Clarian Health Partners, Riley Hospital for Children, Indianapolis, IN, USA.
Pediatr Crit Care Med. 2012 Mar;13(2):e69-72. doi: 10.1097/PCC.0b013e31820ac2e1.
Catheter-associated bloodstream infections have been reported to occur in 3% to 8% of all central venous catheters inserted and are the predominant cause of hospital-acquired infection in intensive care units.
Decreasing the pediatric intensive care unit rate of catheter-associated bloodstream infections became a high priority in 2008 for all members of the intensive care unit team affiliated with central venous catheter insertion and maintenance.
Through a series of multidisciplinary initiatives, the annual average catheter-associated bloodstream infection rate in the pediatric intensive care unit fell from 7.9 infections per 1000 central catheter days in 2007 to 1.3 infections per 1000 central catheter days in 2009, a decrease of 83%. We attribute this success to the implementation of several key interventions, adherence to published insertion and maintenance bundles, and collaboration among pediatric intensive care unit physicians and nurses in all aspects of central catheter care.
Statistically significant interventions included improvements to central venous catheter insertion practices, the development of a dedicated central catheter team, and regular collaborative discussion of central venous catheter necessity. In this 24-month period, this equates to 50 catheter-associated infections avoided, six potential deaths prevented, and an estimated cost savings of $1.45 million (based on $29,000 per infection).
While implementation of these and other interventions has shown a positive impact, this project will continue into the future to assure sustainable successes and continued best practice improvements.
据报道，所有中心静脉导管插入的患者中有 3%至 8%发生导管相关性血流感染，是重症监护病房获得性感染的主要原因。
减少儿童重症监护病房中心静脉导管相关血流感染的发生率成为 2008 年所有重症监护团队成员的首要任务，这些成员与中心静脉导管的插入和维护有关。
通过一系列多学科举措，儿科重症监护病房的中心静脉导管相关血流感染的年平均发生率从 2007 年每千中心导管日 7.9 例下降到 2009 年每千中心导管日 1.3 例，下降了 83%。我们将这一成功归因于实施了几项关键干预措施，坚持使用已发表的插入和维护套件，以及儿科重症监护病房医生和护士在中心导管护理的各个方面的协作。
统计学上显著的干预措施包括改进中心静脉导管插入操作、成立专门的中心导管团队，以及定期协作讨论中心静脉导管的必要性。在这 24 个月期间，这相当于避免了 50 例导管相关性感染，预防了 6 例潜在死亡，估计节省成本 145 万美元（基于每例感染 29000 美元）。
虽然这些干预措施的实施已经显示出积极的影响，但该项目将在未来继续进行，以确保可持续的成功和持续的最佳实践改进。
