Neill Sara, Haithcock Sarah, Smith P Brian, Goldberg Ronald, Bidegain Margarita, Tanaka David, Carriker Charlene, Ericson Jessica E
Department of Advanced Practice Nursing (Ms Neill); Department of Nursing (Mss Haithcock and Carriker), and Department of Pediatrics (Drs Smith, Goldberg, Bidegain, Tanaka, and Ericson), Duke University, Durham, North Carolina; and 4. Duke Clinical Research Institute, Durham, North Carolina (Drs Smith and Ericson).
Adv Neonatal Care. 2016 Feb;16(1):52-9. doi: 10.1097/ANC.0000000000000164.
Bloodstream infections (BSI) cause significant morbidity and mortality among hospitalized infants.
Reduction of BSIs has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in NICUs around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU.
Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1000 infant-days and 2.44/1000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20 to 0.45 infections per 1000 infant-days. This represents a 92% decrease in BSI over a period of more than 5 years.
Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU.
Additional research is needed to effectively expand prevention of central line-associated BSIs to BSIs of all etiologies.
血流感染（BSI）在住院婴儿中会导致显著的发病率和死亡率。
降低血流感染已成为一项重要的患者安全目标。实施中心静脉置管集束化措施、标准化的管路护理方案以及医护人员教育项目，已使美国各地新生儿重症监护病房（NICU）的血流感染率有所降低。大型三级医疗中心降低包括血流感染在内的医院感染的能力已得到证实。然而，婴儿血流感染的长期降低情况尚无充分记录。我们试图证明，在一家三级医疗新生儿重症监护病房，血流感染的低发病率能够长期维持。
2005年和2006年，入住新生儿重症监护病房的婴儿的基线血流感染发病率分别为每1000个婴儿日5.15例和6.08例。在实施方案后，2008年和2009年血流感染发病率分别降至每1000个婴儿日2.14例和2.44例。在接下来的4年里，年发病率一直保持在较低水平，甚至进一步降至每1000个婴儿日0.20至0.45例感染。这代表在超过5年的时间里血流感染率下降了92%。
实施由护士主导的全面感染控制举措能够有效地降低并维持大型三级医疗新生儿重症监护病房婴儿的血流感染发病率。
需要进一步开展研究，以有效地将中心静脉导管相关血流感染的预防扩展到所有病因的血流感染。
