| Objective:The aim of this dissertation is to learn about the status quo of the prevalence rate of tertiary public hospitals in Hubei Province and to estimate the direct economic disease burden of patients with healthcare associated infections and antimicrobial resistance,so as to provide potential evidence for control of healthcare associated infections and antimicrobial resistance and to give some recommendations for the relevant departments from the government and hospitals.Methods:1.Subjects:Based on the geographical,scale,economic representation and research accessibility,five tertiary public hospitals in Hubei Province were selected to participate in the survey of the prevalence of healthcare associated infections in the National Health Commission,Inpatient patients(refer to all hospitalized patients,including those who were discharged from the day,but not the day of admission)at the time of 0:30 am to 23:59 of the day.(2)patients with nosocomial infection and non-hospital infection patients,drug-resistant hospital infection in patients with nosocomial infection in patients with nosocomial infection,(3)to measure the direct economic burden of patients with nosocomial infection and non-nosocomial infection;(4)to compare the prevalence of nosocomial infection And trend analysis,hospital infection patients and drug-resistant patients with nosocomial infection in patients with direct economic burden of the results,put forward reasonable control of hospital infection and bacterial drug resistance policy recommendations.2.Research methods:(1)Descriptive statistical analysis:mainly used for all hospitalized patients social demographic characteristics and hospital disease burden indicators of the mean and standard deviation and composition ratio.(2)General Statistical analysis:chi-square bivariate covariate ratio between the front case and control groups([chi]2)statistical test/two-sample t/z test,determining comparability between cases and controls.Balance covariates examines the ratio between the case group and control group,with paired sample cards square(?2)statistical test,and paired samples t/z test.In addition,the direct economic burden of the case group was measured as follows:cost and hospitalization duration paired t/z test.(3)Tendency ratio method:Adequate matching of case group and control group was performed with gender,age and discharge diagnosis code(ICD-10)as matching condition(the nearest neighbor 1:1 match of caliper = 0.25a)Logistic Regression and Generalized Boosted Modeling(GBM),(P<0.05)Results:1.Hospital basic situation:5 three-level public hospital 2013-2015 in the daily outpatient volume,bed turnover(hospital number/open bed),hospital average hospital day,hospital hospitalized patients total mortality,hospital hospital gross income,The hospital average hospital costs and other indicators are basically similar,little difference.2.The prevalence of hospital infection is the basic situation:(1)the prevalence rate:the prevalence of nosocomial infection and hospital average hospital sensibility rate there is a certain gap,the goup to 5.40%,and the hospital's average hospital sensitivity rate is less than Hospital infection rate,the difference is greater.(2)Target bacterial infection:The total number of cases of infection with copper-green pseudomonas,Staphylococcus aureus,Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli in 2013 and 2015 were 33,36,25,44 and 56,the main target of infection for Escherichia coli and Klebsiella pneumoniae,and different hospitals infected with different target bacteria.(3)target drug-resistant bacteria infection:2013-2015 resistant bacteria,including methicillin-resistant/third-generation Staphylococcus aureus,produced extended-spectrum ?-lactamase/three generations of cephalosporins,extended-spectrum ? Amylase/anti-three-generation cephalosporins,Klebsiella pneumoniae,carbapenems and carbapenem-resistant carbapenem,respectively,16,44,26,19 and 25,the main drug-resistant bacteria for the production of extended-spectrum ?-lactamase/three generations of cephalosporins.(4)Multiple drug-resistant infections:The total number of cases of multiple drug-resistant infections in 2013-2015 was 133,and the number of multiple drug-resistant infections in all hospitals was 128.(5)microbiological test sample delivery rate situation:In addition to HB,2013 and 2014 microbial inspection rate of less than 50%,otherhospitals are more than 50%per year,the maximum rate for HE in 2013 was 88.30%(6)the site of infection:The infection in hospital patients 2013--2015 Main site of infection are ventilator-associated pneumonia(lower respiratory tract infection).(7)Non-attributable death:The current rates of death on the day the number of deaths were 8,8 and 3,whose three years the total number of deaths was 19.Three years of hospital infection non-attributable mortality rates were higher than the hospital average hospital mortality in the hospital.3.Hospital infection in patients with direct economic burden of the situation:the ratio of the ratio of the actual cost of the hospital and the actual number of days can be seen,the hospital infection patients with non-hospital infection patients,the cost and actual hospital days exceeded higher(P<0.05).On the overall average of three years,the infected patients than non-infected patients in the total cost of 38,272.72 yuan higher,more than 13,999.48 yuan,more than 12141.09 yuan at their own expense,and the actual hospital days higher than 25 days.4.Drug-resistant bacteria in patients with nosocomial infection direct economic burden of disease:the trend of the ratio of drug-resistant hospital infection patients than non-hospital infection in the cost of patients and the actual number of hospital days are high,the overall average of three years The difference between the direct economic burden indicators is the total cost of 102723.83 yuan,the cost of 33667.31 yuan,49636.34 yuan at their own expense,and the actual hospital days 40 days.In 2013,the cost of hospital infection in patients with drug-resistant bacteria continued to increase,with the total cost growth rate of 50.98%in 2013 to 2014,24.28%in 2014 to 2015,the growth rate decreased.Conclusion:Tertiary public hospitals reported that the average hospital rate was lower than the current rate of hospital survey rate;hospital microbiological test sample inspection rate difference;hospital non-attributable total mortality was underestimated;after the tendency to match the burden of disease More objective,and hospital infection patients and drug-resistant bacteria in hospital infection patients with direct economic burden higher than non-hospital infection patients.Therefore,the government and the hospital should be from the structure,process and results in three areas,strengthen the management of hospital infection and bacterial resistance,regular training of medical personnel,to develop appropriate incentives to mobilize the enthusiasm of medical staff. |
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