療照護相關感染定義改變對於某醫學中心泌尿道感染趨勢之影響

Impact of Changes in Definitions on Infection Density in a Medical Center

國內新版監測定義於2018年1月起由疾病管制署（以下稱疾管署）公告實施，主要參考美國國家醫療保健安全網（National Healthcare Safety Network, NHSN） 2017年公告之感染監測定義作修訂，感染監測定義改變造成感染密度波動，亦無法與過去長期趨勢比較，實施感染監測新定義之後國內尚無相關文獻討論，故本研究旨在探討2009年、2017年NHSN及2018年疾管署公告之感染監測定義，其各年度泌尿道感染與導尿管相關泌尿道感染個案數及感染密度趨勢變異情形。2013~2017年間符合2009年NHSN監測定義的個案中，全院39.9%、加護病房56.9%泌尿道感染個案未符合2017年NHSN公告之監測定義，另以2018年疾管署公告之監測定義判定，全院14.9%、加護病房15.6%泌尿道感染個案未符合定義；導尿管相關泌尿道感染個案中全院43.6%、加護病房57.2%未符合2017年NHSN公告之監測定義，全院14.4%、加護病房14.8%未符合2018年疾管署公告之監測定義。感染監測定義改變對長期趨勢比較具有重大影響，本研究在感染個案數和發生密度變異，提供重要參考訊息。

As of January 2018, the Centers for Disease Control and Prevention (CDC) in Taiwan updated the surveillance definition that led to a fluctuation in infection density, and there have been no reports about this issue in Taiwan. The current study aimed to compare the infection density and number of cases of urinary tract infections (UTIs) according to different surveillance definitions. The 2017 National Healthcare Safety Network (NHSN) and 2018 Taiwan CDC definitions were applied to the 2013-2017 UTI and catheter-associated UTI (CAUTI) data. The results showed that 39.9% and 56.9% of UTIs did not meet the 2017 NHSN definition hospital-wide and in intensive care units (ICUs), respectively; about half of the CAUTIs did not meet the 2017 NHSN definition both hospital-wide and in ICUs. We also found that about 15% of UTIs and CAUTIs in 2013-2017 did not meet the 2018 Taiwan definition both hospital-wide and in ICUs. This study provides important information about the impact of changes in surveillance definitions on the infection density variations that cannot be compared with long-term trends.