'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England.
'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England.
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DOI：
10.1136/bmjqs-2012-001325
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发表时间：
2013-02
影响因子：
5.4
通讯作者：
Matching Michigan Collaboration & Writing Committee
中科院分区：
文献类型：
--
作者：
Bion J;Richardson A;Hibbert P;Beer J;Abrusci T;McCutcheon M;Cassidy J;Eddleston J;Gunning K;Bellingan G;Patten M;Harrison D;Matching Michigan Collaboration & Writing Committee
来自中心静脉导管（CVC-BSI）的血流感染增加了重症监护室（ICU）的发病率和成本。据报道，使用技术和非技术干预相结合，CVC-BSI发生率大幅降低。我们进行了一项为期2年的四组、分步非随机研究，研究了在英格兰成人和儿科ICU中预防CVC-BSI的技术和非技术（行为）干预措施。随机效应泊松回归模型用于比较感染率。ICU样本参与了数据验证。在英格兰的223个ICU中，215个（196个成人，19个儿科）提交了2787个月中2479个月的数据，147个（66%）提供了完整的数据。暴露率为438 887（404 252成人和34 635儿童）CVC患者日。 在20个月内，报告了1092例CVC-BSI。 其中，884例（81%）为ICU获得性。对于成人ICU，20个月内的平均CVC-BSI率从第一个集群的3.7降至所有集群合并的1.48 CVC-BSI/1000 CVC患者日（p<0.0001），儿科ICU从5.65降至2.89（p=0.625）。 干预培训后，感染率下降的趋势并未加速。CVC的使用率保持稳定。ICU前感染与ICU获得性感染平行下降。标准参考病例记录审查显示，裁定者之间的一致性很高（κ 0.706），但血培养采样率和CVC利用率存在很大差异。通用感染控制方法差异很大。本研究中发现，英国ICU中CVC-BSI发生率的显著降低可能是医疗保健相关感染系统范围内改善的更广泛长期趋势的一部分。存在进一步协调感染控制做法的机会。未来的研究应调查因果机制和背景因素影响的干预措施的影响，旨在改善病人的护理。
Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.
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