Deconstructing infection control bundles and the role of buy-in.
Deconstructing infection control bundles and the role of buy-in.
复制标题
解构感染控制捆绑和支持的作用。
DOI：
10.1097/ccm.0b013e31824316f4
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发表时间：
2012
影响因子：
8.8
通讯作者：
Popovich,KyleJ
中科院分区：
文献类型：
--
作者：
Popovich,KyleJ
1660Crit Care Med 2012年第40卷第5期国家医疗安全网络定义出现在外科和创伤ICU；也许这些病房患者的复杂性导致了国家医疗安全网络CLABSI定义的不同应用。这项研究的第二个潜在弱点是观察到与医疗保健相关的其他结果的比率下降。这项研究是一个准实验设计，使用其他与医疗保健相关的感染率作为“对照”变量，这是一种通常用于加强事前和事后研究设计的方法(17)。普通外科和创伤ICU的继发菌血症发生率不随时间变化，而神经外科ICU的继发菌血症发生率显著下降，尚不清楚是否有其他因素参与其中。此外，作者指出，在研究期间，外科ICU中呼吸机相关性肺炎的发生率下降，同时伴随着肺炎预防捆绑的启动。CLABSI风险的增加与呼吸机使用的增加有关(9)；控制VAP可能会通过减少污染管路插入部位、使用中的旋塞或医护人员手的机会来降低CLABSI的风险。这项研究中一个值得注意的发现是，普通外科和创伤ICU之间的“擦洗中心”运动的结果不同，干预只在护士提出想法并帮助实施干预的病房成功。虽然作者指出，当研究人员进行观察时，100%符合要求，但不同单位之间的不同结果表明，任何感染控制干预措施，即使在研究研究中被发现是有效的，也需要教育、热情和所有相关方的认同才能成功。有趣的是，CHG洗澡确实导致了所有三个ICU中CLABSI的显著减少，尽管医护人员的应用和参与可能是这次干预成功的一个主要因素。为什么“洗刷中枢”运动只导致所研究的两个单位中的一个单位的CLABSI比率下降，目前尚不清楚，因此需要进行额外的评估。这项研究补充了支持重症监护病房每日CHG沐浴对降低CLABSI发生率的有效性的文献。可能需要进一步评估CLABSI定义的应用，特别是在复杂的患者群体中，如外科ICU中的患者。潜在地，除了CHG洗澡之外的干预措施，如ICU护理清单和CHG“擦洗中心”运动，可能会导致CLABSI发生率的进一步降低。鉴于这项试验的准实验性质，以及呼吸机相关肺炎发病率下降可能造成的混乱，主要信息是，任何干预要取得成功，需要负责实施干预的一线工作人员的大力支持和支持。凯尔·J·波波维奇，库克县拉什大学医学中心斯特罗格医院
1660 Crit Care Med 2012 Vol. 40, No. 5 of National Healthcare Safety Network definitions occurred in the surgical and trauma ICU; perhaps the complexity of patients in these units led to differential application of the National Healthcare Safety Network CLABSI definition. A second potential weakness of this study is the observed decline in rates of other healthcare-associated outcomes. The study was a quasi-experimental design using rates of other healthcare-associated infections as “control” variables, a met hod commonly used to strengthen a beforeafter study design (17). While the secondary bacteremia rate did not change over time in the general surgical and the trauma ICU, the secondary bacteremia rate significantly declined in the neurosurgical ICU, making it unclear if other factors were involved in this unit. In addition, the authors note that the rate of ventilator-associated pneumonia declined in the surgical ICU during the study period, coinciding with concomitant initiation of a pneumonia prevention bundle. Increased CLABSI risk has been related to increased ventilator use (9); control of VAP may lessen risk of CLABSI through lessened chance of contaminating line insertion sites, in-use stop-cocks, or healthcare worker hands. A notable finding in this study is the differential results for the “scrub-the-hub” campaign between the general surgical and trauma ICU, with the intervention successful only in the unit where nurses came up with the idea and helped implement the intervention. While the authors noted 100% compliance when observations by research personnel were performed, the differing results between units suggest that any infection control intervention, even if found to be effective in a research study, requires education, enthusiasm, and buy-in from all involved parties for success. Interestingly, CHG bathing did lead to significant reductions in CLABSIs in all three ICUs, even though application and involvement by healthcare personnel would presumably be a major factor in success of this intervention. Why the “scrub-the-hub” campaign only led to reductions in the CLABSI rate in one of two units studied is unclear and warrants additional evaluation. This study adds to the literature supporting the effectiveness of daily CHG bathing in intensive care units for reducing rates of CLABSIs. Further assessment of applications of CLABSI definitions may be needed, especially among complex patient populations, such as those in surgical ICUs. Potentially, interventions in addition to CHG bathing, such as an ICU nursing checklist and a CHG “scrub-the-hub” campaign, could lead to further reductions in the rate of CLABSIs. In light of the quasi-experimental nature of this trial and potential confounding produced by declining ventilator-associated pneumonia rates, the major message is that for any intervention to be successful, there needs to be strong support and buy-in by the line-staff who are charged with implementing the intervention. Kyle J. Popovich, MD Rush University Medical Center Stroger Hospital Of Cook County