预防综合ICU多重耐药菌医院感染的成本效益分析

Cost-benefit of prevention of multidrug-resistant organism healthcare-associated infection in a general intensive care unit

摘要:

目的 了解综合重症监护病房（ICU）多重耐药菌（MDRO）医院感染导致的经济负担，分析MDRO医院感染预防与控制的成本效益。 方法 回顾性调查2016-2017年综合ICU住院患者医院感染情况，以2016年为感染防控措施实施前组，2017年为感染防控措施实施后组，比较两组患者MDRO医院感染发病率。采用配对病例对照研究比较MDRO医院感染与非感染患者的住院费用和住院日数，评估MDRO医院感染造成的经济损失，分析防控的成本投入与效益。 结果 医院感染防控措施实施后，MDRO医院感染发病率由4.4%下降至1.9%。MDRO感染者较非感染者增加住院费用116 147.0元，延长住院日数26.0 d。2016、2017年因MDRO医院感染造成的直接经济损失分别为8 246 437.0、3 716 704.0元，减少收治患者而造成的利润损失分别为232 328.2、90 561.1元，延长住院日数而导致的误工费分别为122 389.8、59 238.4元。2017年增加防控措施投入资金110 469.0元，减少直接和间接经济损失总共4 734 651.5元，效益成本比为42.9：1；医院减少经济损失141 767.1元，效益成本比为1.3：1。 结论 有效地开展医院感染预防与控制，不仅可降低医院感染发病率，还能带来巨大的社会效益和经济效益。

Abstract:

Objective To investigate the economic burden of healthcare-associated infection (HAI) caused by multidrug-resistant organism (MDRO) in general intensive care unit(GICU), analyze the cost-benefit of prevention and control of MDRO HAI. Methods HAI in patients in a GICU from 2016 to 2017 were investigated retrospectively, 2016 and 2017 was as pre- and post-implementation group of infection prevention and control measures respectively, incidence of MDRO infection in two groups of patients was compared. A matched case-control study was used to compare the hospitalization expense and length of hospital stay between patients in MDRO HAI group and non-infection group, economic loss caused by MDRO HAI was evaluated, cost-benefit of prevention and control was analyzed. Results Incidence of MDRO HAI decreased from 4.4% to 1.9% after the implementation of HAI prevention and control measures. Compared with non-infected patients, hospitalization expense of MDRO-infected patients increased by 116 147.0 Yuan and length of hospital stay extended by 26.0 days. In 2016 and 2017, direct economic loss caused by MDRO HAI were 8 246 437.0 and 3 716 704.0 Yuan respectively, the profit loss due to the decrease of admission of patients were 232 328.2 and 90 561.1 Yuan respectively, and charge for loss of working time due to extension of length of hospital stay were 122 389.8 and 59 238.4 Yuan respectively. In 2017, the investment in prevention and control measures increased by 110 469.0 Yuan, direct and indirect economic loss reduced by 4 734 651.5 Yuan, ratio of benefit to cost was 42.9:1; economic loss of hospital reduced by 141 767.1 Yuan, ratio of benefit to cost was 1.3:1. Conclusion Effective implementation of prevention and control of HAI can not only reduce the incidence of HAI, but also bring huge social and economic benefit.