ICU重症患者中心静脉导管相关血流感染的卫生经济学分析  

Health Economic Analysis of Central Line-associated Bloodstream Infections in Critically Ill Patients in Intensive Care Unit

作　　者：蔡莉 冯晓敏 黄竞[2] 陈惠超[2] 李健 欧阳红莲 CAI Li;FENG Xiaomin;HUANG Jing;CHEN Huichao;LI Jian;OUYANG Honglian(Emergency Intensive Care Unit,The Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Emergency Intensive Care Unit,Guangdong Hospital of Traditional Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院重症监护室,广东广州510006 [2]广东省中医院重症监护室,广东广州510120

出　　处：《中山大学学报(医学科学版)》2025年第2期301-310,共10页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：2022年度广州市科技局-市校(院)联合资助项目(202201020315);2023年度广东省中医药局中医药科研项目(20232049)。

摘　　要：【目的】探讨ICU重症患者,进行中心静脉置管(CVC)后发生导管相关血流感染(CLABSI)的增量成本,以及院感防控措施的主要成本,通过增量成本和院感防控措施成本的价值对比,从医疗质量和经济效益角度提高医务人员对预防CLABSI的院感防控措施的重视程度,促进防控措施的落实。【方法】本研究采用整群抽样方法,选取2021年1月至2023年12月期间,在某三甲中医院ICU进行CVC置管的重症患者,CLABSI组65例和非CLABSI组61例,共126例,通过医院医疗病历系统回顾性地收集患者资料,梳理研究对象的疾病类型、性别、年龄、住院时长、转归、住院各项费用等。分析比较不同手卫生方法、不同环境清洁消毒方法的成本。【结果】CLABSI组和非CLABSI组患者的住院时长(Z=-5.35,P<0.05)和住院总费用(Z=-6.79,P<0.05)均存在显著性差异;不同住院时长的患者住院总费用存在显著性差异(H=43.01,P<0.05);住院时长>60 d的患者住院总费用中位数远高于其他3组的患者;男性组(Z=-4.85,P<0.05)住院总费用中位数的差异大于女性组(Z=-3.98,P<0.05);61~80岁组(Z=-5.79,P<0.05)的差异大于其他两组。【结论】CLABSI的发生显著增加了ICU患者的住院时间和住院费用。虽然不同手卫生方式、不同环境清洁消毒方案在成本上存在差异,但与CLABSI发生后产生的增量成本相比,这些成本是可以接受的。因此,医疗机构应重视手卫生和环境清洁消毒等院感防控措施的投入,制定切实、合理、可行的实施方案,确保院感防控措施落实,以避免医院感染发生、促进医疗质量提升、有效控制患者的住院时间和住院费用,力求保障患者安全。【Objective】To explore the incremental cost of central line-associated bloodstream infections(CLABSI)after central venous catheterization(CVC)in critically ill patients in the intensive care unit(ICU),as well as the main cost of nosocomial infection prevention and control.By comparing these two costs,the medical personnel to pay more attention should CLABSI prevention and control from the perspectives of medical quality and economic benefits,and promote the implementation of prevention and control measures.【Methods】Cluster sampling was used to select 126 critically ill patients who underwent CVC in the ICU of a tertiary traditional Chinese medicine hospital from January 2021 to December 2023,including 65 cases in the CLABSI group and 61 in the non-CLABSI group.Patients’data were retrospectively collected from the hospital medical records,including the disease type,gender,age,length of hospital stay,outcome,and hospitalization expenses.The costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection were analyzed and compared.【Results】There were significant differences in the length of hospital stay(Z=-5.35,P<0.05)and total hospitalization expenses(Z=-6.79,P<0.05)between the CLABSI and non-CLABSI group.Total hospitalization expenses showed significant differences among patients with different lengths of hospital stay(H=43.01,P<0.05),with much higher median one in those with 60 or more days of hospital stay than other patients.Greater differences of median total hospitalization expenses were found in males than in females(Z=-3.98,P<0.05),as well as in patients aged 60-80 years than in patients of other ages(Z=-5.79,P<0.05).【Conclusions】The occurrence of CLABSI significantly increases the ICU patients’length of hospital stay and hospitalization expenses.There are differences in the costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection,but these costs are acceptable compared to the incremental costs

关 键 词：重症监护室 中心静脉导管相关血流感染 住院费用 预防与控制 成本 

分 类 号：R446.5[医药卫生—诊断学]