CN101432740A - Method for measuring the incidence of hospital acquired infections - Google Patents
Method for measuring the incidence of hospital acquired infections Download PDFInfo
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Abstract
Disclosed is a method and system for analyzing patient hospitalization data to determine a Nosocomial Infection Marker (NIM), the method comprising receiving from a database hospitalization data associated with at least one patient, calculating from the hospitalization data the number of specimens with non-duplicate hospital isolates (SNDHI) markers, calculating from the hospitalization data antibiotic utilization criteria (AUC) markers, and determining the nosocomial infection marker (NIM) for each patient, based upon the calculated SNDHI and AUC markers.
Description
CROSS-REFERENCE TO RELATED PATENT
The application requires with the following basis of applying for right of priority: the U.S. Provisional Application No.60/591 that submits on July 27th, 2004,561 and the U.S. Provisional Application No.60/678 that submits on May 6th, 2005,899, above-mentioned application is all included in this instructions in this mode by reference.
Background technology
" hospital acquired infections " is by caused to the bad reaction of the pathogen that exists or its toxin and do not occur when being admitted to hospital or the part of hiding or the disease of whole body.In the U.S., annual hospital acquired infections makes 2,000,000 patient infection approximately, and causes about 90,000 deaths.In the U.S., hospital acquired infections is the 4th a dead main cause, is only second to cancer, apoplexy and heart disease.Hospital acquired infections is except the causing death, and the treatment of each this infection all will spend nearly 14,000 dollars, will spend 28,000,000,000 dollars of treatments that are used for hospital acquired infections every year altogether in the U.S..
Consumer, employer, Hosp Ins company, management organization and other aspects wish to know, how many annual numbers that takes place how much to infect and obtain certain infection has in set hospital.Yet, almost do not have a tame hospital can answer these problems.
The present art that is used to discern hospital acquired infections has improved by national inside-hospital infection (NNIS) plan of monitoring in disease prevention and control center (CDC).In NNIS, 13 main infection site classifications and 48 concrete infection sites or type have been formulated standard, (Garner et al., APIC Infection Control and Applied Epidemiology:Principles and Practice, 1996).This method need be through clinical and other data of every patient of the clinical staff artificially of special training examination, these data comprise being admitted to hospital, transferring from one hospital to another of every patient and the data of leaving hospital, laboratory result, pharmacy data, the radiology data, doctor's record and nurse's record.
Be an example in 48 infection standards herein:
Definition: other urinary tract infections must satisfy at least one in the following standard:
Standard 1: the isolated biosome of culture that the patient has the liquid (except the urine) from infection site or organizes.
Standard 2: when directly checking or observe in operation or in histopathological examination that the patient has abscess or other infect sign.
Standard 3: the patient has in the following S or S at least two without any the generation reason of other identification the time: 38 ℃ of heatings (〉), local pain or at relevant position local tenderness, and satisfy in the following condition at least one:
A) discharge purulent material from infection site;
B) from blood, turn out the biosome of the Suspected Area that can be present in infection;
C) the radiography evidence of Gan Raning, for example, unusual ultrasonic, CT scan, magnetic resonance imaging (MRI) or radio-labeled scanning (gallium, technetium) image;
D) doctor of the infection of surrounding tissue or perirenal space surrounding tissue diagnosis behind kidney, ureter, bladder, urethra, the peritonaeum; Or
E) for the infection of surrounding tissue behind kidney, ureter, bladder, urethra, the peritonaeum or perirenal space surrounding tissue, the doctor begins suitable treatment.
The current techniques that is used to discern hospital acquired infections is in the manual method level, does not have a tame hospital to have this method is applied to the required staff of all patients of hospital to such an extent as to this method is very consuming time.Every patient is admitted to hospital needs to determine whether to exist in 20 minutes hospital acquired infections, (SHEA 2004 for Gavin PJ, et al.) at least.If by this speed calculation, the hospital that has 20,000 examples to be admitted to hospital a tame every year will need the well-trained examiner of 5 sole duties can measure the infection rate of hospital reluctantly so.Extremely few hospital has this staffing rank that is used for infection control.
For tackling the deficiency of in most of hospitals all patients being used the required resource of NNIS method, " full institute's content (hospital-widecomponent) " (calculating the incidence of hospital acquired infections of full institute) deleted in the NNIS plan in January, 1999, (national inside-hospital infection monitoring (NNIS) System Reports AM J Infect Control 1999).As a result, most of hospitals only discern some infection in the patient subgroups on some period of this year.Because this limited observational technique, hospital can not determine the whole issue of hospital acquired infections, can not determine its farthest finance influence.
And current manual method comprises many standards that need hospital clinical staff subjective judgement.Using in more than 20 year of NNIS method, a research (Emori, et al, Infect Control Hosp Epidemio.1 1998) about its objectivity is only being arranged.
This part research has been compared by three groups 1,136 identical patient's chart has been examined the infection number reported of back, and these three groups are: NNIS participates in hospital, was subjected to the specialist examination person and the CDC epidemiology expert of CDC training.Check that by three groups the infection number of gained is respectively 611,1264 and 865 behind 1,136 identical patient's chart.And many people wish the infection rate of how tame hospital is compared.Yet the shortage of this objectivity makes so more unreliable.
Summary of the invention
The theme of this patent is the method that is used to discern hospital acquired infections, and this method has solved the defective of prior art level.This method is the electronic surveying method of existing hospital data, can all groups of hospital be studied.This method does not need a large amount of hand labors of prior art level.This method also is different from existing technical merit, and it is objectively with reproducible.By every part of patient is write down and the same standard of every family hospital application, different people is applied to same data set with this method will obtain same measurement result.
This method has been utilized laboratory result, pharmacy data and the patient of the electronic format that each hospital almost all has to be admitted to hospital, to transfer from one hospital to another and has been left hospital data.Utilize described method, people can calculate inside-hospital infection index (NIM) number.Clinical research has shown that the NIM number is corresponding with definite hospital acquired infections number---thus as the clinical module that effectively substitutes.The verified every routine NIM of finance research is related in hospital to live 7.5 days and 14,000 dollars of variable medical expenses (risk adjustment) more.Therefore, this method also can be used to hospital stays length and the expense of predicting that hospital acquired infections involves.
Description of drawings
Include in this instructions and constitute the accompanying drawing of this instructions part, illustrate a plurality of embodiments, and illustrate disclosed structure and method in conjunction with following description.
Fig. 1 is that expression has the block diagram that can realize the example network environment of a plurality of calculation elements of the present invention therein;
Fig. 2 is the block diagram that expression can realize exemplary unrestricted calculation element of the present invention therein;
Fig. 3 is the block diagram of expression the inventive method.
Embodiment
Before disclosure and description this method, should be appreciated that at this used term only for the purpose of describing specific embodiments, rather than be used for restriction.Term " computer-readable medium " comprising: medium or device that distributed medium, intermediate storage medium, computing machine execution internal storage and any other computer program that can store realization the inventive method are distinguished after a while for computing machine.The computer program of realization the inventive method generally on the distributed medium such as floppy disk or CD-ROM, is distributed to the user.This computer program is copied into hard disk or similar intermediate storage medium from this distributed medium usually.When operation, this computer program is loaded into the computing machine execute store from its distributed medium or its middle storage medium, the method according to this invention configuration evaluation work.All these operations are known for the technician in the field of computer.
A. definition
As used in this specification and the appended claims, singulative " a kind of ", " one " and " being somebody's turn to do " are except that context is done clearly to stipulate in addition, and this content comprises a more than indication things.Therefore, comprise the mixing of the infection of two or more these classes when for example, mentioning " a kind of infection ", the rest may be inferred.
The scope of this paper can be used from " pact " concrete numerical value, and/or represents to the concrete numerical value of " pact " another one.When representing such scope, another embodiment comprises from this concrete numerical value and/or to another concrete numerical value.Similarly, when numerical value by utilizing antecedent " pact " when representing approximate value, should be appreciated that this occurrence forms another embodiment.Should be appreciated that further the end points of each of this scope both had meaning when relevant with other end points, be independent of other end points again and have meaning.Be also to be understood that at this to disclose many numerical value, and except disclosing this numerical value itself, also be disclosed as " pact " this special value at this each numerical value.For example, if disclose numerical value " 10 ", " about 10 " are disclosed so also.Be also to be understood that when numerical value to be disclosed as " being less than or equal to " this numerical value, the possible range between " more than or equal to this numerical value " and the numerical value also is disclosed so, as experienced technician institute rightly understanding.For example, if disclose numerical value " 10 ", " being less than or equal to 10 " and " more than or equal to 10 " are disclosed so also.Be also to be understood that in the entire chapter application, to provide data with various form, and the scope of the combination in any of this data representation terminal point, starting point and each data point.For example,, should be appreciated that so and not only think the scope between 10 and 15 of disclosing if disclose concrete data point " 10 " and concrete data point 15, also think disclose greater than, more than or equal to, less than, be less than or equal to 10 and 15.
In this manual and in claims subsequently, will be referred to many terms, these terms will be defined has following implication:
" optionally " or " alternatively " means that next described incident or situation can occur or also can not occur, and this description comprises that the occasion of described incident or situation example and described incident or situation do not have the example that occurs.
" inside-hospital infection " (NI) is also referred to as " hospital acquired infections " is by caused to the bad reaction of the pathogen that exists or its toxin, and not occurring when entering the mechanism of hospital or similar hospital or hide, is in part that the accidental period of contact with the mechanism of hospital or similar hospital obtains or the disease of whole body on the contrary.
" inside-hospital infection index " is the numerical value relevant with the generation of definite inside-hospital infection (NIM).
" separated strain " is the evidence (for example, DNA, serology, histology, microexamination) that the microorganism (bacterium, virus, fungi, yeast, parasite, protozoan) that discerned in the lab analysis of sample or microorganism exist.
" being in hospital " is the situation that is regarded as the patient in the mechanism of hospital or similar hospital in the time of growing arbitrarily.
" hospital " is any mechanism that the patient can obtain medical diagnosis and treatment.
" patient's classification " is the patient's that interrelates by common characteristic combination in any.Such feature can include, but are not limited to: the position in diagnosis, ISP, the hospital, doctor and age.Other features are known for a person skilled in the art, are taken explicitly into account at this.
In the entire chapter application, with reference to various publications.The disclosure of these publications intactly by reference mode is included among the application, so that describe the technical merit relevant with the application more completely.Based on the material of being discussed in the sentence of relying on list of references in the described list of references of being included in, therefore this also by reference mode this list of references is included in herein individually and especially.
B. example networks and distributed environment
Any one those of ordinary skill in the art can recognize and computing machine or other client computer or server unit can be disposed as the part of computer network, or it is deployed in the distributed computing environment.In this respect, the application of any amount that the invention belongs to internal storage with any amount or storage unit and exist on the storage unit of any amount or storage volume and any computer system of processing, this computer system can be carried out and NIM calculates relevant operation.The present invention can be applicable to dispose in network environment or the distributed computing environment environment of server computer and client computer, has long-range or local storage in the described environment.The present invention also can be applied to has programming language function and explanation and executive capability, on the stand-alone computer with generation, reception and transmission and long-range or the information that local service is relevant.
Fig. 1 provides the synoptic diagram of example networks or distributed computing environment.This distributed computing environment comprises calculating object 105a, 105b etc.These objects can comprise program, method, data-carrier store, FPGA (Field Programmable Gate Array) etc.Each object can be via communication network 102 and another object communication.This network itself can comprise that the system in Fig. 1 provides other calculating objects and the calculation element of service.According to an aspect of the present invention, each object 105 or install 101 application programs that can comprise the NIM computational resource of requesting host system.
Therefore, Fig. 1 illustrates wherein server and communicates by letter with client computer by network/bus, and example networks or distributed environment that the present invention is applied.In more detail, a plurality of server 103a, 103b etc. are by being interconnection such as communications network/bus 102 and a plurality of client computer of LAN, WAN, Intranet, internet etc. or remote computing device 101a, 101b, 101c, 101d, 101e, described client computer or remote computing device such as portable computer, handheld computer, thin client, the network equipment or other devices.Illustrated database 104 can reside on servers such as 103a, 103b or other calculation elements.Database 104 can be the arbitrary form of data storage system, including, but not limited to flat file, relational database (SQL) and olap database (MDX and/or its variant).Therefore be contemplated that the present invention can be applicable to any with provide improved NIM calculating relevant calculation element ideally.
C. example calculation device
Fig. 2 and ensuing argumentation are the descriptions that is used to provide the brief outline that can realize suitable computing environment of the present invention therein.Yet should be appreciated that, consider the hand-held of all kinds, portable and other calculation elements and calculating object are used for the present invention.Although multi-purpose computer is described below, this is an example, and utilizes the thin client with network/bus intercommunity and interactivity also can realize the present invention.Therefore, the present invention can realize in the network host service environment, comprises or comprise client resource seldom in this environment hardly, and for example client apparatus is only used the interface of accomplishing network/bus in network environment, such as the object in the equipment of being placed on.In essence, anyly store the environment that environment that data maybe can retrieve data is exactly desirable or suitable the technology of the present invention operation.
Although not necessarily, the present invention can realize using with the developer of services of supplying apparatus or object by operating system, and/or is included in the application software that helps execution NIM calculating.Software is described to the computer executable instructions on the ordinary meaning, and such as program module, this program module is carried out by the one or more computing machines such as client workstation, server or other devices.Usually, program module comprises: routine, program, object, assembly, data structure etc., they are carried out particular task or realize particular abstract.The functional of program module can make up or distribute usually by various embodiments are required.In addition, it should be appreciated by one skilled in the art that, can utilize other computer system configurations to implement the present invention.Can be for suitable other computing systems of knowing used in the present invention, environment and/or configuration including, but not limited to personal computer (PC), server computer, hand-held or laptop devices, multicomputer system, system, programmable consumer electronic device, network PC, microcomputer, large scale computer etc. based on microprocessor.Also can implement the present invention in distributed computing environment, task is by carrying out by the teleprocessing device of communications network/bus or the link of other data transmission medias in distributed computing environment.In distributed computing environment, program module can be arranged in the local and remote computer-storage media that comprises the internal storage memory devices, and client node can be used as server node again conversely.
Therefore, Fig. 2 illustrates an example can realizing suitable computingasystem environment of the present invention therein, although described clearly as mentioned, this computingasystem environment only is an example of suitable computing environment, does not plan any restriction is not done in use of the present invention or functional scope.About in the exemplary operation environment the combination in any of graphic any parts or each parts, this computing environment should be interpreted as it is had any dependence or needs.
With reference to Fig. 2, realize that example system of the present invention comprises the universal computing device of representing with computing machine 101 forms, the parts of computing machine 101 can be including, but not limited to processing unit 201, Installed System Memory reservoir 236 and will comprise that the various system units of Installed System Memory reservoir are attached to the system bus 202 of processing unit 201.System bus 202 can be any type in some types of bus structure, and these types of bus structure comprise internal storage bus or internal storage controller, peripheral bus and utilize the local bus of various bus architectures arbitrarily.
Computing machine 101 typically comprises various computer-readable mediums.Computer-readable medium can be can be by any medium that utilizes of computing machine 101 visit, and computer-readable medium comprises Volatile media and non-volatile media, removable medium and non-moving medium.As an example, but be not restriction, computer-readable medium can comprise computer-readable storage medium and communication media.Computer-readable storage medium can comprise volatibility and non-volatile, the removable and non-moving medium of realizing with any method or technology in order to the information of storage such as computer-readable instruction, data structure, program module or other data.Computer-readable storage medium is including, but not limited to RAM, ROM, EEPROM, flash memory or other internal storage technology, CDROM, digital versatile disc (DVD) or other optical disc memorys, magnetic tape cassette, tape, magnetic disk memory or other magnetic storage apparatus, or any other can be used to preserve information needed and can be by the medium of computing machine 101 visits.Communication media typically is presented as computer-readable instruction, data structure, program module or other data in the modulated data signal such as carrier wave or other transmission mechanisms, and comprises any information conveyance medium.Term " modulated data signal " is meant signal with one group or many stack features or the signal that changes according to this mode of coded message in this signal.As an example, but be not restriction, communication media comprises wire medium and wireless medium, wire medium such as cable network or direct wired connection, wireless medium such as sound, RF, infrared and other wireless mediums.Any combination of above-mentioned medium also should be included in the scope of computer-readable media.
Installed System Memory reservoir 236 comprises the computer-readable storage medium of volatibility and/or Nonvolatile memory reservoir form, such as read-only memory reservoir (ROM) 203 and random-access memory reservoir (RAM) 205.Basic input/output (BIOS) 204 is generally held among the ROM203, and BIOS 204 comprises such as the basic routine that transmits information in help between the starting period in computing machine 101 between the element.RAM205 typically comprises data and/or the program module that can directly visit and/or operate at once by processing unit 201.As an example, but be not restriction, Fig. 2 illustrates operating system 206, application program 207, other program modules 208 and routine data 209.
Computing machine 101 also can comprise other removable/non-moving, volatile/nonvolatile computer storage media.Only as an example, Fig. 2 illustrates the hard disk drive 211 that non-moving, non-volatile magnetic medium is read or writes, to the disc driver 217 removable, that non-volatile magnetic disk 237 reads or writes and to removable, non-volatile CD 238, the CD drive 218 that reads or write such as CD ROM or other light media.Other removable/non-moving, volatile/nonvolatile computer storage media that can be used in the exemplary operation environment include, but are not limited to magnetic tape cassette, flash card, digital versatile disc, digital video band, solid-state RAM, solid-state ROM etc.Hard disk drive 211 typically is connected to system bus 202 by non-moving internal storage interface such as interface 210, and disc driver 217 and CD drive 218 typically are connected to system bus 202 by removable internal storage interface such as interface 216.
Top that discuss and in Fig. 2 the relevant computer-readable storage medium in graphic driver and their provide computer-readable instruction, data structure, program module and other memory of data for computing machine 101.For example, in Fig. 2, hard disk drive 211 is illustrated as preserves operating system 212, application program 213, other program modules 214 and routine data 215.Note these parts can with operating system 206, application program 207, other program modules 208 and routine data 209 or identical, perhaps different.Here operating system 212, application program 213, other program modules 214 are endowed different numerals with routine data 215, are different copies at least so that they are described.The user can be by input equipment such as keyboard 222 and the positioning equipment 220 that is commonly called mouse, trace ball or touch pad, to computing machine 101 input commands and information.Other input equipment (not shown) can comprise microphone, joystick, game paddle, satellite dish and scanner etc.These and other input equipments usually are connected with processing unit 201 by the user's input interface 219 that is attached to system bus 202, but also can pass through other interfaces and bus structure, be connected with processing unit 201 such as parallel port or USB (universal serial bus) (USB).Graphic interface 223 also can be connected to system bus 202.One or more Graphics Processing Unit (GPU) 224 can be communicated by letter with graphic interface 223.The display device of monitor 233 or other types also can be connected to system bus 202 by interface such as video interface 226, thereby communicates by letter with video memory reservoir 225.Except monitor 233, computing machine also can comprise can be by other peripheral output devices of output peripheral interface 231 connections, such as printer 232.
The logic that computing machine 101 can use one or more remote computers such as remote computer 228 connects, and works in network or distributed environment.Remote computer 228 can be personal computer, server, router, network PC, peer device or other common network node, and typically comprise mentioned above with respect to a plurality of of computing machine 101 or all elements, although in Fig. 2, only for example understand internal storage memory devices 229.The logic of describing among Fig. 2 connects and comprises Local Area Network 234 and wide area network (WAN) 235, but also can comprise other network/bus.
In the time of in being used in the LAN networked environment, computing machine 101 is connected to LAN 234 by network interface or adapter 227.In the time of in being used in the WAN networked environment, computing machine 101 typically comprises modulator-demodular unit 221 or is used for setting up other devices of communicating by letter on such as WAN such as the Internet 235.Modulator-demodular unit 221 can be inside or outside, can be connected to system bus 202 by user's input interface 219 or other suitable mechanism.In network environment, described computing machine 101 relevant program module or its parts can be kept in the long-distance inner reservoir memory device.As an example, but be not restriction, Fig. 2 illustrates remote application 230 and resides on the internal storage equipment 229.It is exemplary that network shown in being understood that connects, and can use other devices of setting up communication linkage between computing machine.
D. exemplary NIM calculates the input data
This method depends on the hospitalization data of collecting from the electronics hospital information system, and these data comprise from the laboratory data of laboratory information system collection with from pharmacy indication and medicine that pharmacy information system obtains allots data.Can obtain the patient in hospital statistical figure or be admitted to hospital-transfer from one hospital to another-data of leaving hospital from one or more electronics hospital information systems.These data can flat file or similarly storage format be kept at lightweight in the database of heavyweight.Utilize safety, the HIPAA adaptation method, can be from associated agency (client facility) extracted data continuously.Such nonstandard numbers is according to being organized and being mapped to uniform data, to be fit to comprehensive people's cluster analysis.
As an example, but be not restriction, following data aggregate can be used to form hospitalization data:
1, about every patient be admitted to hospital, leave hospital and transfer from one hospital to another (ADT):
A) medical record number
B) admission date
C) affairs are handled/the ADT date
D) affairs are handled type/incident (A, D, T, be admitted to hospital preceding (pre-admit) etc.)
E) enter place (ward)---be admitted to hospital, transfer from one hospital to another
F) leave place (ward)---transfer from one hospital to another, leave hospital
G) place (mechanism) identifier (if being suitable for)
2, about in the hospital to the patient did each and all microbiology and relevant detections of microbiology:
A) mechanism's name/identifier
B) patient medical record number (MR#)
C) date (for example, being admitted to hospital) of accidental contact
D) the patient place during collection/generation sample
E) sample source/type (for example, phlegm, blood, urine)
F) collect the sample date
G) test sign/title (for example, sign and neurological susceptibility, fungal cultures, virus group, clostridium difficile toxin)
H) separated strain is described (that is the description of the evidence of microorganism name or microorganism existence)
I) test method (for example, MIC, ETEST, Kirby-Bauer, EIA)
J) microbiotic (if be suitable for, if possible, the microbiotic that every biosome is used〉1)
K) illustrated result (if be suitable for, for example, to the resistance (R) of every kind of antiseptic, intermediateness (intermediate, I), susceptibility (S))
3, be in hospital about every patient and antiseptic is joined by institute:
A) medical record number
B) admission date
C) antiseptic title, dosage, method of administration
D) allot the medicine date
E.NIM calculates
Value at this disclosed variable N, J, Y, K, X, Q, P, R and S can be selected by those skilled in the art, and this technician regards these variablees as class of establishment, patient's type, diagnostic-type, infection type, used antiseptic type and by its dependent variable that those skilled in the art approved.
As shown in Figure 3, the first step 302 of NIM calculating is to calculate non-repetitive hospital's separated strain sample (SNDHI) number according to the hospital's data 301 that received in hospital for the each patient.
" separated strain " is the evidence (for example, DNA, serology, histology, microexamination) that the microorganism (bacterium, virus, fungi, yeast, parasite, protozoan) that discerns in the lab analysis of sample (the patient's body fluid or the tissue that are used for lab analysis delivered) or microorganism exist.Sample can produce zero or a plurality of separated strain.
The first step 302a of SNDHI calculating 302 is separated strains that deletion repeats.This step is finished by coming from the first separated strain branch of the same microorganism that same patient obtained in day time at N (N 〉=0), and N can be from for example selecting (N can be 30 days) 1-150 days or 25-50 days, and N is not limited to the scope that be admitted to hospital when inferior.For in the N (N 〉=0) of first separated strain day from each additional separation strain of the same microorganism that same patient obtained, use is less than J (J 〉=0) and plants the antibacterials detection, J can select (J can be 3) from for example 1-20 or 1-10, if this additional separation strain is detected one or more antibacterials of antagonism, and explained the antimicrobial agent sensitivity result that this additional separation strain is different with first separated strain, this additional separation strain is the separated strain of repetition so.For the same microorganism that in N (N 〉=0) day of first separated strain, is obtained (for example, indicant based on any indicant or microorganism) each additional separation strain, if this additional separation strain is detected as non-confrontational antibacterials, this additional separation strain separated strain that is repetition so.
The second step 302b that SNDHI calculates is deletion and sample contamination, monitoring and the relevant separated strain of not infected clinical state.As an example, but be not restriction, the separated strain of deletion can comprise:
1) from coagulase negative staphylococcus, viridans streptococci group, the Mycotoruloides kind of breath sample;
2) from the aspergillus kind of last breath sample;
The coagulase negative staphylococcus of 3) only separating from broth bouillon or laboratory fluids nutrient culture media belongs to kind, Bacillus kind, bar-shaped Pseudomonas kind and diptheroid;
4) separated strain (for example, yeast, mixed bacterial) do not named of its microbial species;
5) separated strain that is obtained from the bedsore sample;
6) separated strain that from can obtain sample, obtains greater than the individual separated strain of Y (Y〉1), Y can select (Y can be 2) from for example 1-20 or 1-10;
7) from the separated strain of monitor sample, described monitor sample is that health care professionals thinks that sample source does not have sample collected when infecting.
8) from the blood flow catheter point, can't be from the separated strain of blood culture thing acquisition;
9) from the separated strain of environmental samples;
10) from the separated strain of gynaecology sample, except the surgical wound sample;
11) from the separated strain of dermatology sample; And
12) output is lower than the urine separated strain of 10,000 bacterium colonies/cubic centimetre urine.
The third step 302c that SNDHI calculates is an identification hospital separated strain." hospital's separated strain " can be in patient's while in hospital or the separated strain of collecting from the patient after leaving hospital that sample obtained." hospital's separated strain " can be at patient the be in hospital separated strain that sample obtained that the back collects from the patient in X days/hour continuously, wherein X〉0 and be in hospital the 0th day for being admitted to hospital the same day." hospital's separated strain " can also be from before sample collection K (K 〉=0) day/hour in the separated strain that sample obtained that the patient of one or many collects of being in hospital.X can from for example 1-20 hour day or 1-10 hour or day select.For example, X can be 2.K can select from for example 1-50 or 1-20 days/hour.For example, K can be 14 days.In this sense, each that discerned " hospital's separated strain " is a SNDHI, and each SNDHI is presented the collection date that obtains this hospital's separated strain sample.
The 4th step 302d that SNDHI calculates can calculate the sum of the SNDHI that is calculated.
AUC calculates and comprises two steps:
Step 1. is identified in allocation antiseptic incident in the process in hospital at step 303a.
If step 2. is allotted microbiotic for the first time when length of stay Q 〉=R (R〉0), and allot at least a other microbiotic: a) ensuing S (S〉0) day every day or b in following time) leave hospital day or c) dead day, so at step 303b for distributing an AUC index in hospital and remembering date Q to it.R can select from for example 1-20 or 1-10, and S can select from the continuous fate of for example 2-20 or 2-10.R can be and was in hospital the 3rd day, and S can be 3.
The final step 304 that NIM calculates by in the following formula one of be the calculating NIM number of at every turn being admitted to hospital, formula is:
1)NIM＝SNDHI
2)NIM＝AUC
Selected NIM computing formula can be selected by those skilled in the art, and this technician regards these variablees as class of establishment, patient's type, diagnostic-type, infection type, used antiseptic type and by its dependent variable that those skilled in the art approved.Formula selects can be depending on the preliminary assessment of SNDHI and AUC, and formula selects and can be changed, and the selection that is used for the formula that NIM calculates like this can be depending on the evaluation of another formula.For example, a certain result (for example 0) of preliminary assessment and the formula 1 of formula 1:NIM=SNDHI can be randomly depended in the selection of formula 2:NIM=AUC.Similarly, the preliminary assessment of formula 2:NIM=AUC and a certain result (for example〉0) can be randomly depended in the selection of formula 1:NIM=SNDHI, and SNDHI AUC occurred in P days/hour.
Final then NIM result can be used to the Quality in Hospitals benchmark and weigh (be the total hospital of NIM/ be admitted to hospital number), and can be used to help hospital to finish hospital acquired infections report to management organization.Final NIM result also can be used as objective module, based on the corelation behaviour performance of this standard between can more many hospitals, and in time improvement or others in the objective metric mechanism.NIM result can be used as the module of financial efficient.NIM result can make hospital's prediction hospital stays relevant with hospital acquired infections and related expense.Damage by discerning the rectifiable process of infection that causes, and when these infringements occur, the corpsman,hospital is focused on notice on the quality problems, thereby make NIM result can be used to reduce the quantity of hospital acquired infections.
The NIM that the NIM that always is admitted to hospital of this hospital in section preset time (for example a year) that obtains divided by being admitted to hospital number of certain hospital leads and other hospitals are same leads relatively, so that the module that provides the objectivity benchmark of the full institute of inside-hospital infection of the how tame mechanism incidence of disease to weigh.
To have the patient's of one or more NIM benefit/lose and not have benefit/loss of the patient of NIM to compare, influence with the finance of estimating hospital acquired infections.The NIM of various types can be used to indicate and may cause the patient care process infringement of inside-hospital infection in the future.
F. embodiment
Provide following embodiment; so that being provided at this claimed method to those of ordinary skill in the art is how to realize and how to the complete disclosure and description of this method assessment, and these embodiment are the exemplary restriction present disclosure of not planning purely.For numeral (for example, amount, temperature etc.), done and endeavoured to ensure much that it is accurate, still should consider some mistakes and error.Unless otherwise point out, umber is parts by weight, and temperature is ℃ or is environment temperature, and pressure is atmospheric pressure or near atmospheric pressure.
1. embodiment 1---and SNDHI calculates
Utilize following standard: (i) for the separated strain that repeats, at N days time durations (wherein N=30), first separated strain from the same biosome that same patient obtained is separated, (ii) for " hospital's separated strain ", only consider the separated strain that sample obtained that the back collects from the patient in X days/hour continuously of being in hospital the patient, wherein X=3 days, and be in hospital the 0th day for being admitted to hospital the same day, be some examples that SNDHI calculates herein:
SNDHI calculated example A:
The 0th day---positive urine---Escherichia coli
The 1st day---no culture
The 2nd day---no culture
The 3rd day---positive blood---MSSA
The 4th day---positive blood---MSSA
The 5th day---no culture
Result: 1 SNDHI
SNDHI calculated example B:
The 0th day---no culture
The 1st day---no culture
The 2nd day---no culture
The 10th day---positive blood---coagulase negative staphylococcus
The 14th day---positive breath sample---klebsiella and Pseudomonas (Pseudom)
Result: 2 SNDHI
SNDHI calculated example C:
The 0th day---positive nose---influenza
The 1st day---no culture
The 2nd day---no culture
The 8th day---positive blood---MRSA
The 9th day---positive breath sample---MRSA
The 11st day---positive breath sample---klebsiella
Result: 2 SNDHI
2. embodiment 2---and AUC calculates
Utilize following standard: if be in hospital the N days same day or be in hospital N days after begin to use antiseptic (wherein N=3 days), and give a) continuous at least 4 days or b) until leave hospital or c) to dead, distributing an AUC index in hospital to this example so, next is the example that AUC calculates:
AUC example A:
The 0th day to the 4th day: give azithromycin
The 4th day: the patient left hospital
Result: 0 AUC
AUC example B:
The 0th day to the 4th day: open azithromycin Zithromyacin into prescription
The 10th day: give lavo-ofloxacin
The 14th day: the patient left hospital
Result: 0 AUC
AUC example C:
The 8th day to the 11st day: give Imipenem
The 11st day: death
Result: 1AUC
AUC example D:
The 8th day to the 15th day: give vancomycin
The 40th day to the 45th day: give Imipenem
The 50th day: the patient left hospital
Result: 1 AUC
3. embodiment 3---and NIM calculates
NIM example A:(utilizes NIM formula 1)
SNDHI number=2
AUC number=0
Result=2NIM
NIM example B:(utilizes NIM formula 1)
SNDHI number=3
AUC number=1
Result=3NIM
NIM example C:(utilizes NIM formula 2)
SNDHI number=2
AUC number=1
Result=1NIM
NIM example D:(utilizes NIM formula 2)
SNDHI number=0
AUC number=1
Result=1NIM
NIM example E:(utilizes NIM formula 1 or 2)
SNDHI number=0
AUC number=0
Result=0NIM
4. embodiment 4
Northwest, Evanston health care (ENH) is the university's subsystem that contains three hospitals, this system is made up of two tame community hospitals and three grades of referral hospitals of family (tertiary-care referralhospital), annual total total 41,000 inpatients that surpass are admitted to hospital.Comprehensive review and NIM by electronic medical record analyze, for providing to be admitted to hospital the situation of inside-hospital infection (NI) appears, example of being admitted to hospital continuously (n=507) that assessment was admitted to hospital from 1 to 3 Dec in 2003 toward ENH and the example of being admitted to hospital continuously (n=400) of being admitted to hospital from 26 to 29 April in 2004 toward ENH in 30 days.These two time periods of special selection are to describe the different times of calendar year.
Define inside-hospital infection according to the CDC standard of being announced.To move in intensive care unit(ICU) (ICU) the 3rd day or move in ICU after three days or leave the NI that occurs in 3 days of ICU and be defined as the NI relevant with ICU.Because in inside-hospital infection control Research on effect (SENIC), the number percent of being admitted to hospital that one or more NI will have been arranged is for infecting the number percent definition, thereby the NI sum be multiply by 100 after divided by the sum of being admitted to hospital again be defined as infection rate (Haley et al., The SENICProject.Study on the efficacy of nosocomial infection control, 1980).
All medical recordss all can provide the electronic form record.Analyze for NIM, on day expection basis, collect all final positive clinical microbiologies and serology and the molecular test result relevant electronicly with communicable disease from the ENH laboratory information system.In addition, every two hours electronization is collected the patient's statistical figure of being admitted to hospital, so that can determine the patient's activity in the whole hospital system.
NIM is defined as patient's sample of non-repetitive hospital separated strain, and wherein sample can be the set of the material that (for example, blood, urine, phlegm, wound) obtained from single source.Non-repetitive separated strain can be first microorganism of directly or indirectly determining from the arbitrary sample of the patient in preceding 30 days.Non-repetitive separated strain can be the non-repetitive separated strain from sample acquisition collected after being in hospital the 3rd day or being in hospital 3 days or in leaving hospital preceding 14 days (the surgical wound sample is 30 days).If two separated strains of same microorganism are that collected sample obtains in separately 30 days, and the both is detected the antagonism antiseptic, so for antiseptic more than two kinds, the illustrated susceptibility result of separated strain of back one sample is different from the susceptibility of separated strain of last sample as a result the time, and the separated strain of back one sample can be non-repeated isolation strain.Otherwise the separated strain of back one sample can be the separated strain of repetition.Before the non-repetitive separated strain of identification, may the result relevant with other non-infected clinical states foreclose with sample contamination.
The examination and the NIM that are finished medical records by the researchist independently of each other analyze, and it is underground that these researchists' result of study keeps before identifying all possible NI.Just think net result if agree between two kinds of methods.Therefore, the examination of medical records and NIM analyze the NI that possible NI that two kinds of methods all discern is considered to determine.Same, do not have the examination of medical records and NIM to analyze being admitted to hospital of being discerned of possible NI and be considered to the NI feminine gender.Examine contradictory case by two communicable diseases (ID) doctor, their unanimous resolution is considered to net result.The expert's chart examination precedent for contradictory possible NI is arranged in the evaluation of NNIS standard, and experienced epidemiologist-doctor's NI mirror bright be the normative reference that the NI recognition methods with the examination of SENIC chart compares.There are the medical skill personnel of clinical microbiology research professional skill to carry out the examination of medical records by an ID doctor and two.Another one ID doctor provides guidance and supervision and participates in the solution of inconsistent problem.Be admitted to hospital 0,1 or a plurality of NIM that every example is studied, and 0,1 or a plurality of NI are arranged.
In the course of the review of first group of example of being admitted to hospital, the comprehensive review number of times of the electronic medical record that every example is admitted to hospital is recorded.All behaviors that relate to this research are ratified by the ENH institutional review board.
Comprehensively the medical records examination identifies the 45 examples possible NIs (infect number percent (IP)=4.4%, infection rate (IR)=5.0) of 40 examples in being admitted to hospital.NIM analyzes and to identify the 60 examples possible NIs of 47 examples in being admitted to hospital (IP=5.2% IR=6.6), and is having the possible NI of 6 examples after being admitted to hospital 30 days.Relatively generation 25 examples of all possible NI that is discerned by two kinds of strategies are inconsistent.Through after the inconsistent resolution, identify the NI that 49 examples of 44 examples in being admitted to hospital determine (IP=4.9%, IR=5.4).The sensitivity and the specificity of medical records examination are respectively 0.92 and 1.0.Sensitivity and specificity that NIM analyzes are respectively 0.86 and 0.984.
NIM analyzes to have from 142 examples and identifies the possible NIs relevant with ICU of 13 examples being admitted to hospital of ICU part, and the medical records examination identifies the possible NIs relevant with ICU of 11 examples.Inconsistent resolution has confirmed by medical records examination (sensitivity 1.0, specificity 1.0) possible NI (the 1 routine bloodstream infection of being discerned of all 11 examples, 4 routine pneumonia, 6 routine urinary tract infections), and confirmed to analyze 11 examples among the possible NI of 13 examples that (sensitivity 1.0, specificity 0.986) discerned by NIM.
The target expection monitoring of hospital infection control becomes the practice standard of the most hospitals of the U.S. now, detects 6 routine NI among 6 patients in two research cycles altogether.
NIM analyzes the NI (4 routine wound infections, 1 routine pneumonia, the 1 example diarrhoea relevant with clostridium difficile, 1 routine endometritis) that does not detect 7 examples and determine.In these cases 6 example does not have the microbiology data of conclusive evidence.4 examples in 6 examples come from not the surgery wound infection cultivated (2 routine caesarean sections partly give a birth wound, 1 routine B Bx wound, and 1 routine postoperative abdominal wound).The other 1 example diarrhoea relevant with clostridium difficile does not detect, and is owing to the laboratory information system reporting errors, and also has 1 routine bacteremia can not differentiate by specialist examination.Both are not within analyst coverage.NIM analyzes and correctly detects in 4 examples are admitted to hospital by the original 4 routine NI that omit of medical records examination (the 1 example diarrhoea relevant with clostridium difficile, 1 routine bloodstream infection, 1 routine pneumonia, 1 routine urinary tract infection).NIM analyzes and has also identified the possible NI of 14 examples, and these possible NI are not NI according to inconsistent resolution.
The manual review of electronic medical record needs average every example to be admitted to hospital 17 minutes, and perhaps about annual per 10,000 examples are admitted to hospital and are needed about 1.5 skilled full time employees.NIM analyzes needs the data transfer mechanism of about about weekly 10 minutes personnel's time with maintenance and efficiency test well afoot, and perhaps per 10,000 examples are admitted to hospital needs about 2 hours.
G. list of references
1.Garner?JS，et?al.CDC?definitions?for?nosocomialinfections.In：Olmsted?RN，ed.：APIC?Infection?Control?andApplied?Epidemiology：Principles?and?Practice.St.Louis：Mosby；1996：pp.A-1--A-20.
2.Gavin?PJ，et?al.Comparison?of′Whole?House′VersusRoutine?Targeted?Surveillance?for?Detection?of?NosocomialInfection.SHEA?2004.
3.National?Nosocomial?Infections?Surveillance(NNIS)System?Report，Data?Summary?from?January?1990-May?1999，IssuedJune?1999.Am?J?Infect?Control?1999；27：520-32.
4.Emori，et?al.Accuracy?of?reporting?nosocomial?infectionsin?intensive?care?unit?patients?to?the?national?nosocomialinfections?surveillance?system：a?pilot?study.Infect?ControlHosp?Epidemiol?1998；19：308-316.
5.Haley?RW，Quade?D，Freeman?HE，Bennett?JV.The?SENICProject.Study?on?the?efficacy?of?nosocomial?infection?control(SENIC?Project).Summary?of?study?design.Am?J?Epidemiol.May1980；111(5)：472-485.
Claims (42)
1. one kind is used to analyze patient's hospitalization data to determine the method for inside-hospital infection index (NIM), and this method comprises:
Receive and at least one the hospitalization data that the patient is relevant from database;
Calculate non-repetitive hospital's separated strain sample (SNDHI) number index from this hospitalization data;
Calculate microbiotic from this hospitalization data and use standard (AUC) index; And
Based on SNDHI that is calculated and AUC index, determine every patient's inside-hospital infection index (NIM).
2. the described method of claim 1, the step of wherein calculating non-repetitive hospital separated strain sample number comprises:
The separated strain that deletion repeats;
Delete the separated strain relevant with sample contamination;
The separated strain that deletion is relevant with monitoring;
Deletion and the relevant separated strain of not infected clinical state;
Identification hospital separated strain;
For every example is calculated non-repetitive hospital separated strain sample number in hospital; And
For each SNDHI that determines distributes a SNDHI index.
3. the described method of claim 2, at least one separated strain of wherein being deleted comprises: from the coagulase negative staphylococcus of breath sample, viridans streptococci group from breath sample, Mycotoruloides kind from breath sample, aspergillus kind from last breath sample, the coagulase negative staphylococcus of being separated from broth bouillon or laboratory fluids nutrient culture media belongs to plants, the Bacillus kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the bar-shaped Pseudomonas kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the diptheroid that from broth bouillon or laboratory fluids nutrient culture media, is separated, the separated strain that its microbial species is not named, the separated strain that is obtained from the bedsore sample, the separated strain that from the bacterial classification of growing way, obtains above other microorganisms of predetermined number, from thinking that the bacterial classification source does not have that monitor sample when infecting is collected and the separated strain that comes, separated strain from environmental samples, separated strain from the gynaecology sample except that the surgery wound, separated strain or output from the dermatology sample are lower than the urine separated strain that 10,000 bacterium colonies/cubic centimetre is urinated.
4. the described method of claim 1, wherein use the step of standard to comprise for every routine inpatient calculates microbiotic:
Being identified in the patient who has allotted antiseptic in the process of being in hospital is admitted to hospital; And
After being in hospital N days or being in hospital N days, begin to give antiseptic, and gave at least continuously X days or gave always up to leaving hospital or when dead, distribute an AUC index in hospital to every example of being discerned in previous step, wherein N is the fate greater than zero, and X is the fate greater than zero.
5. the described method of claim 1 wherein determines whether to exist the step of inside-hospital infection index (NIM) to comprise for every patient:
NIM is set equals AUC quantity.
6. the described method of claim 1 wherein determines whether to exist the step of inside-hospital infection index (NIM) to comprise for every patient:
NIM is set equals SNDHI quantity.
7. the described method of claim 1, wherein said patient's hospitalization data is a laboratory data.
8. the described method of claim 1, wherein said patient's hospitalization data are pharmacy indication and medicine allocation data.
9. the described method of claim 1, wherein said patient's hospitalization data is patient's statistics.
10. the described method of claim 1, wherein said patient's hospitalization data is to be admitted to hospital-to transfer from one hospital to another-data of leaving hospital.
11. the method for claim 1 further comprises:
Show the result that NIM determines.
12. one kind is used to analyze patient's hospitalization data to determine the system of inside-hospital infection index (NIM), this system comprises:
Be used to preserve the database of patient's hospitalization data; And
Be used to carry out the processor of following step:
Receive and at least one the hospitalization data that the patient is relevant from database;
Calculate non-repetitive hospital's separated strain sample (SNDHI) number index from this hospitalization data;
Calculate microbiotic from this hospitalization data and use standard (AUC) index;
Based on SNDHI that is calculated and AUC index, for every patient determines inside-hospital infection index (NIM).
13. the described system of claim 12, the step of wherein calculating non-repetitive hospital separated strain sample number comprises:
The separated strain that deletion repeats;
Delete the separated strain relevant with sample contamination;
The separated strain that deletion is relevant with monitoring;
Deletion and the relevant separated strain of not infected clinical state;
Identification hospital separated strain;
For every example is calculated non-repetitive hospital separated strain sample number in hospital; And
For each SNDHI that determines distributes a SNDHI index.
14. the described system of claim 13, at least one separated strain of wherein being deleted comprises: from the coagulase negative staphylococcus of breath sample, viridans streptococci group from breath sample, Mycotoruloides kind from breath sample, aspergillus kind from last breath sample, the coagulase negative staphylococcus of being separated from broth bouillon or laboratory fluids nutrient culture media belongs to plants, the Bacillus kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the bar-shaped Pseudomonas kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the diptheroid that from broth bouillon or laboratory fluids nutrient culture media, is separated, the separated strain that its microbial species is not named, the separated strain that is obtained from the bedsore sample, the separated strain that from the bacterial classification of growing way, obtains above other microorganisms of predetermined number, from thinking that the bacterial classification source does not have that monitor sample when infecting is collected and the separated strain that comes, separated strain from environmental samples, separated strain from the gynaecology sample except that the surgery wound, separated strain or output from the dermatology sample are lower than the urine separated strain that 10,000 bacterium colonies/cubic centimetre is urinated.
15. the described system of claim 12 wherein uses the step of standard to comprise for the each patient calculates microbiotic in hospital:
Being identified in the patient who has allotted antiseptic in the process of being in hospital is admitted to hospital; And
After being in hospital N days or being in hospital N days, begin to give antiseptic, and gave at least continuously X days or gave always up to leaving hospital or when dead, distribute an AUC index in hospital to every example of being discerned in previous step, wherein N is the fate greater than zero, and X is the fate greater than zero.
16. the described system of claim 12 wherein determines whether to exist the step of inside-hospital infection index (NIM) to comprise for every patient:
NIM is set equals AUC quantity.
17. the described system of claim 12 wherein determines whether to exist the step of inside-hospital infection index (NIM) to comprise for every patient:
NIM is set equals SNDHI quantity.
18. the described system of claim 12, wherein said patient's hospitalization data is a laboratory data.
19. the described system of claim 12, wherein patient's hospitalization data is that pharmacy indication and medicine are allotted data.
20. the described system of claim 12, wherein said patient's hospitalization data is patient's statistics.
21. the described system of claim 12, wherein said patient's hospitalization data is to be admitted to hospital-to transfer from one hospital to another-data of leaving hospital.
22. the described system of claim 12 further comprises:
The output device that shows the result that NIM determines.
23. the described system of claim 12, wherein processor is also carried out following step:
To output device output NIM result of calculation.
24. analyze patient's hospitalization data to determine the computer program of inside-hospital infection index (NIM) for one kind, wherein this computer program is encoded to carry out following step:
Receive and at least one the hospitalization data that the patient is relevant from database;
Calculate non-repetitive hospital's separated strain sample (SNDHI) number index from this hospitalization data;
Calculate microbiotic from this hospitalization data and use standard (AUC) index;
Based on SNDHI that is calculated and AUC index, for every patient determines inside-hospital infection index (NIM).
25. the described computer program of claim 24 wherein comprises for the step that the each patient calculates non-repetitive hospital separated strain sample number in hospital:
The separated strain that deletion repeats;
Delete the separated strain relevant with sample contamination;
The separated strain that deletion is relevant with monitoring;
Deletion and the relevant separated strain of not infected clinical state;
Identification hospital separated strain;
For every example is calculated non-repetitive hospital separated strain sample number in hospital; And
For each SNDHI that determines distributes a SNDHI index.
26. the described computer program of claim 25, at least one separated strain of wherein being deleted comprises: from the coagulase negative staphylococcus of breath sample, viridans streptococci group from breath sample, Mycotoruloides kind from breath sample, aspergillus kind from last breath sample, the coagulase negative staphylococcus of being separated from broth bouillon or laboratory fluids nutrient culture media belongs to plants, the Bacillus kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the bar-shaped Pseudomonas kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the diptheroid that from broth bouillon or laboratory fluids nutrient culture media, is separated, the separated strain that its microbial species is not named, the separated strain that is obtained from the bedsore sample, surpass the separated strain that obtains the bacterial classification of other microorganisms of predetermined number from growing way, from thinking that the bacterial classification source does not have that monitor sample when infecting is collected and the separated strain that comes, separated strain from environmental samples, separated strain from the gynaecology sample except that the surgery wound, separated strain or output from the dermatology sample are lower than the urine separated strain that 10,000 bacterium colonies/cubic centimetre is urinated.
27. the described computer program of claim 24, wherein patient's microbiotic of being in hospital uses the calculation procedure of standard to comprise:
Being identified in the patient who has allotted antiseptic in the process of being in hospital is admitted to hospital; And
After being in hospital N days or being in hospital N days, begin to give antiseptic, and gave at least continuously X days or gave always up to leaving hospital or when dead, distribute an AUC in hospital to every example of being discerned in previous step, wherein N is the fate greater than zero, and X is the fate greater than zero.
28. the described computer program of claim 24 wherein determines whether to exist the step of inside-hospital infection index (NIM) to comprise for every patient:
NIM is set equals AUC quantity.
29. the described computer program of claim 24 wherein determines whether to exist the step of inside-hospital infection index (NIM) to comprise for every patient:
NIM is set equals SNDHI quantity.
30. the described computer program of claim 24, wherein said patient's hospitalization data is a laboratory data.
31. being pharmacy indication and medicine, the described computer program of claim 24, wherein said patient's hospitalization data allot data.
32. the described computer program of claim 24, wherein said patient's hospitalization data is patient's statistics.
33. the described computer program of claim 24, wherein said patient's hospitalization data are to be admitted to hospital-to transfer from one hospital to another-data of leaving hospital.
34. the described computer program of claim 24, wherein said computer program are encoded with the step of further execution to output device output NIM result of calculation.
35. a method that is used to predict a class patient rentability comprises:
Exploitation identification may prolong the index that hospital stay maybe may be suffered the patient of variable cost especially, wherein this index is based on one or more separated strains that sample obtained of collecting from this patient place or gives this patient's antiseptic, and relevant this inpatient cost information of suffering; And
Determine based on this index whether this concrete patient's type can benefit.
36. the described method of claim 35, the step of wherein developing this index comprises for considering some separated strain of deletion.
37. the described method of claim 36, at least one separated strain of wherein being deleted comprises: from the coagulase negative staphylococcus of breath sample, viridans streptococci group from breath sample, Mycotoruloides kind from breath sample, aspergillus kind from last breath sample, the coagulase negative staphylococcus of being separated from broth bouillon or laboratory fluids nutrient culture media belongs to plants, the Bacillus kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the bar-shaped Pseudomonas kind of from broth bouillon or laboratory fluids nutrient culture media, being separated, the diptheroid that from broth bouillon or laboratory fluids nutrient culture media, is separated, the separated strain that its microbial species is not named, the separated strain that is obtained from the bedsore sample, the separated strain that from the bacterial classification of growing way, obtains above other microorganisms of predetermined number, from thinking that the bacterial classification source does not have that monitor sample when infecting is collected and the separated strain that comes, separated strain from environmental samples, separated strain from the gynaecology sample except that the surgery wound, separated strain or output from the dermatology sample are lower than the urine separated strain that 10,000 bacterium colonies/cubic centimetre is urinated.
38. the described method of claim 36, wherein the separated strain of Chong Fuing is deleted.
39. the described method of claim 38, wherein the separated strain of Chong Fuing is the separated strain of the identical microorganism of collecting from patient place in the preset time section, if and described separated strain is tested antibacterials, so described separated strain has the result of different antibacterials susceptibility, and described difference is meant that responsive antibacterials number is less than the presumptive test medicine.
40. the described method of claim 35, wherein the step of development index comprises that identification has the sample of non-repetitive hospital separated strain, and wherein this index is based on the sample exploitation of being discerned.
41. the described method of claim 38, wherein the step of development index also comprises:
Delete the separated strain relevant with sample contamination;
Be identified in the while in hospital or be in hospital back hospital's separated strain that sample obtained of collecting from the patient;
Identification has the sample of hospital's separated strain; With
For every example is calculated the sample number with hospital's separated strain in hospital.
42. the described method of claim 35, the step of wherein developing this index also comprises:
Being identified in the patient who has allotted antiseptic in the process of being in hospital is admitted to hospital; And
Began to give antiseptic after the N that is being in hospital (N〉0) day or the N that is being in hospital (N〉0) day, and gave at least continuously X days or gave always up to leaving hospital or when dead, distributing an AUC in hospital to every example of being discerned in previous step, wherein X is greater than zero.
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| CN103266163A (en) * | 2013-06-13 | 2013-08-28 | 郑州安图生物工程股份有限公司 | Combined detection kit for detecting and identifying candida and trichomonias |
| CN104246499A (en) * | 2012-03-23 | 2014-12-24 | 里昂奥斯皮思民用公司 | Process for determining the susceptibility to nosocomial infections |
| CN109545313A (en) * | 2018-10-27 | 2019-03-29 | 平安医疗健康管理股份有限公司 | Information cuing method, device, equipment and storage medium based on data processing |
| CN112017769A (en) * | 2020-07-15 | 2020-12-01 | 杭州杏林信息科技有限公司 | Method and system for monitoring hospital infection number caused by methicillin-resistant staphylococcus aureus |
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| JP2004152182A (en) * | 2002-10-31 | 2004-05-27 | Matsushita Electric Ind Co Ltd | Medical information processing system and medical information processing server |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN104246499A (en) * | 2012-03-23 | 2014-12-24 | 里昂奥斯皮思民用公司 | Process for determining the susceptibility to nosocomial infections |
| CN103266163A (en) * | 2013-06-13 | 2013-08-28 | 郑州安图生物工程股份有限公司 | Combined detection kit for detecting and identifying candida and trichomonias |
| CN109545313A (en) * | 2018-10-27 | 2019-03-29 | 平安医疗健康管理股份有限公司 | Information cuing method, device, equipment and storage medium based on data processing |
| CN112017769A (en) * | 2020-07-15 | 2020-12-01 | 杭州杏林信息科技有限公司 | Method and system for monitoring hospital infection number caused by methicillin-resistant staphylococcus aureus |
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| ZA200701662B (en) | 2009-06-24 |
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