Render Marta L, Brungs Suzanne, Kotagal Uma, Nicholson Mary, Burns Patricia, Ellis Deborah, Clifton Marla, Fardo Rosie, Scott Mark, Hirschhorn Larry
VA Inpatient Evaluation Center, Veterans Affairs Medical Center, Cincinnati, USA.
Jt Comm J Qual Patient Saf. 2006 May;32(5):253-60. doi: 10.1016/s1553-7250(06)32033-8.
In 2003, through the Greater Cincinnati Health Council nine health care systems agreed to participate and fund 50% of a two-year project to reduce hospital-acquired infections among patients in intensive care units (ICU) and following surgery (SIP).
Hospitals were randomized to either the CR-BSI or SIP project in the first year, adding the alternative project in year 2. Project leaders, often the infection control professionals, implemented evidence-based practices to reduce catheter-related blood stream infections (CR-BSIs; maximal sterile barriers, chlorhexidine) at their hospitals using a collaborative approach. Team leaders entered process information in a secure deidentifled Web-based database.
Of the four initial sites randomized to CR-BSI reduction, all reduced central line infections by 50% (CR-BSI, 1.7 to 0.4/1000 line days, p < .05). At the project midpoint (3 quarters of 2004), adherence to evidence-based practices increased from 30% to nearly 95%.
The direct role of hospital leadership and development of a local community of practice, facilitated cooperation of physicians, problem solving, and success. Use of forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability. The appropriate floor for central line infections in ICUs is < 1 infection /1,000 line days.
2003年，通过大辛辛那提卫生委员会，九个医疗系统同意参与并资助一个为期两年的项目的50%，该项目旨在减少重症监护病房（ICU）患者及术后患者的医院获得性感染（SIP）。
医院在第一年被随机分配到中心静脉导管相关血流感染（CR-BSI）或SIP项目组，第二年加入另一个项目组。项目负责人通常是感染控制专业人员，采用协作方法在其医院实施基于证据的措施以减少导管相关血流感染（CR-BSIs；最大无菌屏障、洗必泰）。团队负责人将过程信息录入一个安全的、去除身份标识的基于网络的数据库。
在最初随机分配到CR-BSI减少项目的四个地点中，所有地点的中心静脉导管感染率均降低了50%（CR-BSI，从1.7降至0.4/1000导管日，p < 0.05）。在项目中期（2004年的三个季度），对基于证据措施的依从性从30%提高到了近95%。
医院领导的直接作用以及当地实践社区的发展促进了医生的合作、问题解决及成功。使用强制手段（去除套件中的碘伏、创建附件包和导管插入检查表）提高了可靠性。ICU中心静脉导管感染的合适发生率应<1感染/1000导管日。
