Hansen S, Schwab F, Schneider S, Sohr D, Gastmeier P, Geffers C
Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin.
Dtsch Med Wochenschr. 2013 Aug;138(34-35):1711-6. doi: 10.1055/s-0033-1349437. Epub 2013 Aug 9.
Intensive care units (ICUs) with high rates of central venous catheter (CVC) -associated bloodstream infections (BSI) were invited to implement a bundle on BSI prevention during an educational programme which was created by the German national reference center for surveillance of nosocomial infections (NRZ). Training of health care workers (HCWs) was the main component and will be presented in the following.
The intervention was realized by local infection control staff from April 2006 to March 2007. Modules were lecture, script and poster. Before the intervention HCWs completed an anonymous multiple choice questionnaire about BSI prevention measures. Lectures could be modified in accordance to the ICUs knowledge of prevention measures. Processes and CVC-BSI rates were surveyed and analysed before and after the intervention and also during an additional 24-months follow-up period.
Thirty-two ICUs with 1,622 HCWs realized the intervention. Knowledge of BSI prevention of 1,251 HCWs was assessed. Knowledge gaps could predominantly be shown for the favored insertion site and the changing intervals of intravenous tubing for aqueous infusions. One third of HCWs said that a daily CVC's dressing change was indicated. After the intervention ICUs showed a significant decrease in the pooled CVC-BSI rate. ICUs showed a significant decrease of the pooled CVC-BSI rate during the follow-up.
In this first assessment of more than 1,200 HCWs' knowledge of BSI prevention in German ICUs knowledge gaps could be identified. During the 12-months intervention the implementation of evidence based IC recommendations improved and the pooled CVC-BSI rate decreased significantly.
中央静脉导管（CVC）相关血流感染（BSI）发生率较高的重症监护病房（ICU）受邀在由德国国家医院感染监测参考中心（NRZ）制定的一项教育计划中实施一套BSI预防措施。医护人员（HCW）培训是主要组成部分，将在下文介绍。
干预措施由当地感染控制人员在2006年4月至2007年3月期间实施。模块包括讲座、手册和海报。在干预措施实施前，医护人员完成了一份关于BSI预防措施的匿名多项选择题问卷。讲座可根据ICU对预防措施的了解情况进行修改。在干预措施实施前后以及另外24个月的随访期内，对流程和CVC-BSI发生率进行了调查和分析。
32个ICU的1622名医护人员实施了干预措施。对1251名医护人员的BSI预防知识进行了评估。在首选置管部位和静脉输液管更换间隔方面，主要存在知识差距。三分之一医护人员表示建议每天更换CVC敷料。干预措施实施后，各ICU的CVC-BSI合并发生率显著下降。在随访期间，各ICU的CVC-BSI合并发生率也显著下降。
在对德国ICU中1200多名医护人员的BSI预防知识进行的首次评估中，发现了知识差距。在为期12个月的干预期间，循证ICU建议的实施情况得到改善，CVC-BSI合并发生率显著下降。
