Hsu Yea-Jen, Weeks Kristina, Yang Ting, Sawyer Melinda D, Marsteller Jill A
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
Am J Infect Control. 2014 Oct;42(10 Suppl):S191-6. doi: 10.1016/j.ajic.2014.05.010.
We sought to examine self-reported compliance with 5 evidence-based central line-associated bloodstream infection (CLABSI) prevention practices and link compliance to CLABSI rates in a national patient safety collaborative.
We analyzed data from a national CLABSI prevention program. Adult ICUs participating in the program submitted their CLABSI rates and a Team Checkup Tool (TCT) on a monthly basis. The TCT responses provided self-reported perceptions about how reliably the unit team performed the evidence-based practices in the previous month. Monthly data were aggregated into quarters for the analysis. We analyzed a total of 2775 ICU quarters during the program.
Chlorhexidine skin preparation and hand hygiene had the highest adherence. Avoidance of the femoral site and removal of unnecessary lines had the lowest compliance. Regression results showed that consistent performance of all practices was significantly associated with lower CLABSI rates. In terms of each practice's independent effect, femoral site avoidance for line placement and removal of unnecessary lines were independently associated with lower CLABSI rates after controlling for other factors.
Our findings suggest that uptake of the 2 low-compliance practices, avoidance of the femoral site and removal of unnecessary lines, is important for reducing CLABSI rates in conjunction with other practices.
我们试图在一项全国性患者安全合作项目中，调查自我报告的对5种循证中心静脉导管相关血流感染（CLABSI）预防措施的依从性，并将依从性与CLABSI发生率联系起来。
我们分析了一项全国性CLABSI预防项目的数据。参与该项目的成人重症监护病房（ICU）每月提交其CLABSI发生率和一份团队检查工具（TCT）。TCT的回答提供了关于该科室团队在前一个月执行循证措施的可靠性的自我报告看法。每月数据汇总为季度数据进行分析。我们在该项目期间共分析了2775个ICU季度的数据。
洗必泰皮肤准备和手部卫生的依从性最高。避免使用股静脉置管部位和拔除不必要的导管的依从性最低。回归结果显示，所有措施的持续执行与较低的CLABSI发生率显著相关。就每种措施的独立作用而言，在控制其他因素后，避免使用股静脉置管部位和拔除不必要的导管与较低的CLABSI发生率独立相关。
我们的研究结果表明，采取避免使用股静脉置管部位和拔除不必要的导管这两种低依从性措施，对于与其他措施一起降低CLABSI发生率很重要。
