Gitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
Department of Surgery, California Medical Center, Los Angeles, United States of America.
Crit Care Med. 2018 Aug;46(8):1357-1366. doi: 10.1097/CCM.0000000000003227.
To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections.
Single-center, prospective, before-and-after feasibility trial.
Emergency department of a sub-Saharan African district hospital.
Patients > 28 days of life admitted to the study hospital for an acute infection.
The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases.
Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 hours after hospital admission; and at discharge. A total of 1,594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001). No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (pre-intervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 hours (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed.
Our results indicate that a focused education program and implementation of an infection treatment bundle in clinical practice increased the rate of early evidence-based interventions in patients with acute infections (mostly malaria) admitted to a sub-Saharan African district hospital. Provision of material resources did not further increase this rate. While no safety issues were detected, this could be related to the very low disease severity of the enrolled patient population (www.clinicaltrials.gov: NCT02697513).
评估聚焦式教育方案和治疗包的实施是否能提高急性感染患者早期循证干预的比例。
单中心、前瞻性、前后可行性试验。
撒哈拉以南非洲地区一家区级医院的急诊科。
年龄＞28 天、因急性感染而入住研究医院的患者。
试验分为三个阶段（每个阶段持续四个月）。干预发生在第二阶段（教育方案和治疗包的实施）和第三阶段（提供实施治疗包的资源）。
在入组时、入院后 24、48 和 72 小时以及出院时收集人口统计学、临床和实验室数据。共纳入 1594 名患者（预干预组 661 名、干预 I 组 531 名、干预 II 组 402 名）。在干预阶段 I，每位患者接受早期循证干预的比例高于预干预阶段（74±17%比 79±15%，p＜0.001）。当将 I 期和 II 期的数据进行比较时，未发现差异（79±15%比 80±15%，p=0.58）。在输血（预干预组 6%、干预 I 组 7%、干预 II 组 7%）或前 24 小时严重不良事件（过敏反应：预干预组 0.2%、干预 I 组 0%、干预 II 组 0%；呼吸衰竭：预干预组 2%、干预 I 组 2%、干预 II 组 2%；急性肾衰竭：预干预组 2%、干预 I 组 2%、干预 II 组 1%）发生率方面，也未观察到差异。
我们的结果表明，聚焦式教育方案和临床实践中治疗包的实施提高了撒哈拉以南非洲地区一家区级医院急性感染（主要是疟疾）患者早期循证干预的比例。提供物质资源并未进一步提高这一比例。虽然未发现安全问题，但这可能与入组患者人群疾病严重程度非常低有关（www.clinicaltrials.gov：NCT02697513）。
