Hermon Andrew, Pain Terina, Beckett Penelope, Jerrett Heather, Llewellyn Nicola, Lawrence Paul, Szakmany Tamas
Royal Glamorgan Hospital, Cwm Taf University Health Board, Llantrisant, UK.
Intensive Care, Cardiff University, Cardiff, UK.
Nurs Crit Care. 2015 Jul;20(4):196-203. doi: 10.1111/nicc.12186. Epub 2015 May 13.
Health care associated infections are a major contributor to avoidable harm experienced by patients in modern health care settings. Recent reports suggest that electronic checklists for the documentation of a central line bundle may significantly enhance documented process compliance and help to reduce catheter-related bloodstream infection rates.
This paper describes the use of our electronic tool to monitor and feedback process compliance in conjunction of introducing bespoke central line insertion packs to tackle catheter-related bloodstream infections in our intensive care unit in a medium-sized district general hospital.
Continuous quality improvement programme with 'Plan-Do-Study-Act' cycles was implemented. The central venous catheter insertion and maintenance bundle was rolled out in 2007. To monitor compliance with the bundle elements, an electronic tool was designed as part of our bedside Clinical Information System. From 2009, regular quarterly feedback was provided on the number of central venous catheter lines inserted, compliance with the insertion and maintenance bundle and catheter-related bloodstream infection rate using the data collected through the Clinical Information System. We have also introduced dedicated line insertion trolleys and factory-prepared insertion packs. We used segmented regression analysis to assess the changes in the catheter-related bloodstream infection rate before and after implementation of the central venous catheter bundle.
Bundle compliance increased during the implementation period and reached over 95% within 6 months. We observed a significant reduction in the catheter-related bloodstream infection rate from 15.6/1000 days to 0.4/1000 days. Regression analysis showed that only the compliance had significant effect on the number and prevalence of catheter-related bloodstream infections.
CONCLUSION/IMPLICATIONS: Implementation of evidence-based care bundles reinforced by real-time feedback on the performance of caregivers can significantly reduce the rate of catheter-related bloodstream infection in the intensive care unit. Ensuring that change processes are seamlessly integrated in the workflow with minimal administrative burden is crucial to the quality improvement process.
在现代医疗环境中，医疗保健相关感染是导致患者遭受可避免伤害的主要因素。近期报告表明，用于记录中心静脉导管集束的电子检查表可能会显著提高记录的流程依从性，并有助于降低导管相关血流感染率。
本文描述了在一家中型地区综合医院的重症监护病房引入定制的中心静脉导管插入包以解决导管相关血流感染问题的同时，使用我们的电子工具来监测和反馈流程依从性的情况。
实施了采用“计划-执行-研究-行动”循环的持续质量改进计划。中心静脉导管插入与维护集束于2007年推出。为监测对集束要素的依从性，设计了一种电子工具作为床边临床信息系统的一部分。从2009年起，利用通过临床信息系统收集的数据，定期每季度反馈中心静脉导管插入的数量、对插入与维护集束的依从性以及导管相关血流感染率。我们还引入了专用的导管插入推车和工厂预制的插入包。我们使用分段回归分析来评估中心静脉导管集束实施前后导管相关血流感染率的变化。
在实施期间，集束依从性有所提高，6个月内达到了95%以上。我们观察到导管相关血流感染率从15.6/1000天显著降至0.4/1000天。回归分析表明，只有依从性对导管相关血流感染的数量和发生率有显著影响。
结论/启示：通过对医护人员表现的实时反馈来强化基于证据的护理集束的实施，可显著降低重症监护病房的导管相关血流感染率。确保变革流程以最小的管理负担无缝融入工作流程对于质量改进过程至关重要。
