Martin Lizabeth D, Rampersad Sally E, Geiduschek Jeremy M, Zerr Danielle M, Weiss Gillian K, Martin Lynn D
Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98103, USA.
Paediatr Anaesth. 2013 Jul;23(7):588-96. doi: 10.1111/pan.12165. Epub 2013 Apr 9.
A major strategic hospital goal is the prevention of catheter associated bloodstream infections (CABSI). In 2009, at our institution, the CABSI rate for patients who traveled out of the ICU to the operating room and other procedural areas under the care of an anesthesiologist was increased compared to patients who remained on the unit.
Our objective was to develop countermeasures to improve intraoperative cleanliness by anesthesia providers, minimize contamination of intravenous access points, and ultimately reduce CABSIs.
MATERIALS & METHODS: A multidisciplinary team identified barriers to following best practices for reducing contamination of intravenous line entry-ports. Using Continuous Performance Improvement (CPI) or Lean techniques, staff directly impacted by the changes developed countermeasures to improve anesthesia practice. Compliance with the new "best practices" improved with coaching and feedback.
Postimplementation, CABSI rates for patients traveling off the ICU with anesthesiology providers decreased from 14.1 per thousand trips off the ICU preintervention in 2009 to 9.7 per 1000 trips in 2010 and to 0 per 1000 trips in 2011 postintervention. Hospital-wide CABSI rates decreased from 3.5 per 1000 central line days preintervention to 2.2 per 1000 central line days after.
Practice modification by anesthesiology providers in the operating room can decrease workspace contamination and is associated with decreased CABSI rates.
医院的一个主要战略目标是预防导管相关血流感染（CABSI）。2009年，在我们机构，离开重症监护病房（ICU）前往手术室及其他在麻醉医生护理下的操作区域的患者的CABSI发生率，相较于留在该科室的患者有所增加。
我们的目标是制定应对措施，以提高麻醉医护人员在术中的清洁程度，尽量减少静脉穿刺点的污染，并最终降低CABSI发生率。
一个多学科团队确定了在遵循减少静脉输液端口污染的最佳实践方面存在的障碍。运用持续绩效改进（CPI）或精益技术，受这些变化直接影响的工作人员制定了改进麻醉操作的应对措施。通过指导和反馈，对新“最佳实践”的依从性得到了提高。
实施后，在麻醉医护人员陪同下离开ICU的患者的CABSI发生率从2009年干预前每千次离开ICU行程中的14.1例，降至2010年每千次行程中的9.7例，并在2011年干预后降至每千次行程0例。全院的CABSI发生率从干预前每千个中心静脉导管留置日3.5例，降至干预后每千个中心静脉导管留置日2.2例。
麻醉医护人员在手术室对操作进行改进，可减少工作区域污染，并降低CABSI发生率。
