The harder you look, the more you find: Catheter-associated bloodstream infection surveillance variability
The harder you look, the more you find: Catheter-associated bloodstream infection surveillance variability
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DOI：
10.1016/j.ajic.2010.04.211
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发表时间：
2010-10-10
影响因子：
4.9
通讯作者：
Niedner, Matthew F.
中科院分区：
文献类型：
--
作者：
Niedner, Matthew F.
背景：导管相关血流感染是一项重要的质量绩效指标，并且仍然是增加发病率、死亡率和医疗费用的重要来源。目的：我们的目标是评估儿科重症监护病房 (PICU) 导管相关血流感染 (CA-BSI) 监测实践、管理和态度/信念的变异性，并确定监测变异与 CA-BSI 发生率之间是否存在任何相关性。方法：我们对多个机构的 5 名医疗保健专业人员进行了调查。结果：来自 16 个儿科重症监护室、5 个专业的 146 名受访者完成了调查，回复率为 40%。所有 10 个 (100%) 感染控制部门均报告纳入或排除了与疾病控制和预防中心 CA-BSI 定义不一致的中心线类型，5 个 (50%) 计算的线天数不一致，只有 5 个 (50%) 使用严格的书面政策对 BSI 进行分类。感染控制部门报告说，用于筛查和裁决 BSI 病例的方法、时间和资源存在很大差异。超过 80% 的中心报告拥有关于获取血培养的正式书面政策，尽管其中不到 80% 的中心涉及从中心静脉导管的患者获取样本，而且据报道，任何此类政策得到遵守的时间都不到一半。血培养实践存在很大差异，例如温度阈值、先发性退烧药和血液采样（体积、数量、部位、频率）。监测积极性评分旨在量化可能增加血流感染识别的做法，并且监测积极性评分与 CA-BSI 率之间存在显着相关性（r = 0.60，P = .034）。在评估态度和信念时，人们对 CA-BSI 作为内部/历史基准的有效性比作为外部/同行基准更有信心，而且最常被认为导致 CA-BSI 发生的因素是患者风险因素，而不是中心导管维护或置入实践。结论：PICU 中报告的 CA-BSI 监测实践存在很大差异，更积极的监测与较高的 CA-BSI 率相关，这对按绩效付费和基准制定具有重要影响应用程序。现在有一个令人信服的机会来改进标准化 CA-BSI 监测，以提高该指标用于机构间比较的有效性。医疗保健专业人员对由患者风险因素驱动的 CA-BSI 的态度和信念将受益于强调更重要的驱动因素（例如中心静脉置管插入和维护的质量）的重新校准。
Background: Catheter-related bloodstream infections are an important quality performance measure and remain a significant source of added morbidity, mortality, and medical costs.Objective: Our objectives were to assess variability in catheter-associated bloodstream infections (CA-BSI) surveillance practices, management, and attitudes/beliefs in pediatric intensive care units (PICUs) and to determine whether any correlation exists between surveillance variation and CA-BSI rates.Methods: We used a survey of 5 health care professions at multiple institutions.Results: One hundred forty-six respondents from 5 professions in 16 PICUs completed surveys with a response rate of 40%. All 10 (100%) infection control departments reported inclusion or exclusion of central line types inconsistent with the Centers for Disease Control and Prevention CA-BSI definition, 5 (50%) calculated line-days inconsistently, and only 5 (50%) used a strict, written policy for classifying BSIs. Infection control departments report substantial variation in methods, timing, and resources used to screen and adjudicate BSI cases. Greater than 80% of centers report having a formal, written policy about obtaining blood cultures, although less than 80% of these address obtaining samples from patients with central venous lines, and any such policies are reportedly followed less than half of the time. Substantial variation exists in blood culturing practices, such as temperature thresholds, preemptive antipyretics, and blood sampling (volumes, number, sites, frequencies). A surveillance aggressiveness score was devised to quantify practices likely to increase identification of bloodstream infections, and there was a significant correlation between the surveillance aggressiveness score and CA-BSI rates (r = 0.60, P = .034). In assessing attitudes and beliefs, there was much greater confidence in the validity of CA-BSI as an internal/historical benchmark than as an external/peer benchmark, and the factor most commonly believed to contribute to CA-BSI occurrences was patient risk factors, not central line maintenance or insertion practices.Conclusion: There is substantial variation in reported CA-BSI surveillance practices among PICUs, and more aggressive surveillance correlates to higher CA-BSI rates, which has important implications in pay-for-performance and benchmarking applications. There is a compelling opportunity to improve standardized CA-BSI surveillance to enhance the validity of this metric for interinstitutional comparisons. Health care professionals' attitudes and beliefs about CA-BSI being driven by patient risk factors would benefit from recalibration that emphasized more important drivers-such as the quality of central line insertion and maintenance.