Medical Department, Children's Specialized Hospital, New Brunswick, NJ 08901, USA.
Pediatrics. 2011 Nov;128(5):e1273-8. doi: 10.1542/peds.2010-3617. Epub 2011 Oct 24.
To report our quality improvement efforts to reduce total parenteral nutrition (TPN)-associated bloodstream infections, and the results of those efforts, during the period including the first quarter of 2004 through the third quarter of 2010.
A variant on failure modes and effect analysis and existing guidelines were used to develop and modify interventions. Effectiveness of the interventions was assessed by using a graphical depiction of interrupted time-series data on TPN-associated infections per 1000 TPN-days, aggregated across quarters within intervention periods.
Although initial interventions yielded limited reductions in infection rates, it was not until the implementation of a multifaceted "maintenance intervention bundle" that rates strongly responded. After this key intervention revision, the TPN-associated infection rate decreased between implementation in the first quarter of 2008 from 26.1 to 4.8 per 1000 TPN-days during the 8 quarters aggregated comprising the first quarter of 2008 through the fourth quarter of 2009. The final addition of an alcohol-swab cap resulted in a reduction of rates to 0 for the first three-quarters of 2010.
Our evidence suggests that iterative design/redesign of interventions using failure modes and effect analysis has directly reduced TPN-associated bloodstream infections.
报告我们在 2004 年第一季度至 2010 年第三季度期间，为降低全肠外营养（TPN）相关血流感染所做的质量改进工作及其结果。
采用失效模式和影响分析的变体以及现有的指南来制定和修改干预措施。通过对每 1000 个 TPN 天的 TPN 相关感染进行季度内时间序列数据的图形描述，评估干预措施的有效性。
尽管最初的干预措施仅使感染率略有降低，但直到实施多方面的“维持性干预包”后，感染率才出现明显下降。在对这一关键干预措施进行修订后，在 2008 年第一季度实施期间，感染率从每 1000 个 TPN 天 26.1 例降至 2008 年第一季度至 2009 年第四季度的 8 个季度汇总的每 1000 个 TPN 天 4.8 例。最后添加酒精擦拭帽使 2010 年前三个季度的感染率降至 0。
我们的证据表明，使用失效模式和影响分析对干预措施进行迭代设计/重新设计可直接降低 TPN 相关血流感染。
