Institutional risk factors for outbreaks of nosocomial gastroenteritis: survival analysis of a cohort of hospital units in South-west England, 2002-2003

被引:29
作者
Lopman, BA
Andrews, N
Sarangi, J
Vipond, IB
Brown, DWG
Reacher, MH
机构
[1] Hlth Protect Agcy, Ctr Communicable Dis Surveillance, Gastrointestinal Dis Dept, London, England
[2] Hlth Protect Agcy, Ctr Communicable Dis Surveillance, Stat Modelling & Econ Unit, London, England
[3] Hlth Protect Agcy, Local & Reg Serv, Bristol, Avon, England
[4] Hlth Protect Agcy, Bristol Publ Hlth Lab, Bristol, Avon, England
[5] Hlth Protect Agcy, Enteric, Resp & Neurol Virus Lab, Specialist & Reference Microbiol Div, London, England
关键词
norovirus; nosocomial; gastroenteritis; hospital design; regression analysis; Cox regression;
D O I
10.1016/j.jhin.2004.10.021
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Nosocomial. outbreaks of gastroenteritis are a major burden on hospital inpatient services, costing an estimated El 15 million annually to the English National Health Service. We actively followed-up 171 inpatient units from four major acute hospitals and 11 community hospitals in South-west England for one year. Outbreaks of gastroenteritis were ascertained through an active surveillance network using standard clinical. definitions. Survival analysis Cox regression models using an outbreak of gastroenteritis as The endpoint were fitted to identify institutional and operational attributes related to increased outbreak rates at the level of the care unit. Greater number of beds in unit [hazard ratio (HR) 1.22 (per 10 additional beds), 95% confidence intervals (CI) 0.96-1.55] was associated with increased hazard, as were geriatric (HR 2.6, 95% CI 1.6-4.3) and general, medical (HR 1.7, 95% CI 1.1-2.6) care units. The average length of stay on a unit was inversely associated with outbreak incidence [HR=0.89 (per additional week of stay), 95% CI 0.80-0.99]. Larger care units and those with higher throughput have increased rates of gastroenteritis outbreaks. These results should guide infection control policy and support the design of hospitals with smaller care units. (c) 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
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页码:135 / 143
页数:9
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