National Center for Infection Control, Israel Ministry of Health, Israel.
Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
Infect Control Hosp Epidemiol. 2019 Oct;40(10):1094-1099. doi: 10.1017/ice.2019.190. Epub 2019 Jul 24.
Prevention of central-line-associated bloodstream infection (CLABSI) represents a complex challenge for the teams involved in device insertion and maintenance. First-tier practices for CLABSI prevention are well established.
We describe second-tier prevention practices in Israeli medical-surgical ICUs and assess their association with CLABSI rates.
In June 2017, an online survey assessing infection prevention practices in general ICUs was sent to all Israeli acute-care hospitals. The survey comprised 14 prevention measures supplementary to the established measures that are standard of care for CLABSI prevention. These measures fall into 2 domains: technology and implementation. The association between the number of prevention measures and CLABSI rate during the first 6 months of 2017 was assessed using Spearman's correlation. We used negative binomial regression to calculate the incidence rate ratio (IRR) associated with the overall number of prevention measures and with each measure individually.
The CLABSI rates in 24 general ICUs varied between 0.0 and 17.0 per 1,000 central-line days. Greater use of preventive measures was associated with lower CLABSI rates (ρ, -0.70; P < .001). For each additional measure, the incidence of CLABSI decreased by 19% (IRR, 0.81; 95% CI, 0.73-0.89). Specific measures associated with lower rates were involvement of ward champions (IRR, 0.47; 95% CI, 0.31-0.71), auditing of insertions by infection control staff (IRR, 0.35; 95% CI, 0.19-0.64), and simulation-based training (IRR, 0.38; 95% CI, 0.22-0.64).
Implementation of second-tier preventive practices was protective against CLABSI. Use of more practices was correlated with lower rates.
预防中心静脉导管相关血流感染（CLABSI）对于参与导管插入和维护的团队来说是一个复杂的挑战。预防 CLABSI 的一级措施已经确立。
我们描述了以色列内科外科 ICU 的二级预防措施，并评估了它们与 CLABSI 发生率的关系。
2017 年 6 月，向所有以色列急性护理医院发送了一项在线调查，评估普通 ICU 的感染预防措施。该调查包括 14 项预防措施，这些措施是预防 CLABSI 的标准护理措施之外的补充措施。这些措施分为 2 个领域：技术和实施。使用 Spearman 相关系数评估 2017 年上半年的预防措施数量与 CLABSI 发生率之间的关系。我们使用负二项回归计算与整体预防措施数量和单独每个措施相关的发病率比（IRR）。
24 个普通 ICU 的 CLABSI 发生率在 0.0 至 17.0 每 1000 个中心静脉置管天数之间变化。更多使用预防措施与较低的 CLABSI 发生率相关（ρ，-0.70；P<0.001）。每增加一项措施，CLABSI 的发生率降低 19%（IRR，0.81；95%CI，0.73-0.89）。与较低发生率相关的具体措施包括病房冠军的参与（IRR，0.47；95%CI，0.31-0.71）、感染控制人员对插入物的审核（IRR，0.35；95%CI，0.19-0.64）和基于模拟的培训（IRR，0.38；95%CI，0.22-0.64）。
实施二级预防措施可预防 CLABSI。使用更多的措施与更低的发生率相关。
