A Study Of Health-care Associated Infection Indicator Selection Criteria And Indicator Sets Basing On Public Report

[Objectives] The health-care associated infection(HCAI) has become a major public health problem affecting the community rehabilitation nowadays. It is particularly serious in China and lack of effective innovate supervision method on its regulation. Due to the successful application of transparent regulation in other countries, exploring report the HCAI quality indicators and regulate effectively becoming a trend of in China. But researches show the indicators in countries that have introduced transparence are various and diversified. And there is a dispute on the standard of public indicators and the suited indicators. So the study aims to design the best health-care associated infection(HCAI) indicator selection criteria with high evidence according to existing criteria for public reporting. Then based on this criteria, establishing HCAI quality indicator set which is suitable for public reporting in China in order to provide theoretical support and evidence-based basis for the innovation of the management of hospital infection and the improvement of the efficient for hospital regulation. [Methods] 1. Using the method of literature review, the researchers searched the domestic and foreign literature database, and finding 1161 related literature of "indicator selection criteria or standard" and 3848 related literature of "hospital infection indicators". The researchers determined the initial indicator selection criteria and indicators sets by their further reading of literature theme and content.2. Using focus group discussion method, the researchers organized experts to further screening, supplement and evaluation on initial indicator selection criteria and indicators sets. The discussion group consisted of 12 experts from the administrative departments of public health, health management school in universities and hospital infection management office. The discussion finally formed with hospital infection professional selection criteria set and indicators pool can be used for expert advice with the principle of “information saturation".3. Researchers made a questionnaire with the indicator selection criteria and indicators set. Then by using Likert 5 points method, they required the experts to base on the criteria to rate the indicators through the Delphi expert consultation method. From the perspective of the hospital infection top experts, the study selected 20 domestic well-known experts who were from hospital infection control and prevention departments, research institutions and universities engaging in epidemiology or medical management by the way of snowball. Through the calculation of positive coefficient, authority coefficient of experts and using mean, coefficient of variation, Kendall coordination coefficient and chi-square analysis on the importance of the indicators and the concentration of expert’ opinion. According to the statistics and experts’ advice, the researchers increased or decreased the indicators and tickled them to the next round of consultation questionnaire. The indicator set was determined by two rounds of consultation. [Results]1. We form a professional HCAI indicators selection criteria set including the impact, preventability, inclusiveness, timeliness, accessible and manageable to data, accuracy, and ease of risk adjustment.2. We form 38 initial indicators for expert advice, including 4 structural indicators such as "there is a pharmaceutical affairs management committee which supervises the use of antibiotic ";14 process indicator such as “hand hygiene compliance rate of medical staff”, “therapeutic drug etiology inspection rate when using” and "antimicrobial drug use in hospitalized patients”; 20 outcome indicators such as “SSI”, “rate of CLABSI”, “rate of CAUTI”, “rate of ICU MRSA”.3. We put 38 initial indicators for expert evaluation. The positive coefficient of two rounds consultation was 90% and 100%, indicating the experts’ motivation on this questionnaire was high. The questionnaire efficient was 100%.More than 95% of experts had more than 10 years working experience, more than 70% of experts had senior titles, and more than 50% of experts had master degree or above. Most experts had rich scientific research experience in the field of hospital infection. 15 experts involved in the infection research of 3 or more items, and 17 expert had the statistical background. At the same time, the authority coefficient of the two rounds of experts were above 0.9, showing that the selection of institute of experts had considerable authority.4. The first and second round of Kendall coordination mean coefficient of all indicators was 0.124(p < 0.05) and 0.500(p < 0.05). According to the requirement on consistency of expert advice, the researchers ended the consultation. In the first round of consultation, the researchers removed 13 indicators from the initial 38 indicators, and revised two indicators. Finally, a total of 25 indicators were retained to the next round of consultation. In the second round of consultation, the researchers removed three indicators from 25, and modified one indicator, and finally determined 22 recommended HCAI indicators for public reporting including “compliance rate of perioperative prophylactic rational use of antimicrobial drug”, “antimicrobial drug use in hospitalized patients”, “hand hygiene compliance rate of medical staff”, “forced prevention measures on VAP”, “NNIS SSI” and so on. This study also rated the indicators by the mean sum of experts’ score in order to provide the weight of indicators which is suitable for reporting. [Conclusion]Basing on the maneuverability, feasibility, validity and other characteristics of public indicators, and the experts of the individual interview and focus group discussion, the study summarizes the indicator selection criteria and definite the meaning of this criteria. So the design of criteria framework of this study is comprehensive and scientific.Recommended public HCAI indicators were consisted of one structure indicator(there is a pharmaceutical affairs management committee which supervises the use of antibiotic and records should be saved), nine process indicators(such as compliance rate of perioperative prophylactic rational use of antimicrobial drug, antimicrobial drug use in hospitalized patients, hand hygiene compliance rate of medical staff) and 12 outcome indicators(such as NNIS SSI, CLABSI, CAUTI and so on). The study is scientific and rational on the election of experts, design of criteria and screening of indicators. According to the positive coefficient and authority coefficient of experts, and the variation coefficient and consistency of results, we argued that expert consultation result is reliable.