standardized effect indexes of knowledge,attitude,and behavior were 3.70,3.40,and 4.04 after the intervention,which showed a good results of comprehensive intervention effect.(3)2513 patients(male 1431,female 1082)were chosen from the ICU monitoring room of two comprehensive hospitals: 1595 cases from the comprehensive hospital ICU patients,and 918 cases from the specialty hospital ICU patients.There were altogether 529 person-times of hospital infection,and after the adjustment,the incidence of hospital infection in the two comprehensive hospitals was 9.31‰,and10.33 ‰ in the Specialty comprehensive hospital.Comprehensive ICU infection rates in Tumor Specialty hospital were slightly higher than the general hospital.The top five infections in the two hospitals were: respiratory tract infection(66.67%),abdominal pelvic infection(8.82%),blood infection(5.83%),urinary tract infection(5.53%),gastrointestinal tract infection(4.78%).According to a comprehensive basic situation of infection patients admitted in ICU hospital,the results on the single influence factor showed that there were relevant between theinfection and age,gender,hospitalization days,the number of basic diseases and hospital diagnose diseases of nervous system diseases,respiratory diseases,musculoskeletal system and connective tissue diseases,which had statistical differences(P<0.05).The results of single factor on three invasive operation instrument for hospital infections showed that there was statistical differences(P<0.05)on the use of breathing machine,the time of using breathing machine,central venous catheter,central venous catheter detaining urethral catheter time.ICU patients from the two comprehensive hospitals had participated in the construction of hospital infection prediction model.From the point of Logistic regression equation,there were more infection risks because of the longer time of the ICU admission,the use of center venipuncture,the use of antibacterial drugs,combined use of antimicrobial agents,and patients with more basic diseases.Females admitted to hospital,diagnosed with musculoskeletal system and connective tissue diseases,and with injury,poisoning of other external diseases,have low risk of infection.(4)According to the matching rate of 1:1,190 patients from the general hospital ICU ward were matched,103 from Specialty hospital.From the general hospital ICU,the median value of total hospitalized cost was 162 747.61 yuan,and the median value of total hospitalized cost from the contrast group was 81 334.12 yuan,and the difference between the case group and the control group was 68 508.69 yuan.From the specialty hospital ICU,the median value of total hospitalized cost was 102 866.00 yuan,and the median value of total hospitalized cost from the contrast group was 64311.00 yuan.The difference between the case group and the control group was 44561.00 yuan.There was statistically significant(P<0.05)differences between the two hospitals case group and control group.The direct economic loss caused by the general hospital is higher than the specialty hospital,in which payment for medicine infection account for the biggest part of the direct economic loss.In the comprehensive hospital ICU ward,the difference of the total hospitalization median days between the case group and the control group was 10 days,and the difference of ICU admission between the case group and the control group was 9 days.In the specialty hospital ICU ward,the difference of total hospitalization median days between the case group and the control group was 9 days,and the difference of ICU admission between the case group and the control group was 4 days.The differences had statistically significant(P<0.05).?Conclusions?(1)There is still a gap between the requirements of the country and the ICU medical staffs in the Grade III,Class A hospitals in Xinjiang,and there are many factors that have influenced the mastery of infection knowledge.Hospital infection knowledge has some influence on the behavior of hand hygiene through indirectly attitude to the infection knowledge in hospital.Thus,we should attach great importance to the role of hospital infection related attitude.(2)There is obvious intervention effect on improving the ICU hospital infection medical related knowledge,attitude,practice and the compliance through comprehensive intervention measures.Therefore,the medical institutions can draw lessons from the beneficial experience of comprehensive intervention measures in the existing hospital infection related training education,to improve and enhance the knowledge of hospital infection knowledge and hand hygiene compliance intervention effect,and reduce the incidence of hospital infection.(3)Targeted monitoring results on the different types of ICU show that ICU hospital infection rates in specialty hospital are slightly higher than the general hospital.The morbidity rate of hospital patients aged above 60 years is significantly higher than other age groups of patients;infection rate of male patient is significantly higher than that of female patients;The incidence of hospital infection in patients with30 days hospitalization days is higher than other patients with fewer hospitalization days.The highest rate of hospital infection occurs in hospital infection,especially in hospital;the longer the use of medical equipment,the higher the possibility of hospital infection,and the higher the occurrence of risk.According to the hospital infection risk factors,we have strengthened monitoring and implement targeted intervention.(4)ICU infection occurred in comprehensive hospital can cause seriously direct economic loss,prolong the patient's hospital stay,and reduce the utilization efficiency of medical institution beds,which has brought great economic burden on patients,medical institutions and society.