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[JAMA既往论文]: 因感染控制原因接受隔离患者的安全性
2021年01月30日 时讯速递, 进展交流 暂无评论

Original Contribution October 8, 2003

Safety of Patients Isolated for Infection Control

Henry Thomas Stelfox, David W. Bates, Donald A. Redelmeier, et al

JAMA 2003;290(14):1899-1905. doi:10.1001/jama.290.14.1899

Abstract

Context 背景

Hospital infection control policies that use patient isolation prevent nosocomial transmission of infectious diseases, but may inadvertently lead to patient neglect and errors.

医院的感染控制措施要求对患者进行隔离以预防感染性疾病的院内传播,但这可能造成对患者疏于照顾或医疗错误

Objective 目的

To examine the quality of medical care received by patients isolated for infection control.

研究因感染控制原因接受隔离的患者的医疗质量

Design, Setting, and Patients 试验设计,场景及研究人群

We identified consecutive adults who were isolated for methicillin-resistant Staphylococcus aureus colonization or infection at 2 large North American teaching hospitals: a general cohort (patients admitted with all diagnoses between January 1, 1999, and January 1, 2000; n = 78); and a disease-specific cohort (patients admitted with a diagnosis of congestive heart failure between January 1, 1999, and July 1, 2002; n = 72). Two matched controls were selected for each isolated patient (n = 156 general cohort controls and n = 144 disease-specific cohort controls).

我们在北美2家大型教学医院入选了因MRSA定植或感染接受隔离到的成年患者:一般队列(1999年1月1日至2000年1月1日间因所有诊断入院的患者; n = 78);疾病特异性队列(1999年1月1日至2000年1月1日间因充血性心力衰竭入院的患者; n = 72)。对每个隔离患者队列选择了匹配的对照组(n = 156 一般队列对照;n = 144疾病特异性队列对照)。

Main Outcome Measures 主要预后指标

Quality-of-care measures encompassing processes, outcomes, and satisfaction. Adjustments for study cohort and patient demographic, hospital, and clinical characteristics were conducted using multivariable regression.

医疗质量指标包括过程、结局和满意度指标。采用多因素回归模型对研究队列、患者人口统计学、医院及临床特征进行校正。

Results 结果

Isolated and control patients generally had similar baseline characteristics; however, isolated patients were twice as likely as control patients to experience adverse events during their hospitalization (31 vs 15 adverse events per 1000 days; P<.001). This difference in adverse events reflected preventable events (20 vs 3 adverse events per 1000 days; P<.001) as opposed to nonpreventable events (11 vs 12 adverse events per 1000 days; P = .98). Isolated patients were also more likely to formally complain to the hospital about their care than control patients (8% vs 1%; P<.001), to have their vital signs not recorded as ordered (51% vs 31%; P<.001), and more likely to have days with no physician progress note (26% vs 13%; P<.001). No differences in hospital mortality were observed for the 2 groups (17% vs 10%; P = .16).

接受隔离与对照患者的基线情况相似;但是,住院期间隔离患者发生不良事件的风险是对照患者的2倍(每1000天31 vs 15 次不良事件; P<.001)。这一差异主要由可预防事件(每1000天20 vs 3次不良事件; P<.001)而非不可预防事件(每1000天11 vs 12 次不良事件; P = .98)导致。更多隔离患者就医疗工作向医院投诉(8% vs 1%; P<.001),其生命体征更多未得到记录 (51% vs 31%; P<.001),更多住院日没有住院病程记录(26% vs 13%; P<.001)。两组患者住院病死率没有差异(17% vs 10%; P = .16)。

Conclusion 结论

Compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.

与对照组相比,因感染控制原因接受隔离的患者经历更多可预防的不良事件,对治疗更多不满,有记录的医疗过程更少。

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