Duke Regional Hospital, Durham, NC.
Duke University School of Nursing, Infection Control and Hospital Epidemiology, Duke University Hospital, Durham, NC.
Am J Infect Control. 2023 Sep;51(9):1034-1037. doi: 10.1016/j.ajic.2023.01.007. Epub 2023 Feb 2.
Daily chlorhexidine gluconate (CHG) bathing is a well-supported intervention to reduce patient's risk of central line associated bloodstream infection (CLABSI); however, compliance with this practice is suboptimal. One major barrier is patient refusals of CHG bathing. The purpose of this project was to implement tailored interventions to mitigate this barrier. The specific aims were to reduce patient refusals, increase compliance with CHG bathing, and evaluate CLABSI rates and nursing staff's knowledge of CHG bathing.
Iterative Plan-Do-Study-Act (PDSA) cycles were implemented over the course of 6 months. Run charts were used to identify signals of improvement. Interventions included printed educational flyers for staff and patients, educational sessions, an electronic learning module, and a "badge buddy."
We saw a reduction in the median percentage of patient refusals documented, from 23% to 8% after the PDSA cycles. Documentation compliance with CHG bathing increased only slightly from 46% to 47%. CLABSI rates decreased 6% from 0.69 to 0.65.
Using interventions tailored to the clinical setting can impact patient outcomes. Other health care systems should consider implementing PDSA cycles to improve evidence-based practices.
Using PDSA cycles can result in a reduction in patient refusal documentation, and may slightly improve CHG bathing compliance and CLABSI rates.
每天使用葡萄糖酸氯己定（CHG）沐浴是一种经过充分验证的干预措施，可以降低患者发生中心静脉相关血流感染（CLABSI）的风险；然而，这种做法的依从性并不理想。主要障碍之一是患者拒绝接受 CHG 沐浴。本项目的目的是实施针对性干预措施来减轻这一障碍。具体目标是减少患者拒绝率，提高 CHG 沐浴的依从性，并评估 CLABSI 发生率和护理人员对 CHG 沐浴的知识。
在 6 个月的时间里，我们采用迭代的计划-执行-研究-行动（PDSA）循环。运行图用于识别改进的信号。干预措施包括为员工和患者提供印刷教育传单、教育课程、电子学习模块和“徽章伙伴”。
我们观察到记录的患者拒绝百分比中位数从 PDSA 循环前的 23%下降到 8%。CHG 沐浴的记录依从性仅从 46%略有增加到 47%。CLABSI 发生率从 0.69 下降到 0.65，下降了 6%。
使用针对临床环境定制的干预措施可以影响患者的结果。其他医疗保健系统应考虑实施 PDSA 循环，以改进基于证据的实践。
使用 PDSA 循环可以减少患者拒绝记录，并且可能略微提高 CHG 沐浴的依从性和 CLABSI 发生率。
