Pronovost Peter, Needham Dale, Berenholtz Sean, Sinopoli David, Chu Haitao, Cosgrove Sara, Sexton Bryan, Hyzy Robert, Welsh Robert, Roth Gary, Bander Joseph, Kepros John, Goeschel Christine
School of Medicine, Johns Hopkins University, Baltimore, USA
N Engl J Med. 2006 Dec 28;355(26):2725-32. doi: 10.1056/NEJMoa061115.
Catheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.
We conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based intervention was used to reduce the incidence of catheter-related bloodstream infections. Multilevel Poisson regression modeling was used to compare infection rates before, during, and up to 18 months after implementation of the study intervention. Rates of infection per 1000 catheter-days were measured at 3-month intervals, according to the guidelines of the National Nosocomial Infections Surveillance System.
A total of 108 ICUs agreed to participate in the study, and 103 reported data. The analysis included 1981 ICU-months of data and 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P< or =0.002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16 to 18 months of follow-up (P<0.002). The regression model showed a significant decrease in infection rates from baseline, with incidence-rate ratios continuously decreasing from 0.62 (95% confidence interval [CI], 0.47 to 0.81) at 0 to 3 months after implementation of the intervention to 0.34 (95% CI, 0.23 to 0.50) at 16 to 18 months.
An evidence-based intervention resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period.
重症监护病房（ICU）中与导管相关的血流感染很常见，成本高昂且可能致命。
我们主要在密歇根州的重症监护病房开展了一项合作队列研究。采用基于证据的干预措施来降低与导管相关的血流感染发生率。使用多水平泊松回归模型比较研究干预实施前、实施期间以及实施后长达18个月的感染率。根据国家医院感染监测系统的指南，每3个月测量每1000导管日的感染率。
共有108个重症监护病房同意参与研究，103个报告了数据。分析纳入了1981个重症监护病房月的数据和375,757个导管日。每1000导管日与导管相关的血流感染中位数率从基线时的2.7例感染降至研究干预实施后3个月时的0例（P≤0.002），每1000导管日的平均感染率从基线时的7.7例降至随访16至18个月时的1.4例（P<0.002）。回归模型显示感染率较基线有显著下降，发病率比从干预实施后0至3个月时的0.62（95%置信区间[CI]，0.47至0.81）持续降至16至18个月时的0.34（95%CI，0.23至0.50）。
基于证据的干预措施使与导管相关的血流感染率大幅且持续降低（高达66%），并在整个18个月的研究期间得以维持。
