Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Curr Opin Pediatr. 2012 Feb;24(1):103-12. doi: 10.1097/MOP.0b013e32834ebdc3.
Healthcare-associated infections cause substantial harm to hospitalized neonates and children. Efforts that prevent these infections are a major focus of current patient safety initiatives. This review focuses on the reports of quality improvement interventions to prevent central line-associated bloodstream infections (CLABSIs) in neonates and children.
Single-center and multicenter collaborative studies have examined the effect of quality improvement interventions to reliably implement central line insertion and maintenance bundles on CLABSI rates in neonatal and pediatric intensive care units. Quality improvement interventions were associated with reductions in CLABSI rates in neonates and children by a half or more, although many of the studies have important methodologic limitations. Studies that utilized improvement science methodologies demonstrated larger improvement effects, but required a sizable investment of institutional support and personnel time.
Quality improvement interventions to reduce CLABSI are an important component of patient safety initiatives. Future studies of quality improvement interventions to reduce HAI among hospitalized neonates and children will benefit from further investigation of methods to enhance reliable implementation of evidence-based practices, factors that enable multicenter collaboratives to be more successful, and better understanding of the causes of heterogeneity in the results at different centers.
医疗保健相关感染给住院新生儿和儿童带来严重危害。预防这些感染的努力是当前患者安全计划的重点。本综述重点关注预防中心静脉相关血流感染（CLABSI）的质量改进干预措施的报告，这些措施适用于新生儿和儿童。
单中心和多中心合作研究已经检查了质量改进干预措施对可靠实施中心静脉置管和维护包的效果，以降低新生儿和儿科重症监护病房的 CLABSI 率。质量改进干预措施与 CLABSI 率降低一半或更多有关，尽管许多研究存在重要的方法学限制。利用改进科学方法学的研究显示出更大的改善效果，但需要机构支持和人员时间的大量投入。
降低 CLABSI 的质量改进干预措施是患者安全计划的重要组成部分。未来研究预防住院新生儿和儿童的医疗保健相关感染的质量改进干预措施将受益于进一步研究增强可靠实施基于证据的实践的方法、使多中心合作更成功的因素，以及更好地了解不同中心结果异质性的原因。
