Hebbar Kiran B, Cunningham Charlene, McCracken Courtney, Kamat Pradip, Fortenberry James D
Children's Healthcare of Atlanta at Egleston, United States; Emory University School of Medicine, United States.
Children's Healthcare of Atlanta at Egleston, United States.
Intensive Crit Care Nurs. 2015 Feb;31(1):44-50. doi: 10.1016/j.iccn.2014.10.003. Epub 2014 Nov 22.
Research has demonstrated that additional reduction in paediatric catheter associated blood stream infection (CA-BSI) rates can be achieved through improving compliance with maintenance bundle care for central venous lines. Our objective was to improve maintenance bundle compliance rates and nursing competency surrounding central venous line (CVL) care in our paediatric intensive care unit (PICU).
A multidisciplinary team developed a bedside simulation-based training programme to improve compliance with standard PICU CVL maintenance bundle. We then performed a randomised comparison study comparing a standard CVL bundle training process for bedside PICU nurses in a control group (CG) to an intervention group (IG) receiving bedside training to simulate a CVL dressing change and maintenance bundle followed by intermittent training refreshers. Groups were assessed for compliance with prescribed components of the CVL bundle maintenance (CVL score).
At baseline the CG and IG had similar mean CVL scores (p=0.725). At twelve months mean CVL bundle compliance score in the IG was significantly higher than in the CG (p<0.0001). The largest CVL score increase for IG occurred between zero and three months. Coincidentally, CA-BSI rates in the Egleston PICU significantly decreased from 1.9±2.2 BSIsper 1000/CVL days, prior to the study, to 0.6±1.6 BSIsper 1000/CVL days following implementation of the intervention (p=0.034).
Bedside simulation based training in CVL dressing change is associated with improved compliance with CVL maintenance bundle practice. Enhanced CVL maintenance bundle practice could contribute to reduction in CA-BSI rates.
研究表明，通过提高对中心静脉导管维护集束护理的依从性，可进一步降低儿科导管相关血流感染（CA-BSI）率。我们的目标是提高儿科重症监护病房（PICU）中心静脉导管（CVL）护理的维护集束依从率和护理能力。
一个多学科团队制定了一项基于床边模拟的培训计划，以提高对PICU标准CVL维护集束的依从性。然后，我们进行了一项随机对照研究，将对照组（CG）中PICU床边护士的标准CVL集束培训过程与接受床边培训以模拟CVL换药和维护集束并随后进行间歇性培训复习的干预组（IG）进行比较。评估两组对CVL集束维护规定组件的依从性（CVL评分）。
基线时，CG和IG的平均CVL评分相似（p = 0.725）。在12个月时，IG的平均CVL集束依从性评分显著高于CG（p < 0.0001）。IG的CVL评分最大增幅出现在0至3个月之间。巧合的是，埃格尔斯顿PICU的CA-BSI率从研究前的每1000/CVL日1.9±2.2例BSI显著降至干预实施后的每1000/CVL日0.6±1.6例BSI（p = 0.034）。
基于床边模拟的CVL换药培训与CVL维护集束实践依从性的提高相关。加强CVL维护集束实践可能有助于降低CA-BSI率。
