Bion Julian, Richardson Annette, Hibbert Peter, Beer Jeanette, Abrusci Tracy, McCutcheon Martin, Cassidy Jane, Eddleston Jane, Gunning Kevin, Bellingan Geoff, Patten Mark, Harrison David
University of Birmingham, N5 Queen Elizabeth Hospital, Birmingham, UK.
BMJ Qual Saf. 2013 Feb;22(2):110-23. doi: 10.1136/bmjqs-2012-001325. Epub 2012 Sep 20.
Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.
We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.
Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.
The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.
中心静脉导管相关血流感染（CVC-BSIs）会增加重症监护病房（ICU）的发病率和成本。据报道，采用技术和非技术干预相结合的方法可大幅降低CVC-BSI发生率。
我们在英格兰的成人和儿科ICU进行了一项为期2年、四组、逐步的非随机技术和非技术（行为）干预研究，以预防CVC-BSIs。采用随机效应泊松回归模型比较感染率。部分ICU参与了数据验证。
在英格兰的223个ICU中，215个（196个成人ICU，19个儿科ICU）提交了2787个可能月份中的2479个月份的数据，147个（66%）提供了完整数据。暴露率为438887个CVC-患者日（404252个成人患者日和34635个儿科患者日）。在20个月内，报告了1092例CVC-BSIs。其中，884例（81%）是在ICU获得的。对于成人ICU，所有组合并后，CVC-BSI平均发生率在20个月内从第一组的3.7降至1.48例CVC-BSIs/1000个CVC-患者日（p<0.0001），对于儿科ICU，从5.65降至2.89（p=0.625）。干预培训后感染率下降趋势并未加速。CVC使用率保持稳定。ICU前感染与ICU获得性感染同步下降。标准参照病例记录审查显示评审员之间的一致性较高（κ=0.706），但血培养采样率和CVC使用率差异很大。一般感染控制措施差异很大。
本研究发现英国ICU中CVC-BSI发生率显著降低，这可能是医疗保健相关感染全系统改善这一更广泛长期趋势的一部分。存在进一步统一感染控制措施的机会。未来的研究应调查影响旨在改善患者护理的干预措施效果的因果机制和背景因素。
