Quan Kathleen A, Cousins Sarah M, Porter Darlene D, O'Brien Margaret, Rudkin Scott, Lambertson Brian, Hoang Dennis, Dangodara Amish A, Huang Susan S
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, CA.
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA.
Am J Infect Control. 2016 Apr 1;44(4):438-43. doi: 10.1016/j.ajic.2015.10.036. Epub 2015 Dec 21.
Central line-associated bloodstream infections (CLABSIs) continue to cause preventable morbidity and mortality, but methods for tracking and ensuring consistency of CLABSI-prevention activities remain underdeveloped.
We created an integrated electronic health record solution to prompt sterile central venous catheter (CVC) insertion, CVC tracking, and timely line removal. The system embedded central line insertion practices (CLIP) elements in inserter procedure notes, captured line days and new lines, matching each with its CLIP form and feeding back compliance, and enforced daily documentation of line necessity in physician progress notes. We examined changes in CLIP compliance and form submission, number of new line insertions captured, and necessary documentation.
Standard reporting of CLIP compliance, which measures compliance per CLIP form received, artificially inflated CLIP compliance relative to compliance measured using CVC placements as the denominator; for example, 99% per CLIP form versus 55% per CVC placement. This system established a higher threshold for CLIP compliance using this denominator. Identification of CVCs increased 35%, resulting in a decrease in CLABSI rates. The system also facilitated full compliance with daily documentation of line necessity.
Integrated electronic health records systems can help realize the full benefit of CLABSI prevention strategies by promoting, tracking, and raising the standard for best practices behavior.
中心静脉导管相关血流感染（CLABSI）持续导致可预防的发病和死亡，但跟踪和确保CLABSI预防活动一致性的方法仍不完善。
我们创建了一个综合电子健康记录解决方案，以促进无菌中心静脉导管（CVC）插入、CVC跟踪和及时拔管。该系统将中心静脉导管插入操作（CLIP）要素嵌入插入者操作记录中，记录导管留置天数和新置管情况，将每一项与相应的CLIP表格匹配并反馈合规情况，并在医生病程记录中强制要求每日记录导管必要性。我们检查了CLIP合规性和表格提交情况的变化、捕获的新置管数量以及必要的记录。
CLIP合规性的标准报告以每份收到的CLIP表格来衡量合规性，相对于以CVC置管数作为分母衡量的合规性，人为地夸大了CLIP合规性；例如，每份CLIP表格的合规率为99%，而每份CVC置管的合规率为55%。该系统使用此分母为CLIP合规性设定了更高的阈值。CVC的识别率提高了35%，导致CLABSI发生率下降。该系统还促进了对导管必要性每日记录的完全合规。
综合电子健康记录系统可通过促进、跟踪和提高最佳实践行为标准，帮助实现CLABSI预防策略的全部益处。
