Kampf Günter, Reise Gesche, James Claudia, Gittelbauer Kirsten, Gosch Jutta, Alpers Birgit
Bode Science Center, Bode Chemie GmbH, Hamburg, Germany ; Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt Universität Greifswald, Germany.
GMS Hyg Infect Control. 2013 Nov 6;8(2):Doc18. doi: 10.3205/dgkh000218. eCollection 2013.
Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.
The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI) including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology). A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback), followed by a second observation period. During the last observation week, participants evaluated the intervention.
In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test). Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after). Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68.6% when three of five steps were done; p<0.001). The intervention was described as helpful by 46.8% of the participants, as neutral by 46.8%, and as disruptive by 6.4%.
A multimodal strategy to improve both compliance with safety steps for peripheral venous catheter insertion and performance of an optimum procedure was effective and was regarded helpful by healthcare workers.
外周静脉导管在住院患者中经常使用，但会增加医院血流感染的风险。循证指南描述了已知可降低感染风险的具体步骤。然而，这些指南在临床实践中的实施程度尚不清楚。本研究的目的是确定临床实践中外周静脉导管插入具体步骤的使用情况，并实施一项多模式干预措施，旨在提高依从性以及步骤的最佳执行顺序。
本研究在汉堡大学医院进行。基于三项循证指南（世界卫生组织、美国疾病控制与预防中心、德国罗伯特·科赫研究所）定义了外周静脉导管插入的最佳程序，包括五个步骤，证据等级为1A或1B：接触患者前手部消毒、穿刺部位皮肤消毒、不触摸已处理的穿刺部位、无菌操作前手部消毒以及穿刺部位无菌敷料覆盖。一名研究护士观察并记录了四个不同科室（内镜科、中央急诊室、儿科和皮肤科）医护人员外周静脉导管插入的操作过程。建立了一项包含五个要素的多模式干预措施（教学课程、模拟训练、电子学习工具、平板电脑和海报以及直接反馈），随后进入第二个观察期。在最后一个观察周，参与者对干预措施进行了评估。
在对照期观察到207次插入操作，干预期观察到202次。五个步骤中的四个步骤的依从性显著提高（例如，接触患者前手部消毒从11.6%提高到57.9%；p<0.001，卡方检验）。穿刺部位皮肤消毒的依从性在干预前后都很高（干预前为99.5%，干预后为99.0%）。按正确顺序执行具体步骤的情况也有所改善（例如，当完成五个步骤中的三个步骤时，从7.7%提高到68.6%；p<0.001）。46.8%的参与者认为干预措施有帮助，46.8%认为是中性的，6.4%认为有干扰性。
一项旨在提高外周静脉导管插入安全步骤依从性和最佳程序执行情况的多模式策略是有效的，并且医护人员认为有帮助。
