Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study.

OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

Zr-Doped Ir as an Effective Anode for Refractory SMX Degradation.

Electrochemical oxidation has been considered as an efficient method to degrade pharmaceuticals and personal care products. Maintaining low power consumption while increasing the number of oxidation intermediates is deserving of exploring. Herein, Ti/SnO2-Sb/Zr0.3Ir0.7O2 was prepared by Zr doped into IrO2 and used for Sulfamethoxazole (SMX) degradation. The addition of Zr significantly increased the electrochemically active area and facilitated the catalyst to degrade SMX dramatically at a lower overpotential. The extremely outstanding lifetime of catalysts can reach 800 h during the accelerated life test, which showed excellent stability and developmental prospects. The overpotential at 10 mA·cm-2 is about 329 mV, indicating that this electrode has a high oxygen evolution reaction activity. Furthermore, the electrical efficiency per log order for the electrode is only 8.50 kW h m-3 at 4 V. Our research provides new anode electrochemical catalysts for the degradation of organic pollutants.

Dimensional Stable Lead Electrode Modified by SDS for Efficient Degradation of Bisphenol A.

The dimensional stable lead electrodes modified by sodium dodecyl sulfate (SDS) were prepared with electrochemical deposition and it shows that a more compact, uniform, and smooth film of Ti/PbO2(F+SDS) electrode reduces the corroded crystal faces and surface defects. Characterization results demonstrate that the oxygen evolution potential (OEP) of the Ti/PbO2(F+SDS) electrode was higher, and its service life is almost 1.6 times longer than the Ti/PbO2(F) electrode. Compared with Ti/PbO2(F) electrode, the soluble Pb concentration of the Ti/PbO2(F+SDS) electrode decreased 15.1%, which indicates that the decrease of crystal surface defects leads to the reduction of Pb ions so that the excellent corrosion resistance electrodes cause low environmental risks. The modified electrodes were used as anodes to degrading bisphenol A (BPA) when an electrolyte is 0.2 M Na2SO4, the applied voltage is 5 V and electrodes distance is 3 cm, 20 mg/L BPA for electrolysis time of 180 min can reach up to 97.6%.