{"id":19676,"date":"2021-01-30T05:34:00","date_gmt":"2021-01-29T21:34:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19676"},"modified":"2021-02-05T14:38:30","modified_gmt":"2021-02-05T06:38:30","slug":"jama%e6%97%a2%e5%be%80%e8%ae%ba%e6%96%87-%e5%9b%a0%e6%84%9f%e6%9f%93%e6%8e%a7%e5%88%b6%e5%8e%9f%e5%9b%a0%e6%8e%a5%e5%8f%97%e9%9a%94%e7%a6%bb%e6%82%a3%e8%80%85%e7%9a%84%e5%ae%89%e5%85%a8%e6%80%a7","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19676","title":{"rendered":"[JAMA\u65e2\u5f80\u8bba\u6587]: \u56e0\u611f\u67d3\u63a7\u5236\u539f\u56e0\u63a5\u53d7\u9694\u79bb\u60a3\u8005\u7684\u5b89\u5168\u6027"},"content":{"rendered":"\n

Original Contribution October 8, 2003<\/p>\n\n\n\n

Safety of Patients Isolated for Infection Control<\/h1>\n\n\n\n

Henry Thomas Stelfox, David W. Bates, Donald A. Redelmeier, et al<\/h3>\n\n\n\n

JAMA 2003;290(14):1899-1905. doi:10.1001\/jama.290.14.1899<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Context<\/strong> \u80cc\u666f<\/h3>\n\n\n\n

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

\u533b\u9662\u7684\u611f\u67d3\u63a7\u5236\u63aa\u65bd\u8981\u6c42\u5bf9\u60a3\u8005\u8fdb\u884c\u9694\u79bb\u4ee5\u9884\u9632\u611f\u67d3\u6027\u75be\u75c5\u7684\u9662\u5185\u4f20\u64ad\uff0c\u4f46\u8fd9\u53ef\u80fd\u9020\u6210\u5bf9\u60a3\u8005\u758f\u4e8e\u7167\u987e\u6216\u533b\u7597\u9519\u8bef<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h3>\n\n\n\n

To examine the quality of medical care received by patients isolated for infection control.<\/p>\n\n\n\n

\u7814\u7a76\u56e0\u611f\u67d3\u63a7\u5236\u539f\u56e0\u63a5\u53d7\u9694\u79bb\u7684\u60a3\u8005\u7684\u533b\u7597\u8d28\u91cf<\/p>\n\n\n\n

Design, Setting, and Patients<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u4eba\u7fa4<\/h3>\n\n\n\n

We identified consecutive adults who were isolated for methicillin-resistant\u00a0Staphylococcus aureus<\/em>\u00a0colonization 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).<\/p>\n\n\n\n

\u6211\u4eec\u5728\u5317\u7f8e2\u5bb6\u5927\u578b\u6559\u5b66\u533b\u9662\u5165\u9009\u4e86\u56e0MRSA\u5b9a\u690d\u6216\u611f\u67d3\u63a5\u53d7\u9694\u79bb\u5230\u7684\u6210\u5e74\u60a3\u8005\uff1a\u4e00\u822c\u961f\u5217\uff081999\u5e741\u67081\u65e5\u81f32000\u5e741\u67081\u65e5\u95f4\u56e0\u6240\u6709\u8bca\u65ad\u5165\u9662\u7684\u60a3\u8005; n = 78\uff09\uff1b\u75be\u75c5\u7279\u5f02\u6027\u961f\u5217\uff081999\u5e741\u67081\u65e5\u81f32000\u5e741\u67081\u65e5\u95f4\u56e0\u5145\u8840\u6027\u5fc3\u529b\u8870\u7aed\u5165\u9662\u7684\u60a3\u8005; n = 72\uff09\u3002\u5bf9\u6bcf\u4e2a\u9694\u79bb\u60a3\u8005\u961f\u5217\u9009\u62e9\u4e86\u5339\u914d\u7684\u5bf9\u7167\u7ec4\uff08n = 156 \u4e00\u822c\u961f\u5217\u5bf9\u7167\uff1bn = 144\u75be\u75c5\u7279\u5f02\u6027\u961f\u5217\u5bf9\u7167\uff09\u3002<\/p>\n\n\n\n

Main Outcome Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u533b\u7597\u8d28\u91cf\u6307\u6807\u5305\u62ec\u8fc7\u7a0b\u3001\u7ed3\u5c40\u548c\u6ee1\u610f\u5ea6\u6307\u6807\u3002\u91c7\u7528\u591a\u56e0\u7d20\u56de\u5f52\u6a21\u578b\u5bf9\u7814\u7a76\u961f\u5217\u3001\u60a3\u8005\u4eba\u53e3\u7edf\u8ba1\u5b66\u3001\u533b\u9662\u53ca\u4e34\u5e8a\u7279\u5f81\u8fdb\u884c\u6821\u6b63\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

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;\u00a0P<\/em><.001). This difference in adverse events reflected preventable events (20 vs 3 adverse events per 1000 days;\u00a0P<\/em><.001) as opposed to nonpreventable events (11 vs 12 adverse events per 1000 days;\u00a0P<\/em>\u00a0= .98). Isolated patients were also more likely to formally complain to the hospital about their care than control patients (8% vs 1%;\u00a0P<\/em><.001), to have their vital signs not recorded as ordered (51% vs 31%;\u00a0P<\/em><.001), and more likely to have days with no physician progress note (26% vs 13%;\u00a0P<\/em><.001). No differences in hospital mortality were observed for the 2 groups (17% vs 10%;\u00a0P<\/em>\u00a0= .16).<\/p>\n\n\n\n

\u63a5\u53d7\u9694\u79bb\u4e0e\u5bf9\u7167\u60a3\u8005\u7684\u57fa\u7ebf\u60c5\u51b5\u76f8\u4f3c\uff1b\u4f46\u662f\uff0c\u4f4f\u9662\u671f\u95f4\u9694\u79bb\u60a3\u8005\u53d1\u751f\u4e0d\u826f\u4e8b\u4ef6\u7684\u98ce\u9669\u662f\u5bf9\u7167\u60a3\u8005\u76842\u500d\uff08\u6bcf1000\u592931 vs 15 \u6b21\u4e0d\u826f\u4e8b\u4ef6;\u00a0P<\/em><.001\uff09\u3002\u8fd9\u4e00\u5dee\u5f02\u4e3b\u8981\u7531\u53ef\u9884\u9632\u4e8b\u4ef6\uff08\u6bcf1000\u592920 vs 3\u6b21\u4e0d\u826f\u4e8b\u4ef6;\u00a0P<\/em><.001\uff09\u800c\u975e\u4e0d\u53ef\u9884\u9632\u4e8b\u4ef6\uff08\u6bcf1000\u592911 vs 12 \u6b21\u4e0d\u826f\u4e8b\u4ef6;\u00a0P<\/em>\u00a0= .98\uff09\u5bfc\u81f4\u3002\u66f4\u591a\u9694\u79bb\u60a3\u8005\u5c31\u533b\u7597\u5de5\u4f5c\u5411\u533b\u9662\u6295\u8bc9(8% vs 1%;\u00a0P<\/em><.001)\uff0c\u5176\u751f\u547d\u4f53\u5f81\u66f4\u591a\u672a\u5f97\u5230\u8bb0\u5f55 (51% vs 31%;\u00a0P<\/em><.001)\uff0c\u66f4\u591a\u4f4f\u9662\u65e5\u6ca1\u6709\u4f4f\u9662\u75c5\u7a0b\u8bb0\u5f55(26% vs 13%;\u00a0P<\/em><.001)\u3002\u4e24\u7ec4\u60a3\u8005\u4f4f\u9662\u75c5\u6b7b\u7387\u6ca1\u6709\u5dee\u5f02(17% vs 10%;\u00a0P<\/em>\u00a0= .16)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusion<\/strong> \u7ed3\u8bba<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u4e0e\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0c\u56e0\u611f\u67d3\u63a7\u5236\u539f\u56e0\u63a5\u53d7\u9694\u79bb\u7684\u60a3\u8005\u7ecf\u5386\u66f4\u591a\u53ef\u9884\u9632\u7684\u4e0d\u826f\u4e8b\u4ef6\uff0c\u5bf9\u6cbb\u7597\u66f4\u591a\u4e0d\u6ee1\uff0c\u6709\u8bb0\u5f55\u7684\u533b\u7597\u8fc7\u7a0b\u66f4\u5c11\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Contribution October 8, 2003 Safety of Pa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19676"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19676"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19676\/revisions"}],"predecessor-version":[{"id":19679,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19676\/revisions\/19679"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19676"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19676"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}