Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit
Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit
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DOI：
10.1097/00003246-200201000-00009
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发表时间：
2002-01-01
影响因子：
8.8
通讯作者：
Fraser, VJ
中科院分区：
文献类型：
--
作者：
Coopersmith, CM;Rebmann, TL;Fraser, VJ
目的：本研究的目的是确定旨在改善中心静脉导管插入和护理的教育倡议是否可以降低原发性血流感染的发生率。设计：干预前和干预后观察性研究。设置：城市教学医院的18床外科/烧伤/创伤重症监护室（ICU）。患者：1998年1月1日至2000年12月31日期间，共有4，283名患者入住ICU。干预：一个多学科工作组开发了一个主要针对注册护士的项目，以强调中心静脉导管插入和维护的正确实践。该计划包括一个10页的自学模块，内容涉及导管相关感染的风险因素和实践修改，以及员工会议上的口头在职培训。每个参与者在参加学习模块之前都要参加一次预测试，在完成学习模块之后还要参加一次相同的测试。事实说明书和海报，加强在研究模块中的信息也张贴在整个ICU.Measurements和主要结果：74原发性血流感染发生在6874导管天（10.8每1000导管天）在18个月前的干预。在实施教育模块后，7044个导管日的原发性血流感染数量下降到26例（每1000个导管日3.7例），下降了66%（p < .0001）。干预后18个月内，感染率下降带来的估计成本节省在185，000美元至280.8万美元之间。结论：主要针对ICU护理人员的重点干预可以导致原发性血液感染的发生率急剧下降。教育计划可能导致中心静脉导管插入术的费用、发病率和死亡率大幅下降。
Objective:The purpose of the study was to determine whether an education initiative aimed at improving central venous catheter insertion and care could decrease the rate of primary bloodstream infections.Design: Pre- and postintervention observational study.Setting: Eighteen-bed surgical/burn/trauma intensive care unit (ICU) in an urban teaching hospital.Patients: A total of 4,283 patients were admitted to the ICU between January 1, 1998, and December 31, 2000.Interventions: A program primarily directed toward registered nurses was developed by a multidisciplinary task force to highlight correct practice for central venous catheter insertion and maintenance. The program consisted of a 10-page self-study module on risk factors and practice modifications involved in catheter-related infections as well as a verbal in-service at staff meetings. Each participant was required to take a pretest before taking the study module and an identical test after its completion. Fact sheets and posters reinforcing the information in the study module were also posted throughout the ICU.Measurements and Main Results: Seventy-four primary bloodstream infections occurred in 6874 catheter days (10.8 per 1000 catheter days) in the 18 months before the intervention. After the implementation of the education module, the number of primary bloodstream infections fell to 26 in 7044 catheter days (3.7 per 1000 catheter days), a decrease of 66% (p < .0001). The estimated cost savings secondary to the decreased infection rate for the 18 months after the intervention was between $185,000 and $2.808 million.Conclusions: A focused intervention primarily directed at the ICU nursing staff can lead to a dramatic decrease in the incidence of primary bloodstream infections. Educational programs may lead to a substantial decrease in cost, morbidity, and mortality attributable to central venous catheterization.