使用循证干预和护士赋权降低 CLABSI：巴基斯坦一家三级护理新生儿重症监护病房的质量改进举措。
CLABSI reduction using evidence based interventions and nurse empowerment: a quality improvement initiative from a tertiary care NICU in Pakistan.
机构信息
Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan.
出版信息
Arch Dis Child. 2021 Apr;106(4):394-400. doi: 10.1136/archdischild-2019-318779. Epub 2020 Apr 6.
OBJECTIVE
Central line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions.
DESIGN
This was a quality improvement (QI) project. Data collection was divided into three phases (pre-implementation, implementation and post implementation). SQUIRE2.0 guidelines were used to design, implement and report this QI initiative.
SETTING
A tertiary care level 3 NICU at the Aga Khan University Hospital (AKUH), Karachi, Pakistan.
PATIENTS
All patients admitted to the AKUH NICU from 1 January 2016 to 31 March 2018 who had a central line in place during their NICU admission.
INTERVENTIONS
CPP used evidence-based interventions focusing on hand hygiene, aseptic central line insertion techniques and central line care, prevention of fungal infections and nurse empowerment.
MAIN OUTCOME MEASURES
CLABSI rates pre and post intervention were recorded. Secondary outcomes were risk factors for CLABSI, device (central line) utilisation ratio, CLABSI related mortality and micro-organism profile.
RESULTS
CLABSI rates decreased from 17.1/1000 device days to 5.0/1000 device days (relative risk (RR)=0.36, CI=0.17-0.74). Device (central line) utilisation ratio declined from 0.30 to 0.25. Out of 613 patients enrolled in our study, 139 (22.7%) died. Mortality was higher in CLABSI group (n=20, 44%) as compared with non CLABSI group (n=119, 21.1%) (p<0.001). Gestational age of <27 weeks was an independent risk factor for CLABSI (RR=4.45, CI=1.10-18.25, p=0.03). A total of 158 pathogens were isolated among which 68 were associated with CLABSI. Gram-negative bacteria 31 (47.7%) were the most common cause of CLABSI. Ninety-seven (61%) micro-organisms were multi-drug resistant.
CONCLUSIONS
CPP was effective in decreasing NICU CLABSI rates and can be used as a model to decrease NICU CLABSI rates in low or middle-income countries.
目的
中心静脉相关血流感染（CLABSI）是新生儿重症监护病房（NICU）发病率和死亡率的重要原因。我们设计了一个中心静脉导管相关血流感染预防包（CPP），以降低 NICU 的 CLABSI 发生率，使用经过验证的干预措施。
设计
这是一项质量改进（QI）项目。数据收集分为三个阶段（实施前、实施中和实施后）。使用 SQUIRE2.0 指南来设计、实施和报告这一 QI 计划。
地点
巴基斯坦卡拉奇 Aga Khan 大学医院（AKUH）的三级护理 3 级 NICU。
患者
所有于 2016 年 1 月 1 日至 2018 年 3 月 31 日期间入住 AKUH NICU 并在 NICU 住院期间放置中心静脉导管的患者。
干预措施
CPP 使用了以手部卫生、无菌中心静脉置管技术和中心静脉护理、预防真菌感染和护士赋权为重点的循证干预措施。
主要观察指标
记录干预前后 CLABSI 发生率。次要结局为 CLABSI 的危险因素、器械（中心静脉导管）使用率、CLABSI 相关死亡率和微生物谱。
结果
CLABSI 发生率从 17.1/1000 器械日降至 5.0/1000 器械日（相对风险（RR）=0.36，CI=0.17-0.74）。器械（中心静脉导管）使用率从 0.30 降至 0.25。在我们的研究中，613 名患者中有 139 名（22.7%）死亡。CLABSI 组（n=20，44%）的死亡率高于非 CLABSI 组（n=119，21.1%）（p<0.001）。胎龄<27 周是 CLABSI 的独立危险因素（RR=4.45，CI=1.10-18.25，p=0.03）。共分离出 158 种病原体，其中 68 种与 CLABSI 相关。革兰氏阴性菌 31 株（47.7%）是 CLABSI 的最常见原因。97 株（61%）微生物为多药耐药菌。
结论
CPP 可有效降低 NICU 的 CLABSI 发生率，可作为降低中低收入国家 NICU CLABSI 发生率的模型。
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