Johns Hopkins University School of Medicine, Department of Pediatrics, 2091 Rubenstein Child Health Building, 200 N. Wolfe St, Baltimore MD, 21287, USA.
Pediatrics. 2012 Oct;130(4):e996-e1004. doi: 10.1542/peds.2012-0295. Epub 2012 Sep 3.
To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population.
We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model.
CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02).
A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread.
调查多学科、最佳实践的中心静脉置管维护护理包是否能降低住院儿科肿瘤患者的中心静脉相关血流感染（CLABSI）发生率，并进一步阐明该人群中 CLABSI 的流行病学。
我们进行了一项前瞻性、中断时间序列研究，该研究采用了针对中心静脉置管护理所有方面的最佳实践护理包：减少置管次数、无菌置管以及更换部件时的无菌操作。基于持续质量改进模型，对提高每个护理包元素的依从性进行了针对性干预。在实施护理包前后的 10 个月和 24 个月期间，收集了 CLABSI 发生率和流行病学数据，并在泊松回归模型中进行了比较。
CLABSI 发生率从基线时的每 1000 个中心静脉置管日 2.25 例下降到干预期间的每 1000 个中心静脉置管日 1.79 例（发病率比[IRR]：0.80，P =.58）。二次分析表明，干预的第 12 个月，CLABSI 发生率降低至每 1000 个中心静脉置管日 0.81 例（IRR：0.36，P =.091）。59%的感染来自革兰阳性病原体，37%的 CLABSI 患者需要拔除中心静脉置管，与使用 Infusaports 的患者相比，使用 Hickman 导管的患者更有可能发生 CLABSI（IRR：4.62，P =.02）。
最佳实践的中心静脉置管维护护理包可以在住院儿科肿瘤患者中实施，尽管可能需要较长的时间来充分利用其益处。需要进一步的研究来确定这种 CLABSI 发生率的降低是否可以持续和推广。
