Taylor Jacqueline E, McDonald Susan J, Earnest Arul, Buttery Jim, Fusinato Bree, Hovenden Samantha, Wallace Andrea, Tan Kenneth
LaTrobe University, Bundoora, Victoria, Australia.
Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
Eur J Pediatr. 2017 May;176(5):639-646. doi: 10.1007/s00431-017-2888-x. Epub 2017 Mar 10.
Central line associated blood stream infections (CLABSI) are the most common complication of central catheters in neonates. These infections increase length of hospital stay, hospital costs and impact on mortality and morbidities. We performed a quasi-experimental study, over 24 months, utilising a pre-post design to determine the impact checklists had on central line infections. We introduced checklists for insertion, daily maintenance and procedural access based on the existing clinical guideline. Infections and compliance were monitored and reported back to the unit each month. We utilised the interrupted time series analysis to evaluate the impact of introduction of the checklists. Over the 24 months, 318 infants were included with a total of 509 central lines inserted. In the post intervention phase, definite CLABSI rates declined by 41%, from 13.8 definite CLABSIs per 1000 central-line days to 7.8 definite CLABSIs per 1000 central-line days. There was significant change in the mean levels in the post intervention phase (coefficient crude -0.01015; 95% CI -0.01980-0.00051, p value 0.039). Checklist compliance for insertion was 70%, and daily maintenance compliance overall mean was 66%.
Our quality improvement initiative using checklists, supported with education and feedback, significantly reduced CLABSI in our neonatal unit. What is Known: • Central line associated blood stream infection (CLABSI) continue to cause mortality and morbidity in the neonatal population. • Bundles of intervention use quality improvement methodology to reduce CLABSI and checklists can assist with the introduction of these. What is New: • Checklists assist with reducing central line infection. • To ensure the success of checklists, robust education, leadership and continuous feedback are vital.
中心静脉导管相关血流感染（CLABSI）是新生儿中心静脉导管最常见的并发症。这些感染会延长住院时间、增加住院费用，并对死亡率和发病率产生影响。我们进行了一项为期24个月的准实验研究，采用前后对照设计来确定检查表对中心静脉导管感染的影响。我们根据现有临床指南引入了插入、日常维护和操作接入检查表。每月对感染情况和依从性进行监测并反馈给科室。我们采用中断时间序列分析来评估检查表引入的影响。在这24个月中，共纳入318名婴儿，共插入509根中心静脉导管。在干预后阶段，确诊的CLABSI发生率下降了41%，从每1000个中心静脉导管日13.8例确诊CLABSI降至每1000个中心静脉导管日7.8例确诊CLABSI。干预后阶段的平均水平有显著变化（系数粗略值为-0.01015；95%置信区间为-0.01980至-0.00051，p值为0.039）。插入检查表的依从率为70%，日常维护总体平均依从率为66%。
我们使用检查表并辅以教育和反馈的质量改进举措，显著降低了新生儿重症监护病房的CLABSI。已知信息：• 中心静脉导管相关血流感染（CLABSI）继续在新生儿群体中导致死亡和发病。• 一系列干预措施采用质量改进方法来降低CLABSI，检查表有助于引入这些措施。新发现：• 检查表有助于减少中心静脉导管感染。• 为确保检查表的成功实施，强有力的教育、领导和持续反馈至关重要。
