Kime Tammy, Mohsini Khawar, Nwankwo Martin U, Turner Barbara
Covenant Healthcare, Saginaw, Michigan, USA.
Adv Neonatal Care. 2011 Aug;11(4):242-8; quiz 249-50. doi: 10.1097/ANC.0b013e3182256680.
Central line associated blood stream infections (CLABIs) are associated with an increase in length of stay, morbidity, hospital costs, and mortality. In 2009, CLABIs were on the increase at Covenant Healthcare's 55 bed Level III neonatal intensive care unit (NICU). Prior to this practice initiative, there were no standardized central line management practices in the NICU. We retrospectively reviewed the incidence CLABIs for the six months prior to the initiation of the standardization of central line management and then 3 months following the implementation of the new practice policy. Specific outcomes measured were the number of CLABIs, length of stay related to CLABIs, and adherence to the policies and procedures. The project was implemented in four phases: 1) hand hygiene, 2) "scrub the hub", 3) central line tubing changes, 4) central line insertion, removal, and dressing changes. Although there were no statistically significant changes in the outcome measures, there were clinically significant differences between length of stay and risk for central line infection, incidence of CLABIs, and an increase in adherence to the central line practice change policies. The study showed for every week that is added to the patient stay, the patient was 7 times more likely to have a CLABIs. The rate of central line infection was decreased from 15.6 percent per 1000 line days to zero in 2010.
中心静脉导管相关血流感染（CLABIs）与住院时间延长、发病率增加、医院成本上升以及死亡率升高相关。2009年，在圣约医疗中心拥有55张床位的三级新生儿重症监护病房（NICU）中，CLABIs的发生率呈上升趋势。在这项实践举措实施之前，NICU没有标准化的中心静脉导管管理规范。我们回顾性分析了中心静脉导管管理标准化实施前六个月以及新实践政策实施后三个月的CLABIs发生率。所测量的具体结果包括CLABIs的数量、与CLABIs相关的住院时间以及对政策和程序的遵守情况。该项目分四个阶段实施：1）手卫生，2）“擦拭接头”，3）更换中心静脉导管管路，4）中心静脉导管的插入、拔除及更换敷料。尽管在结果指标上没有统计学上的显著变化，但在住院时间和中心静脉导管感染风险、CLABIs发生率以及对中心静脉导管操作变更政策的遵守程度增加方面存在临床显著差异。研究表明，患者每多住院一周，发生CLABIs的可能性就增加7倍。2010年，中心静脉导管感染率从每1000导管日15.6%降至零。
