美国CDC：医院获得性感染率正在下降

美国疾病控制与预防中心（CDC）的一项全国分析显示，2013年医院中的手术部位和中心导管相关血流感染率显著降低。

对14,500个医疗机构递交的数据进行分析发现，2008年至2013年，中心导管相关血流感染（CLABSI）率降低46%，手术部位感染（SSI）率降低19%。SSI数据来自10种手术，包括髋关节置换术、膝关节置换术、结肠手术、直肠手术、经腹子宫切除术、经阴道子宫切除术、冠状动脉旁路移植术、其它心脏手术、周围血管旁路手术和腹主动脉瘤修复术。

除了SSI和CLABSI之外，该报告结果还显示，2011年至2013年，耐甲氧西林金黄色葡萄球菌 （MRSA）血流感染率降低8%，艰难梭菌感染率降低10%。然而，导管相关尿路感染率自2009年起增加6%。

各州之间进行比较发现，26个州在按州跟踪的6类感染中的至少2类感染方面的数据表现优于全国数据。16个州在至少3类感染方面的数据表现优于全国数据，19个州在2类感染方面的数据表现差于全国数据。并非所有州都具有足够的数据来计算报告中各类感染的有效感染信息。在2,543个具有足够数据计算标准化感染比值（standardized infection ratio ，SIR）的美国医院中，9%的医院计算得出的SIR显著差于全国SIR（0.81）。

虽然取得一定进展，但该报告呼吁采取更多的行动来消除医院感染并建议卫生部门、医院协会、专业学会、卫生保健系统和机构、以及质量改进小组使用其报告来识别那些需要额外预防措施的感染。

该CDC报告的数据仅来自急性医院。

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Hospitals reduced significantly the number of surgical site and central-line associated bloodstream infections in 2013, according to a national analysis by the Centers for Disease Control and Prevention.

A review of data submitted by 14,500 health facilities found that central line–associated bloodstream infections (CLABSIs) fell by 46% between 2008 and 2013, and surgical site infections (SSIs) dropped by 19% over the same period. SSI data were derived from 10 select procedures, including hip arthroplasty, knee arthroplasty, colon surgery, rectal surgery, abdominal hysterectomy, vaginal hysterectomy, coronary artery bypass graft, other cardiac surgery, peripheral vascular bypass surgery, and abdominal aortic aneurysm repair.

Increased reporting by health care providers and quality measures imposed by the Centers for Medicare and Medicaid Services are likely contributors to the report’s findings, said Dr. Henry Pitt, chief quality officer for Temple University Health System, Philadelphia.

“Because of all the reporting that is being done, and the potential financial burdens that exist through CMS’s value-based purchasing program, and the work people are doing to improve these things, it’s not surprising that the data are looking better,” Dr. Pitt said in an interview.

The CDC’s annual National and State Healthcare-associated Infection Progress report summarizes data submitted to the CDC’s National Healthcare Safety Network (NHSN), a nationwide infection tracking system used by all 50 states, Washington, and Puerto Rico. In addition to SSIs and CLABSIs, findings of the report show also that methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections decreased by 8% from 2011 to 2013 and that Clostridium difficile infections dropped by 10% between 2011 and 2013. However, catheter-associated urinary tract infections have risen by 6% since 2009.

In a state-by-state comparison, 26 states performed better than the nation on at least two of the six infection types tracked by state. Sixteen states performed better than the nation on three or more infections and 19 states performed worse than the nation on two infections. Not all states reported or had enough data to calculate valid infection information on every infection in the report. Among the 2,543 U.S. hospitals with enough data to calculate a standardized infection ratio (SIR), 9% had an SIR significantly worse than the national SIR of 0.81.

Despite the progress, the report calls for more action to eliminate hospital infections and recommends its report be used by health departments, hospital associations, professional societies, health care systems and facilities, and quality improvement groups to identify infections that need additional prevention efforts.

Dr. Pitt added that CMS programs that use infection control and reduction as quality metrics will no doubt continue to impact infection reporting and outcomes. The three CMS programs associated with infection control and hospital payments include its hospital value-based purchasing, hospital readmissions reduction, and hospital-acquired condition reduction programs.

“Again, people are paying more attention, in addition to it’s the right thing to do, because more money is at risk,” Dr. Pitt said.

Data in the CDC report are from acute hospitals only.

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