Shimoyama Yuichiro, Umegaki Osamu, Agui Tomoyuki, Kadono Noriko, Komasawa Nobuyasu, Minami Toshiaki
1Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
2Department of Surgery, Osaka Medical College, Takatsuki, Japan.
JA Clin Rep. 2017;3(1):23. doi: 10.1186/s40981-017-0095-4. Epub 2017 May 8.
Central venous catheters (CVCs) are commonly used in the management of critically ill patients. This study aimed to determine whether an educational program could reduce the rate of catheter-related bloodstream infections (CRBSIs) in intensive care units (ICUs).
All patients admitted to a medical ICU at a college affiliated with the Japan Society of Intensive Care Medicine between January 2008 and December 2014 were surveyed prospectively for the development of CRBSIs. A mandatory educational program (the intervention) targeting an infection control committee consisting of physicians was developed by a multidisciplinary task force to highlight correct practices for preventing CRBSIs. The program included a 30-min video-based introduction, 120-min lectures with a number of hands-on training sessions, a post-test, posters, safety check sheets, and feedback from the infection control committee. Lectures based on the education program were held every 3 months, and participants were free to choose when they attended the lectures. Each participant was required to view the 30-min introduction before attending the 120-min lectures and complete the post-test after each lecture. Safety check sheets were made to ascertain adherence to contents of the educational program. Posters describing the educational program were posted throughout the ICU. A pre- and post-intervention observational study design was employed, with the main outcome measure being yearly CRBSIs. We also calculated cost savings that resulted from improved CRBSI rates.During the 12-month pre-intervention period, four episodes of CRBSIs occurred in 1171 patient ICU-days (i.e., 3.4 per 1000 patient ICU-days). In the first year after the intervention, the rate of CRBSIs decreased to 0 in 1157 patient ICU-days ( ≤ 0.05). The estimated cost savings secondary to this decreased rate for the 1 year following introduction of the program was between 1850,000 and 27,000,000 yen ($14,800-$216,000).
A program aimed at educating healthcare providers on the prevention of CRBSIs led to a dramatic decrease in the rate of primary bloodstream infections. This suggests that educational programs may substantially decrease medical care costs and patient morbidity attributed to central venous catheterization when implemented as part of mandatory training.
中心静脉导管（CVC）常用于重症患者的管理。本研究旨在确定一项教育计划是否能降低重症监护病房（ICU）中导管相关血流感染（CRBSI）的发生率。
对2008年1月至2014年12月期间入住日本重症医学会附属大学医学ICU的所有患者进行前瞻性调查，以了解CRBSI的发生情况。一个多学科特别工作组针对由医生组成的感染控制委员会制定了一项强制性教育计划（干预措施），以强调预防CRBSI的正确做法。该计划包括30分钟的视频介绍、120分钟的讲座及多次实践培训课程、一次课后测试、海报、安全检查表以及感染控制委员会的反馈。基于该教育计划的讲座每3个月举行一次，参与者可自由选择参加讲座的时间。每位参与者在参加120分钟讲座前需观看30分钟的介绍，并在每次讲座后完成课后测试。制作安全检查表以确定对教育计划内容的遵守情况。描述该教育计划的海报张贴在整个ICU。采用干预前后观察性研究设计，主要结局指标为年度CRBSI。我们还计算了因CRBSI发生率改善而节省的成本。在干预前的12个月期间，1171个患者ICU日发生了4例CRBSI（即每1000个患者ICU日3.4例）。干预后的第一年，1157个患者ICU日的CRBSI发生率降至0（≤0.05）。该计划实施后，因发生率降低，估计在随后1年节省的成本在185万至2700万日元之间（14,800美元至216,000美元）。
一项旨在教育医护人员预防CRBSI的计划导致原发性血流感染率大幅下降。这表明，作为强制性培训的一部分实施时，教育计划可能会大幅降低因中心静脉置管导致的医疗成本和患者发病率。
