预防中心静脉导管相关血流感染：是否是时候将模拟培训纳入预防方案中了？
Prevention of central venous catheter-related bloodstream infections: is it time to add simulation training to the prevention bundle?
机构信息
Department of Anesthesiology, Cooper University Hospital, Camden, NJ 08103, USA.
出版信息
J Clin Anesth. 2012 Nov;24(7):555-60. doi: 10.1016/j.jclinane.2012.04.006.
STUDY OBJECTIVE
To study the impact of adding simulation-based education to the pre-intervention mandatory hospital efforts aimed at decreasing central venous catheter-related blood stream infections (CRBSI) in intensive care units (ICU).
DESIGN
Pre- and post-intervention retrospective observational investigation.
SETTING
24-bed ICU and a 562-bed university-affiliated, urban teaching hospital.
PATIENTS
ICU patients July 2004-June 2008 were studied for the development of central venous catheter related blood stream infections (CRBSI).
MEASUREMENTS
ICU patients from July 2004-June 2008 were studied for the development of central venous catheter-related blood stream infections (CRBSI). PRE-INTERVENTION: mandatory staff and physician education began in 2004 to reduce CRBSI. The CRBSI-prevention program included online and didactic courses, and a pre- and post-test. Elements in the pre-intervention efforts included hand hygiene, full barrier precautions, use of Chlorhexidine skin preparation, and mask, gown, gloves, and hat protection for operators. A catheter-insertion cart containing all supplies and checklist were was a mandatory element of this program; a nurse was empowered to stop the procedure for non-performance of checklist items.
INTERVENTION
As of July 1, 2006, a mandatory simulation-based program for all intern, resident, and fellow physicians was added to teach central venous catheter (CVC) insertion.
MEASUREMENTS
Data collected pre- and post-intervention were CRBSI incidence, number of ICU catheter days, mortality, laboratory pathogen results, and costs.
MAIN RESULTS
The pre-intervention CRBSI incidence of 6.47/1,000 catheter days was reduced significantly to 2.44/1,000 catheter days post-intervention (58%; P < 0.05), resulting in a $539,902 savings (USD; 47%), and was attributed to shorter ICU and hospital lengths of stay.
CONCLUSIONS
Following simulation-based CVC program implementation, CRBSI incidence and costs were significantly reduced for two years post-intervention.
研究目的
研究在强化治疗病房（ICU）中对旨在降低中心静脉导管相关血流感染（CRBSI）的干预前强制性医院工作中添加模拟教育的效果。
设计
干预前和干预后回顾性观察性研究。
地点
24 床 ICU 和一所拥有 562 张床位的大学附属医院，城市教学医院。
患者
2004 年 7 月至 2008 年 6 月 ICU 患者被研究以发展中心静脉导管相关血流感染（CRBSI）。
测量
2004 年 7 月至 2008 年 6 月 ICU 患者被研究以发展中心静脉导管相关血流感染（CRBSI）。干预前：2004 年开始对员工和医生进行强制性教育，以降低 CRBSI。CRBSI 预防计划包括在线和理论课程，以及预测试和后测试。干预前工作的要素包括手部卫生、全面屏障预防措施、使用氯己定皮肤准备以及操作人员的口罩、长袍、手套和帽子保护。载有所有用品和检查表的导管插入推车是该计划的强制性要素；护士有权因不执行检查表项目而停止手术。
干预
自 2006 年 7 月 1 日起，为所有实习医师、住院医师和研究员添加了强制性基于模拟的计划，以教授中心静脉导管（CVC）插入。
测量
收集干预前后的数据包括 CRBSI 发生率、ICU 导管天数、死亡率、实验室病原体结果和成本。
主要结果
干预前的 CRBSI 发生率为每 1000 个导管日 6.47 例，干预后显著降低至每 1000 个导管日 2.44 例（58%；P < 0.05），节省了 539902 美元（USD；47%），这归因于 ICU 和住院时间的缩短。
结论
实施基于模拟的 CVC 计划后，干预后两年内 CRBSI 的发生率和成本显著降低。
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