Department of Medical Sciences and Public Health, University of Cagliari, Italy.
Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Hosp Infect. 2017 Nov;97(3):275-281. doi: 10.1016/j.jhin.2017.08.010. Epub 2017 Aug 16.
Bloodstream infections (BSIs) associated with insertion and maintenance of central venous catheters (CRBSIs) are the most frequent causes of healthcare-associated infections in intensive care units (ICUs). They are responsible for increased length of hospital stay and additional healthcare costs.
To investigate whether an educational programme aimed at healthcare workers resulted in a significant change in the level and trend of infections.
The research was conducted in five Italian ICUs from July 2012 to August 2014. Surveillance and educational interventions to control infections were applied. Compliance with hand hygiene procedures was assessed via relative risk and 95% confidence interval. Interrupted time-series analysis was used to investigate the change in level and trend of infection during the intervention.
Compliance with hand hygiene procedures improved during the intervention for all staff groups, but physicians showed the lowest compliance rates (nurses from 52.4% to 92.1%; nurse aides from 71.0% to 92%; physicians from 71.0% to 92%; P < 0.001). Significant reductions of 21-55% in CRBSI were observed during the intervention. Small improvements in the monthly infection trend were also observed, but these were not statistically significant.
An educational programme focusing on general good infection control practice, rather than CVC care bundles, led to a decreased CRBSI rate, even if the improvement was not sustained over time. Continuous performance feedback should be provided to promote long-term adherence to guidelines among all health workers.
与中心静脉导管（CRBSI）的插入和维护相关的血流感染（BSIs）是重症监护病房（ICU）中最常见的医疗相关感染原因。它们导致住院时间延长和额外的医疗保健费用增加。
调查针对医护人员的教育计划是否会导致感染水平和趋势发生显著变化。
该研究于 2012 年 7 月至 2014 年 8 月在意大利的五个 ICU 进行。实施了针对感染控制的监测和教育干预措施。通过相对风险和 95%置信区间评估手部卫生程序的依从性。使用中断时间序列分析来调查干预期间感染水平和趋势的变化。
在干预期间，所有医护人员群体的手部卫生程序依从性均有所提高，但医生的依从性最低（护士从 52.4%提高到 92.1%；护士助理从 71.0%提高到 92%；医生从 71.0%提高到 92%；P<0.001）。观察到 CRBSI 减少了 21-55%。每月感染趋势也有较小的改善，但无统计学意义。
专注于一般良好感染控制实践的教育计划，而不是 CVC 护理包，可降低 CRBSI 发生率，尽管改善并未随着时间的推移而持续。应提供持续的绩效反馈，以促进所有卫生工作者长期遵守指南。
