Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.
Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.
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DOI：
10.1136/bmj.c309
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发表时间：
2010-02-04
期刊：
影响因子：
--
通讯作者：
Needham D
中科院分区：
文献类型：
--
作者：
Pronovost PJ;Goeschel CA;Colantuoni E;Watson S;Lubomski LH;Berenholtz SM;Thompson DA;Sinopoli DJ;Cosgrove S;Sexton JB;Marsteller JA;Hyzy RC;Welsh R;Posa P;Schumacher K;Needham D
目的评价参与Keystone ICU项目的重症监护室在何种程度上持续降低导管相关血流感染的发生率。设计协作队列研究，实施和评估干预措施，以提高患者的安全性。 主要在美国密歇根州的重症监护病房。干预概念模型旨在改善临床医生对五项循证建议的使用，以降低导管相关血流感染率，并测量和反馈感染率。在可持续性期间，重症监护室团队被指示将此干预纳入员工培训，每月从医院感染控制人员那里收集数据，并向适当的利益相关者报告感染率。主要结果测量在可持续性期间（实施干预后19-36个月）每1000个导管日导管相关血流感染的季度发生率。结果90（87%）的原始103个重症监护病房参与，报告1532重症监护病房月的数据和300 310导管天的可持续性期间。导管相关血流感染的平均和中位发生率从基线时的7.7和2.7（四分位数间距0.6-4.8）降至实施后16-18个月时的1.3和0（0-2.4）以及34-36个月时的1.1和0（0.0-1.2）。多水平回归分析显示，发生率比值从0-3个月的0.68（95%置信区间0.53 - 0.88）降至实施后16-18个月的0.38（0.26 - 0.56）和34-36个月的0.34（0.24-0.48）。在可持续性期间，平均血流感染率与实施后最初18个月相比没有显著变化（-1%，95%置信区间-9%至7%）。结论：在实施后最初18个月内实现的导管相关血流感染率降低持续了18个月，因为参与的重症监护病房将干预措施纳入实践。广泛使用这种干预措施并取得类似结果，可以大大降低与导管相关血流感染相关的发病率和费用。
Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients’ safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians’ use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (−1%, 95% confidence interval −9% to 7%). Conclusions The reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.
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