Division of Nosocomial Infections, Center for Epidemiologic Surveillance 'Prof. Alexandre Vranjac', Center of Disease Control, São Paulo State Health Department, São Paulo, Brazil.
Division of Nosocomial Infections, Center for Epidemiologic Surveillance 'Prof. Alexandre Vranjac', Center of Disease Control, São Paulo State Health Department, São Paulo, Brazil.
J Hosp Infect. 2018 Nov;100(3):e163-e168. doi: 10.1016/j.jhin.2018.04.020. Epub 2018 May 4.
There have been few studies exploring implementation strategies to central line-associated bloodstream infections (CLABSIs) in low- or middle-income countries.
To implement tailored interventions to reduce CLABSI rates in adult intensive care units.
The implementation strategy of the State Health Department was performed in São Paulo State, Brazil, over two cycles. Cycle 1 (56 hospitals) was exploratory and cycle 2 (77 hospitals) was designed to confirm the hypothesis generated by the first cycle, with three phases each (pre-intervention, intervention, post-intervention). Cycles included: evaluation of healthcare workers' knowledge, observation of practices, and CLABSI rates monthly report. In cycle 1, a log-normal mixed model was used to select variables significantly associated with the reduction of CLABSI. In cycle 2, CLABSI rates were evaluated.
Healthcare workers' practices improved after intervention. In cycle 1, reduction of CLABSI rates was more pronounced in hospitals with initial CLABSI rates >7.4 per 1000 catheter-days (P < 0.001) and those that introduced the use of peripherally inserted central catheters (P = 0.01). For hospitals with high CLABSI initial rates, simulation demonstrated that the rates were expected to decrease by 36% (95% CI: 9-63), no matter the type of intervention. In cycle 2, there was an overall decrease in CLABSI rates during the intervention period; whereas the mean rate fell further post-intervention, rates at the 90 percentile increased.
The implementation strategy may have had an effect on infection rates independently of the specific interventions implemented; however, the sustainability of reduction in the post-intervention period remains a challenge.
针对中低收入国家的中心静脉相关血流感染（CLABSI），鲜有研究探索实施策略。
实施针对性干预措施，降低成人重症监护病房的 CLABSI 发生率。
巴西圣保罗州实施了州卫生局的实施策略，该策略跨越两个周期进行。第一周期（56 家医院）为探索性周期，第二周期（77 家医院）旨在证实第一周期产生的假设，每个周期分为三个阶段（干预前、干预中和干预后）。周期包括：评估医护人员的知识、观察实践和每月报告 CLABSI 率。在第一周期中，使用对数正态混合模型选择与降低 CLABSI 显著相关的变量。在第二周期中，评估 CLABSI 率。
干预后医护人员的实践有所改善。在第一周期中，CLABSI 率降低更为明显的是初始 CLABSI 率>7.4/1000 导管日的医院（P<0.001）和引入使用外周插入中心导管的医院（P=0.01）。对于初始 CLABSI 率较高的医院，模拟显示，无论干预类型如何，预计 CLABSI 率将降低 36%（95%CI：9-63）。在第二周期中，干预期间 CLABSI 率总体下降；而干预后平均率进一步下降，第 90 百分位的率则上升。
实施策略可能对感染率产生影响，而与实施的具体干预措施无关；然而，干预后降低的可持续性仍然是一个挑战。
