应用中断时间序列设计评估某三甲专科医院强化感控措施对医院感染发病率的影响
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1.四川大学华西第二医院/华西妇产儿童医院医院感染管理部, 四川 成都 610041;2.四川大学出生缺陷与相关妇儿疾病教育部重点实验室, 四川 成都 610041

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李娟  E-mail: 7223770@qq.com

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Effect of enhanced infection prevention and control measures on incidence of healthcare-associated infection in a tertiary first-class specialty hospital: an interrupted time-series analysis
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1.Department of Healthcare-associated Infection Management, West China Second University Hospital of Sichuan University/West China Women's and Children's Hospital, Chengdu 610041, China;2.Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China

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    摘要:

    目的 分析医疗机构响应重大突发公共卫生事件前后医院感染发病率的变化趋势, 为医疗机构在重大突发公共卫生事件状态下感染预防与控制(简称感控)应急化响应体系建设提供依据。 方法 分析2018年1月—2021年6月某三甲专科医院医院感染日发病率, 采用中断时间序列分析方法, 通过分段回归分析定量评估应对突发公共卫生事件的强化感控措施对医院感染发病率的影响。 结果 2018—2019年强化感控措施干预前该院基线医院感染日发病率为1.44‰(95%CI: 1.35‰~1.53‰); 2020年1月—2021年6月干预后医院感染日发病率为0.94‰(95%CI: 0.88‰~1.02‰)。2019年12月强化感控措施启动后医院感染日发病率立即下降, 短期效果显著(aIRR=57.60%, 95%CI: 46.84%~70.66%, P<0.001);其后医院感染日发病率逐渐上升, 长期斜率为100.08%(aIRR=100.08%, 95%CI: 100.04%~100.12%, P<0.001)。干预后每月实际新发医院感染例数与模型预测无干预情况下新发感染例数标准化感染比(SIR)显示, 除2020年1月(SIR: 0.62, 95%CI: 0.41~0.91, P=0.013)、2月(SIR: 0.51, 95%CI: 0.31~0.78, P<0.001)、3月(SIR: 0.37, 95%CI: 0.21~0.61, P<0.001)、7月(SIR: 0.48, 95%CI: 0.29~0.75, P<0.001)外, 其余月份医院感染日发病率较干预前无明显差异。 结论 应对重大突发公共卫生事件的强化感控措施能在短时间内显著降低每月医院感染日发病率, 但该效果随时间延长逐渐消失并趋于回归干预前水平, 造成干预效果呈V字形的具体原因有待进一步分析。

    Abstract:

    Objective To analyze the changing trend of the incidence of healthcare-associated infection (HAI) before and after the response of medical institutions to major public health emergencies, and provide a basis for the construction of emergency response system of infection prevention and control (IPC) in medical institutions under major public health emergencies. Methods HAI incidence density rate in a tertiary first-class specialty hospital from January 2018 to June 2021 were analyzed. Enhanced IPC measures in response to public health emergencies on the incidence of HAI were quantitatively evaluated with piecewise regression of interrupted time-series (ITS) analysis. Results From 2018 to 2019, the baseline HAI incidence density rate of this hospital before the intervention with enhanced IPC measures was 1.44 ‰(95%CI: 1.35‰-1.53‰). From January 2020 to June 2021, HAI incidence density rate after the intervention was 0.94‰ (95%CI: 0.88‰-1.02‰). In December 2019, HAI incidence density rate immediately dropped after the launch of the enhanced IPC measures, with significant short-term effect(aIRR=57.60%, 95%CI: 46.84%-70.66%, P < 0.001). HAI incidence density rate gradually increased thereafter, with a long-term slope of 100.08% (aIRR=100.08%, 95%CI: 100.04%-100.12%, P < 0.001). Stan-dardized infection ratio (SIR) of the actual number of emerging HAI per month after intervention to the number from model prediction without intervention showed that except January 2020 (SIR: 0.62, 95%CI: 0.41-0.91, P=0.013), February 2020 (SIR: 0.51, 95%CI: 0.31-0.78, P < 0.001), March 2020 (SIR: 0.37, 95%CI: 0.21-0.61, P < 0.001), and July 2020 (SIR: 0.48, 95%CI: 0.29-0.75, P < 0.001), HAI incidence density rate in other months after intervention were not significantly different from that before intervention. Conclusion The enhanced IPC measures in response to major public health emergencies can significantly reduce HAI incidence density rate of each month in a short period, but the effect gradually disappears over time and returns to the pre-intervention level. The specific causes for the V-shaped effect of intervention need to be further analyzed.

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赵霏,周威龙,范培杨,等.应用中断时间序列设计评估某三甲专科医院强化感控措施对医院感染发病率的影响[J]. 中国感染控制杂志,2023,(11):1364-1369. DOI:10.12138/j. issn.1671-9638.20232306.
Fei ZHAO, Wei-long ZHOU, Pei-yang FAN, et al. Effect of enhanced infection prevention and control measures on incidence of healthcare-associated infection in a tertiary first-class specialty hospital: an interrupted time-series analysis[J]. Chin J Infect Control, 2023,(11):1364-1369. DOI:10.12138/j. issn.1671-9638.20232306.

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  • 收稿日期:2023-06-11
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  • 在线发布日期: 2024-04-28
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