医院感染监测还要做，但必须大幅度改革－德国KISS介绍
Mandatory Reporting of Healthcare-Associated Infections: How do we Measure Success?The German Approach.
PETRA GASTMEIER, MD.;
Hanover Med. Univ., Hannover, Germany.
In order to measure healthcare-associated infections (HAI), a surveillance system was established in Germany in 1997, which is known under the acronym KISS (Krankenhaus-Infektions-Surveillance-System). The system is based on the experiences and principles of the American NNIS system, but takes into account the local circumstances of participating hospitals in Germany. Hospitals can select among seven KISS components, which focus on the following topics or areas: intensive care units (ICUs), neonatology intensive care patients with very low birth weight, hematology-oncology patients, surgical patients, non-ICU patients with vascular or urinary catheters, as well as outpatients with ambulatory operations. A further module was developed for surveillance of MRSA in hospitals. KISS is a voluntary system, only the reference data are published and can be used for benchmarking by the individual hospitals. Meanwhile more than 400 of a total of about 2000 German hospitals are participating. Healthcare associated infection reduction rates between 20-30 % were achieved for the individual surveillance components.
One of the most crucial points for relying on surveillance data is data validity. Therefore a validation study was performed for the ICU component in 2000. A total of 286 reported infections and 1,195 medical records with no reported infection from 20 randomly selected KISS ICUs were reviewed by two trained physicians. The median specificity was 99.6%, the median sensitivity was 81%, however with a range from 30 to 100%. In 2006 a further validation study using case histories was organized. 10 case studies including 13 HAI were sent to 364 persons responsible for surveillance in their ICUs. The response rate was 46%. The overall median specificity was 94 % (range 65-100%), the overall median sensitivity was 69% (range 31-100%).
Therefore the key questions for mandatory public reporting of HAI remain: Will the information mislead or confuse rather than empower consumers? Will there be an increased motivation for clinicians and hospital administrators to attend to HAI reduction that leads to safer care and fewer HAI? Until now most of the German consumers are not demanding it. However, the insurance companies are more and more demanding mandatory participation in surveillance systems. For example all German neonatal ICUs caring for very low birth weight infants have to participate in the KISS surveillance component for very low birth weight infants.
回复 #1 icchina 的帖子
来试一下，看能不能翻译出来哦！！如果不行的话，一定不要笑话我哦！！！！:lol :lol :lol
这篇短，我来作，不要抢哈！！！:handshake :handshake :handshake
哈哈,老师真支持,谢谢,期待您的好作!
回复 #2 一枝梅 的帖子
版终于出手了！期待哦！回复 #2 一枝梅 的帖子
看不懂英文，期待你的中文版！:handshake :handshakealign=center]医疗相关感染的强制报告：我们怎样测量成功？为了评价医疗相关感染（HAI），德国在1997年建了了监测系统，即为人们所知的首字母缩写的KISS（医院感染监测系统：Krankenhaus-Infektions-Surveillance-System）。这个系统是基于美国NNIS的经验与原理的，但也考虑了德国参加医院的当地环境。医院可以在七个KISS因素中选择，主要关注以下课题或领域：重症监护病房（ICUs），新生儿病房重症监护的极低体重患儿、血液系统肿瘤病人、手术病人、静脉置管或尿道插管的非ICU住院病人、还有流动手术的门诊病人。为监测医院的MRSA建立了一个更进一步的模式。KISS是一个自愿参加的系统，只有参考文献出版，并被某些医院作为标准。然而德国大约2000所医院中超过400所医院参与其中。其中有的监测因素的医疗相关感染减少了20-30%。
相信监测数据的最关键要点之一是数据的有效性。因此就ICU这个因素在2000年进行了准确性研究。两位经过培训的医师对来自于20个随机选择的KISS中ICU的总共286例报告感染的病例和1195份没有报告感染的医学记录进行了复查。特异性中位数为99.6%，敏感性中位数为81%，但是波动范围从30%到100%。在2006年组织了更进一步的使用病历的准确性研究。包括13次HAI的10份病历送给了364名负责其所在的ICU监测工作的人。应答率为46%。所有结果的特异性中位数为94%（65-100%），敏感性中位数为69%（31-100%）
因此对于强制公众报告HAI的关键问题出现了：相比于授权与消费者信息是否会误导或混乱？是否会增加临床医师与医院管理者关注HAI的降低的动机而走向更安全的治疗和更少的HAI？大多数的德国消费者至今并没有这样要求。但是，保险公司越来越要求强制参与监测系统。例如，德国所有治疗极低体重婴儿的新生儿ICU不得不参与KISS对极低体重婴儿的监测工作中。
当之处还望各位指正！
回复 #6 wshh1975 的帖子
的速度挺快的，可是不是抢了梅版的功劳？回复 #8 gxmuic 的帖子
好意思,今天迎接上面检查,现在才回家上网看,很好,那下次吧!!!真的很抱歉了!!!
明天回原单位办正式调动手续,可能耽搁两天,暂时与大家告别两天,请谅解!!!:lol :lol
来试一下，看能不能翻译出来哦！！
如果不行的话，一定不要笑话我哦！！！！:lol :lol :lol
这篇短，我来作，不要抢哈！！！:handshakedshake" /> :handshakedshake" /> :handshakedshake" />
抱歉哦,没有看到!:$
梅版不要兴师问罪啊!:L
回复 #10 wshh1975 的帖子
谢!!我怎么问罪啊!!!我就是不能作到语序通顺,真不好意思!!!:lol :lol
嘿,两位老师都是为了我们大家辛勤,辛苦了,非常谢谢哦!
看来没有先后，只有速度哦！:lol :lol :lol
回复 #13 wen8023 的帖子
梅版也有速度啊！占位速度.......:haha回复 #14 无极紫晶 的帖子
哈:lol ，那看来梅版要是把另一个速度提上来了的话，再加上这个速度，那岂不是双剑合璧，无与伦比啊，下次谁都不要抢了哦！:lol :lol :lol 主要关注以下课题或领域：重症监护病房（ICUs），新生儿病房重症监护的极低体重患儿、血液系统肿瘤病人、手术病人、静脉置管或尿道插管的非ICU住院病人、还有流动手术的门诊病人。 :victory:两位高人:victory: :victory:两位高人:victory:
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