Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences
Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences
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DOI：
10.1016/j.ajic.2010.11.005
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发表时间：
2011-10-01
影响因子：
4.9
通讯作者：
Vigen, Cheryl
中科院分区：
文献类型：
--
作者：
Kim, James S.;Holtom, Paul;Vigen, Cheryl
背景：中心静脉管（CVL）广泛用于重症监护病房（ICU），但有时会导致导管相关的血流感染（CRBSI）。本研究评估了“CVL 捆绑”，以了解 CRBSI 率是否会下降，分析 CRBSI 菌群的任何变化，并预测医疗保健成本是否会下降。方法：从 2008 年 1 月开始，对所有入住 ICU 的患者实施 CVL 捆绑。汇集 2006 年和 2007 年 CRBSI 率的数据来比较干预措施。泊松分析产生了相对风险降低。通过将超额住院时间乘以我们机构的其他费用（用品、药物、CVL 更换费用）来确定费用。结果：随着所有参与的 ICU 中 CRBSI 的改善，总体感染率有所下降。尽管革兰氏阴性菌的比例没有显着变化，但革兰氏阳性菌感染的比例有所下降（P = .05），而真菌感染的比例有所增加（P = .04）。每个生物体的总超额费用由以下公式确定：总超额费用=超额住院时间+CVL更换+药物施用+抗生素费用。加权超额成本将总超额成本乘以基于有机体频率的校正因子。任何特定 CRBSI 的总超额成本约为 32,254 美元。结论：预防 CRBSI 可以改善患者护理，同时减少住院时间、费用和可能的死亡率。 CVL 捆绑相当容易执行，结果可重复。
Background: Central venous lines (CVLs) are used extensively in intensive care units (ICUs) but can sometimes lead to catheter-related blood stream infections (CRBSIs). This study evaluated a "CVL bundle" to see whether the CRBSI rate would decrease, analyze any changes in the flora of CRBSIs, and project any decrease in health care costs.Methods: The CVL bundle was implemented on all patients admitted to the ICU starting January 2008. Data from CRBSI rates from 2006 and 2007 were pooled to compare the intervention. A Poisson analysis generated a relative risk reduction. Determination of costs were made by taking the excess length of stay multiplied by other costs (supplies, medications, cost of replacement of CVL) at our institution.Results: Overall infection rates decreased with an improvement in CRBSIs in all ICUs that participated. Although the proportion of gram-negative organisms did not change significantly, there was a decrease in the proportion of gram-positive infections (P = .05) and an increase in fungal infections (P = .04). The total excess cost per organism was determined by the following: total excess cost = excess length of stay + replacement of CVL + drug administration + antibiotic cost. The weighted excess cost took the total excess cost times a correction factor based on organism frequency. The total excess cost of any given CRBSI is approximately $32,254.Conclusion: Preventing CRBSIs can improve patient care while reducing hospital stays, costs, and possible mortality. CVL bundles are fairly easy to perform with reproducible results.