Balla Kalyan Chakravarthy, Rao Suman Pn, Arul Celine, Shashidhar A, Prashantha Y N, Nagaraj Savitha, Suresh Gautham
Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India.
Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India. Correspondence to: Dr Suman PN Rao, Department of Neonatology, St John's Medical College Hospital, Sarjapur Road, Koramangala, Bangalore 560 034, Karnataka, India.
Indian Pediatr. 2018 Sep 15;55(9):753-756.
To study the impact of a quality improvement (QI) initiative using care bundle approach on Central-line associated bloodstream infections (CLABSI) rates.
A QI team for infection control in NICU was formed in a tertiary-care neonatal intensive care unit (NICU) from June 2015 to August 2016. Baseline data were collected over first 3 months followed by the intervention period of 1 year. Measures with respect to strengthening hand hygiene and central line bundle care were implemented during the intervention period. Audits assessing the compliance to hand hygiene and CLABSI bundle protocols were used as process indicators. Multiple PDSA cycles were used to strengthen the practices of proposed interventions, documentation of data and audits of the processes during the study period.
The QI initiative achieved a 89% reduction in CLABSI from the baseline rate of 31.7 to 3.5 per 1000 line-days. The blood stream Infections reduced from 7.3 to 2.3 per 1000 patient-days. The overall mortality showed a reduction from 2.9% to 1.7% during the intervention period. There was a significant improvement in compliance with hand hygiene protocol and compliance with CLABSI protocols.
This study demonstrated that simple measures involving hand hygiene and strengthening of the care bundle approach through quality improvement could significantly reduce the blood stream Infections and CLABSI rates.
研究采用护理集束化方法的质量改进（QI）举措对中心静脉导管相关血流感染（CLABSI）发生率的影响。
2015年6月至2016年8月，在一家三级护理新生儿重症监护病房（NICU）组建了一个NICU感染控制QI团队。在最初3个月收集基线数据，随后是为期1年的干预期。在干预期实施了加强手卫生和中心静脉导管集束化护理的措施。评估手卫生和CLABSI集束化方案依从性的审核用作过程指标。在研究期间，使用多个计划-执行-检查-处理（PDSA）循环来强化拟实施干预措施的实践、数据记录和过程审核。
QI举措使CLABSI发生率从基线的每1000导管日31.7例降至3.5例，降幅达89%。血流感染率从每1000患者日7.3例降至2.3例。干预期间总体死亡率从2.9%降至1.7%。手卫生方案和CLABSI方案的依从性有显著改善。
本研究表明，通过质量改进采取涉及手卫生和强化护理集束化方法的简单措施，可显著降低血流感染率和CLABSI发生率。
