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员“飞舞”的帖子：“大家能否告诉我哪些地区已经实行“因院内感染发生的费用由医院自己支付”？大家做了热烈讨论。阐述了自己的看法。最近，美国的一篇调查报告中，显示了部分相关信息，拿来供大家参考和了解。
该调查报告中，使用的词组：可防止的感染（Preventable Infections）和可避免的感染（Avoidable Infections），反映了对医院感染性质的区别和界定，有那么一类是本不该发生的。值得推敲和思考。
同时，这篇美国LG的调查报告，还反映了目前美国医院感染控制的现状，同样也不容乐观。存在的问题与我国也比较类似。从中，大家对院感工作的国内外现状也有个了解，合理定位。不要盲目悲观。看管理层面的问题，定院感工作的方向。
文献： 美国87 ％的医院没有落实可以防止感染的建议措施
华盛顿哥伦比亚特区：根据美国年度医疗质量与安全等级评价体系的常规做法，对1256家医院的医疗质量和安全测评进行了一项调查分析。调查结果显示：被调查的美国医院中，8 7％的医院没有落实预防最常见的医院获得性感染的建议和政策。
美国每年有两百万人在医疗机构发生过一次感染。大约是美国住院病人的1/20 ？ 。其中有 9万人死亡。医院感染（HAI）增加每个病人的医疗费用平均为一万五千美元。每年可以避免总额超过30亿美元的费用，却造成了浪费。
医疗保险和医疗补助服务中心宣布，自2007年8月18日起，医疗保险将不再对受益人负担某些医院获得性感染的额外费用。
LG（leapfroggroup见下）调查组询问医院对他们诊疗中四种最常见的感染所采取的预防措施。它们分别是：引流（aspiration）和呼吸机相关肺炎（VAP）;中央静脉导管相关性血流感染（CV-CBI）;外科手术部位感染(SSI)及流行性感冒（工作人员接种流感疫苗）。同时还询问调查可以影响不同类型的医院感染比率的洗手状况。通过上述询问调查，考察医院为预防感染，无论是在管理、还是究责上，在感染监控（跟踪其对感染问题的监管频度和严格程度）上医院的法人和负责人的努力程度与投资水平。结果发现，为防止某些本可以避免的感染所制定的建议和标准，执行的很不理想。见下表：
感染类型或预防实践 医院遵守标准的％
引流与呼吸机相关肺炎 38.5 ％
中央静脉导管相关性血流感染 35.4 ％
外科手术部位感染 32.3 ％
流感 30.7 ％
手部卫生 35.6 ％
医疗保险和医疗补助服务中心代理行政主管Herb Kuhn,说：“继续落实把医院获得性感染信息作为对集体与个人投保的付款限制政策，仍需要不断加强和完善”。健康与福利Marriott国际股份有限公司副董事长，LG主席Jill Berger指出，每所医院都应该有预防感染的管理制度与行为准则。但不幸的是，许多医院都有缺失，并且在工作人员、病人、医院和管理制度方面，都有缺陷。LG的医院调查，有助于确定医院减少可预防感染上的重大缺陷。LG总裁Suzanne Delbanco指出，目前，医院需要建立评价可预防感染的标准化考核测量管理制度。没有这些措施，很难找出杜绝医院获得性感染的最佳办法。本年度LG汇集所有分析数据形成的《医疗质量与安全调查报告》，将于9月18日发布。
原文献：EIGHTY-SEVEN PERCENT OF US HOSPITALS DO NOT TAKE RECOMMENDED STEPS TO PREVENT AVOIDABLE INFECTIONS
WASHINGTON, DC – Eighty-seven percent of U.S. hospitals surveyed by the Leapfrog Group do not have all of the recommended policies in place to prevent many of the most common hospital-acquired infections, according to findings issued today. The results are from an analysis of 1,256 hospitals that participate in the Leapfrog Hospital Quality and Safety Survey, an annual rating system that provides an up-to-the-minute assessment of a hospital’s quality and safety practices.
Each year two million people – one out of every 20 who obtain care at an American hospital – contract an infection during their care; 90,000 of them die. On average, so-called hospital acquired infections (HAI) add over $15,000 to a patient’s hospital bill, amounting to over $30 billion a year wasted on avoidable costs. The Centers for Medicare and Medicaid Services announced on August 18, 2007 that the Medicare program will no longer provide reimbursement for the additional costs incurred when beneficiaries experience certain hospital-acquired conditions, such as certain infections.
The Leapfrog Survey asks hospitals about their practices related to the prevention of four common infections: aspiration and ventilator associated pneumonia; central venous catheter related bloodstream infection; surgical site infection; and influenza (staff vaccination against the flu). The Survey also asks about hand washing hygiene, which can impact the rates of several different kinds of hospital acquired infection. For each of these areas, the Survey inquires about a hospital’s efforts on infection surveillance (tracking the frequency and severity of the infection in question), whether management is held accountable for preventing the infection, the hospital’s level of investment in improving its ability to reduce the preventable infection, and whether it is taking further action to detect and prevent the infection.
The Leapfrog Group, representing major corporations and public agencies that buy health benefits, finds an alarmingly low level of full compliance with any of its recommended standards for preventing certain avoidable infections.
Infection Type or Preventive Practice % Hospitals with Full Compliance
Aspiration and Ventilator Associated Pneumonia 38.5%
Central Venous Catheter Related Bloodstream Infection 35.4%
Surgical Site Infection 32.3%
Influenza 30.7%
Hand Hygiene 35.6%
Herb Kuhn, Deputy Administrator, Centers for Medicare & Medicaid Services, stated, “A continued focus on hospital acquired infections provides critical information as both public and private purchasers implement payment policies to provide incentives for improvement in this area.” Jill Berger, Chair of The Leapfrog Group and Vice President, Health & Welfare for Marriott International, Inc., stated, “There are protocols that every hospital should have in place to prevent infections. Unfortunately, many hospitals are missing the mark and that spells trouble for everyone: the patient, the hospital and the health care system.” “Leapfrog’s hospital survey helps identify significant shortcomings in hospitals’ practices to reduce preventable infections. The health care system needs now to agree to standardized measures to assess the frequency and impact of preventable infections. Without such measures, it will be difficult to identify the best ways to put an end to hospital-acquired infections,” stated Suzanne Delbanco, CEO, The Leapfrog Group. A full analysis of the data gathered from this year’s Leapfrog Hospital Quality and Safety Survey will be released on September 18.
Healthcare is part of The Thomson Corporation (NYSE: TOC; TSX: TOC).
上一篇:中医院的院感工作与西医院有何差异？如何突出中医特色？下一篇:你认为医院感染管理工作的最大的难点什么？
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发表于 2008-7-23 18:34:00
发表于 2008-7-23 18:34:01
