风险修正后的新生儿重症监护室内的医院感染监测：系统综述

David

Review
Risk-adjusted surveillance of hospital-acquired infections in neonatal intensive care units: a systematic review
风险修正后的新生儿重症监护室内的医院感染监测：系统综述
P. Phillipsa, , , M. Cortina-Borjaa, M. Millarb and R. Gilberta

aMRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK bDepartment of Medical Microbiology, Barts and the London NHS Trust, London, UK
Received 23 May 2008;  accepted 20 June 2008.  Available online 23 August 2008.

Summary
Comparisons of bacteraemia incidence between neonatal intensive care units (NICUs) can identify centres with effective infection control, whose practices can be shared with other units. For fair comparisons, infection incidence must be risk-adjusted to control for differences between centres in the vulnerability of babies and the intensity of invasive procedures which can introduce infection. We reviewed risk adjustment methods for between-NICU comparisons of bacteraemia incidence, both in the published literature and in regional and national NICU infection monitoring systems. PubMed and Embase were searched for studies reporting risk-adjusted bacteraemia incidence in more than one NICU. An internet search found NICU infection monitoring systems in Western industrialised countries. In all nine studies that met the inclusion criteria, risk adjustment reduced but did not eliminate variation in bacteraemia incidence between NICUs. In both the studies and the regional monitoring systems, adjustment for baby susceptibility generally involved stratification by factors measured at birth. Adjustment for length of stay and invasive procedures involved reporting incidence by days with a device, such as central venous catheter days. Methods for NICU infection monitoring lack consistency. Adjustment for factors measured at birth fails to capture changes in susceptibility throughout admission and adjustment for device days does not adequately reflect risk to babies not treated with the device. Further research should address variation in risk for all babies throughout their NICU stay.

Keywords: Risk adjustment; Neonatal intensive care; Monitoring; Bacteraemia; Systematic review

Article Outline
Introduction
Methods
Systematic review of studies reporting risk adjustment
Review of regional monitoring systems
Results
Systematic review of studies reporting risk adjustment
Quality of literature
Risk adjustment
Regional monitoring systems
Risk adjustment
Discussion
Conflict of interest statement
Funding sources
References

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竹：不好意思，本人英文差，很想看到该篇文章，不知可否讲中文版上传，期待。:loveliness:

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