Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial.
Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial.
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DOI：
10.1186/s13012-021-01112-4
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发表时间：
2021-04-26
期刊：
影响因子：
--
通讯作者：
Granger BB
中科院分区：
文献类型：
--
作者：
Reynolds SS;Woltz P;Keating E;Neff J;Elliott J;Hatch D;Yang Q;Granger BB
中央静脉相关血流感染（CLABSIs）每年导致约28,000人死亡，并给美国医疗保健系统增加约23亿美元的成本，然而，许多这些感染是可以预防的。在美国东南部的两个大型卫生系统中，clabsi仍然是一个有机会的领域。尽管有强有力的证据表明干预措施可以预防CLABSI并减少相关的患者伤害，例如使用葡萄糖酸氯己定（CHG）沐浴，但在实践中采用这些干预措施的情况很差。本研究的主要目的是评估一个量身定制的、多方面的实施方案对护理人员对危重病人的CHG沐浴过程和电子健康记录（EHR）文件的依从性的影响。次要目的是考察(1)单位特征和文化背景的调节作用，(2)对护理人员CHG洗浴知识和认知的干预作用，以及(3)对CLABSI率的干预作用。采用阶梯楔形聚类随机设计，将单元聚为4个序列；每个组在4个月的时间里连续开始干预。格罗尔和温辛实施模式有助于指导实施战略的选择，其中包括教育外展访问以及审计和反馈。对适当的CHG沐浴过程和每日CHG沐浴文件的依从性进行评估。干预12个月后评估结果以评估可持续性。在参与研究的14个临床单位中，8个在大学医院，6个在社区医院。干预后CHG洗浴流程依从性及护理人员对CHG洗浴的知识和认知均显著提高（p = 0.009, p = 0.002, p = 0.01）。CHG沐浴文件依从性和CLABSI率没有显著改善；然而，CLABSI发生率却显著降低了27.4%。使用教育外展访问和审计和反馈实施策略可以改善基于证据的CHG洗浴实践的采用。ClinicalTrials.gov, NCT03898115，注册于2019年3月28日。在线版本包含补充资料，网址为10.1186/s13012-021-01112-4。
Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. ClinicalTrials.gov, NCT03898115, Registered 28 March 2019. The online version contains supplementary material available at 10.1186/s13012-021-01112-4.
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DOI：
10.1056/nejmoa1113849
发表时间：
2013-02-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Climo MW;Yokoe DS;Warren DK;Perl TM;Bolon M;Herwaldt LA;Weinstein RA;Sepkowitz KA;Jernigan JA;Sanogo K;Wong ES
通讯作者：
Wong ES
DOI：
10.4103/2229-5151.164940
发表时间：
2015-07
影响因子：
--
作者：
Kornbau C;Lee KC;Hughes GD;Firstenberg MS
通讯作者：
Firstenberg MS
影响因子：
158.5
作者：
Huang, Susan S.;Septimus, Edward;Platt, Richard
通讯作者：
Platt, Richard
影响因子：
2.2
作者：
Hussey, Michael A.;Hughes, James P.
通讯作者：
Hughes, James P.
影响因子：
4.5
作者：
Dicks, Kristen V.;Lofgren, Eric;Anderson, Deverick J.
通讯作者：
Anderson, Deverick J.