Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections
Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections
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DOI：
10.1007/s00134-017-5007-6
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发表时间：
2018-01-01
影响因子：
38.9
通讯作者：
Zingg, Walter
中科院分区：
文献类型：
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作者：
van der Kooi, Tjallie;Sax, Hugo;Zingg, Walter
目的：为了测试中心静脉导管（CVC）插入策略和手部卫生（HH）改善策略的有效性，以防止中心静脉导管相关血流感染（CRBSI）在欧洲重症监护病房（ICU），测量过程和结果indicators.Methods：成人ICU从14家医院在11个欧洲国家参加了这个阶梯楔形集群随机对照多中心干预研究。在6个月基线后，三家医院每个季度随机接受三种干预措施之一：（1）CVC插入策略（CVCi）;（2）HH促进策略（HHi）;和（3）两种干预措施组合（COMBi）。主要结局是前瞻性CRBSI发病率密度。次要结局是CVC插入评分和HH依从性。结果：共纳入25，348例患者，35，831例CVC。CRBSI发病密度从基线时的2.4/1000 CVC-天降至0.9/1000（p < 0.0001）。当调整患者和CVC特征时，所有三种干预措施均显著降低CRBSI发病率密度。当额外调整基线下降趋势时，HHi和COMBi组仍然有效。CVC插入分数和HH依从性增加显着与所有三个interventions.Conclusions：这项研究表明，旨在提高CVC插入实践和HH减少CRBSI在不同的欧洲ICU的多模式预防策略。合规部解释说，CRBSI减少和未来的质量改进研究应鼓励测量过程指标。
Purpose: To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators.Methods: Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance.Results: Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions.Conclusions: This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.