The Home Infusion Collaborative to Eliminate Central Line-Associated Bloodstream Infections (CLABSI)

需要长期使用中心静脉导管(CVCs)进行化疗、全胃肠外营养(TPN)、 门诊非肠道抗菌治疗(OPAT)和其他适应症通常在家中支持下维持CVC 来自家庭护理和家庭输液机构。家庭输液疗法的市场每年增长8%，目前 每年达到120万名患者。与医院不同，家庭输液疗法患者和他们的照顾者(即，家人， 朋友、邻居，甚至同事)在家培训后进行日常CVC护理和输液入门 输液或家庭保健护士。然而，家庭输液治疗的并发症，如中线相关 血液感染(CLABSI)一直不是研究或监管的重点。事实上，我们目前还没有 在家庭输液治疗中广泛接受的CLABSI定义。迫切需要这样的定义来执行 标杆和全行业的质量倡议。此外，提高了对如何在中执行此工作的了解 家庭输液治疗是必要的。没有CLABSI基准或报告平台可供家庭输液机构使用 可以将他们的CLABSI比率与其他人进行比较。没有一个集中的报告平台。与此同时，虽然CLABSI 预防工具包现在是急诊医院的护理标准，类似的CLABSI预防工具包还没有 在家庭中广泛实施输液疗法。以证据为基础的适应，例如专门的培训材料 面向患者和非正式护理人员，以及关于在洗澡时覆盖心血管疾病的具体建议，已被 已开发但未广泛实施。我们之前已经召集了医疗保健流行病学的利益相关者， 使用改进的Delphi方法进行感染预防、输液护理和家庭输液治疗以开发试点 家用输液CLABSI定义。通过在不同地区的五家家庭输液机构的合作 国家，我们将努力验证和基准这一新的家庭输液CLABSI定义，测试喂养的影响 基准家庭CLABSI数据向机构回输CLABSI费率，并实施CLABSI预防 家庭输液疗法中的维护工具包。我们将通过以下具体目标来实现这一目标：(一) 通过以下方式确定候选家庭输液CLABSI监测定义的有效性和实施的障碍 家庭输液机构，(2)制定家庭输液治疗患者CLABSI比率的基准，并设计和 实施用于分发基准费率的仪表盘，以及(3)调整和实施现有的CLABSI 家庭输液疗法预防工具包，并衡量其对五家家庭输液机构CLABSI发生率的影响。 这项工作的主要成果将是(1)经过验证的家庭输液CLABSI监测定义，(2)基准 对于家庭输液CLABSI，具有用于分发基准费率的仪表板，以及(3)了解 CLABSI预防工具包对家庭输液CLABSI率的影响。

Patients who need long-term central venous catheters (CVCs) for chemotherapy, total parenteral nutrition (TPN), outpatient parenteral antimicrobial therapy (OPAT), and other indications often maintain CVCs at home, with support from home nursing and home infusion agencies. The market for home infusion therapy grows 8% a year, and currently reaches 1.2 million patients yearly. Unlike in hospitals, home infusion therapy patients and their caregivers (i.e., family, friends, neighbors, or even coworkers) perform day-to-day CVC care and infusion initiation after training by home infusion or home health nurses. However, complications of home infusion therapy such as central line associated bloodstream infections (CLABSI) have not been a focus of research or regulation. In fact, we do not currently have a widely-accepted definition of CLABSI in home infusion therapy. Such a definition is urgently needed to perform benchmarking and industry-wide quality initiatives. Furthermore, improved understanding how to perform this work in home infusion therapy is needed. There is no CLABSI benchmark or reporting platform by which home infusion agencies can compare their CLABSI rates with others. There is no centralized reporting platform. Meanwhile, while CLABSI prevention toolkits are now standards of care in acute care hospitals, similar CLABSI prevention toolkits have not been widely implemented in home infusion therapy. Evidence-based adaptations, such as training materials specifically geared towards patients and informal caregivers, and specific advice on covering CVCs during bathing, have been developed but not widely implemented. We have previously gathered stakeholders in healthcare epidemiology, infection prevention, infusion nursing, and home infusion therapy using a modified Delphi approach to develop a pilot home infusion CLABSI definition. Through a collaborative of five home infusion agencies in different regions of the country, we will work, to validate and benchmark this new home infusion CLABSI definition, test the impact of feeding benchmarked home infusion CLABSI data back to agencies on CLABSI rates, and implement a CLABSI prevention maintenance toolkit in home infusion therapy. We will accomplish this through the following Specific Aims: (1) To determine the validity of a candidate home infusion CLABSI surveillance definition and barriers to its implementation by home infusion agencies, (2) To develop a benchmark for CLABSI rates in home infusion therapy patients and design and implement a dashboard for dissemination of benchmarked rates, and (3) To adapt and implement an existing CLABSI prevention toolkit for home infusion therapy and measure its impact on CLABSI rates in five home infusion agencies. The major outcomes of this work will be (1) a validated home infusion CLABSI surveillance definition, (2) a benchmark for home infusion CLABSI with a dashboard for dissemination of benchmarked rates, and (3) an understanding of the impact of a CLABSI prevention toolkit on home infusion CLABSI rates.