Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists
Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists
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DOI：
10.1542/peds.2010-2873
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发表时间：
2011-03-01
期刊：
影响因子：
8
通讯作者：
Saiman, Lisa
中科院分区：
文献类型：
--
作者：
Schulman, Joseph;Stricof, Rachel;Saiman, Lisa
目的：2008年，纽约州的所有18个区域转诊NICU都采用了中心静脉导管插入和维护捆绑包，并同意使用检查表来监测维护捆绑包的遵守情况并报告检查表的使用情况。我们试图确认是否采用标准化束和使用中心线维护检查表减少中心线相关血流感染（CLABSI）。方法：这是一项前瞻性队列研究，纳入了所有新生儿与中心线谁在任何18个新生儿重症监护病房住院。每个NICU报告了CLABSI和中心静脉导管利用率数据和检查表使用情况。我们使用卡方检验（2）比较干预前（2007年1月至12月）与干预后（2009年3月至12月）的CLABSI发生率，并使用Poisson回归对调整后的CLABSI发生率进行建模。CLABSI率在全州范围内下降了67%（风险比：0.33 [95%置信区间：0.27-0.41]; P < .0005）;在2008年调整了改变的中心线相关血流感染定义后，下降了40%（风险比：0.60 [95%置信区间：0.48-0.75]; P < .0005）。18个NICU中共有13个报告使用维护检查表的时间为10%至100%的中心线日。检查表使用率与CLABSI率相关（系数：-0.57，P = .04）。18个NICU中共有10个是独立的CLABSI率预测因子，范围从1个风险大大降低的部位（发病率比：0.04，P < .0005）至1个风险大大增加的部位（发病率比：2.87，P < .0005）。尽管标准化的中心线护理元素导致了全州范围内NICU CLABSI的显著下降，但护理地点仍然是一个独立的风险因素。使用维护检查表减少CLABSI。儿科2011;127：436-444
OBJECTIVE: In 2008, all 18 regional referral NICUs in New York state adopted central-line insertion and maintenance bundles and agreed to use checklists to monitor maintenance-bundle adherence and report checklist use. We sought to confirm whether adopting standardized bundles and using central-line maintenance checklists reduced central-line-associated bloodstream infections (CLABSI).METHODS: This was a prospective cohort study that enrolled all neonates with a central line who were hospitalized in any of 18 NICUs. Each NICU reported CLABSI and central-line utilization data and checklist use. We used chi(2) to compare CLABSI rates in the preintervention (January to December 2007) versus the postintervention (March to December 2009) periods and Poisson regression to model adjusted CLABSI rates.RESULTS: Each study period included more than 55 000 central-line days and more than 200 000 patient-days. CLABSI rates decreased 67% statewide (risk ratio: 0.33 [95% confidence interval: 0.27-0.41]; P < .0005); after adjusting for the altered central-line-associated bloodstream infection definition in 2008, by 40% (risk ratio: 0.60 [95% confidence interval: 0.48-0.75]; P < .0005). A total of 13 of 18 NICUs reported using maintenance checklists for 10% to 100% of central-line days. The checklist-use rate was associated with the CLABSI rate (coefficient: -0.57, P = .04). A total of 10 of 18 NICUs were independent CLABSI rate predictors, ranging from 1 site with greatly reduced risk (incidence rate ratio: 0.04, P < .0005) to 1 site with greatly increased risk (incidence rate ratio: 2.87, P < .0005).CONCLUSIONS: Although standardizing central-line care elements led to a significant statewide decline in NICU CLABSIs, site of care remains an independent risk factor. Using maintenance checklists reduced CLABSIs. Pediatrics 2011;127:436-444