肾移植重症监护病房医疗相关感染的多方面控制干预措施：临床结局改善与集束化依从性
Multifaceted Control Interventions for Healthcare-associated Infections in a Kidney Transplant Intensive Care Unit: Clinical Outcome Improvement and Bundle Adherence.
作者信息
Calegari Luana Oliveira, Peruzzo Maria Bethânia, Foresto Renato Demarchi, Tedesco-Silva Helio, Medina Pestana José, Requião-Moura Lúcio R
机构信息
Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.
Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil.
出版信息
Transplant Direct. 2024 Oct 28;10(11):e1718. doi: 10.1097/TXD.0000000000001718. eCollection 2024 Nov.
BACKGROUND
Healthcare-associated infections (HAIs) are preventable complications that overwhelm the healthcare system. The implementation of multifaceted control intervention actions in the intensive care setting modifies clinical outcomes, but its effectiveness has not been specifically investigated for high-risk patients, such as kidney transplant recipients (KTRs).
METHODS
This observational retrospective natural experiment evaluated the effectiveness of multifaceted control interventions (bundles) in reducing HAIs in a KTR intensive care unit. We also measured the bundle adherence rate during 16 mo in the after era.
RESULTS
We included 1257 KTRs, 684 before and 573 in the postintervention period. After the bundle implementation, the incidence density of device-associated HAIs decreased from 8.5 to 3.9 per 1000 patient-days (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.25-0.85; = 0.01), primarily because of the reduction in central line-associated bloodstream infection from 8.0 to 3.4 events per 1000 catheter-days (RR = 0.43; 95% CI, 0.22-0.83; = 0.012). Reductions in catheter-associated urinary tract infection (2.5 versus 0.6 per 1000 catheter-days; RR = 0.22; 95% CI, 0.03-1.92; = 0.17) and ventilator-associated pneumonia (3.4 versus 1.0 per 1000 ventilator-days; RR = 0.29; 95% CI, 0.03-2.63; = 0.27) were not significant. Central venous ( = 0.53) and urinary catheter ( = 0.47) insertion adherence were stable during 16 mo, whereas central venous ( < 0.001) and urinary catheter ( = 0.004) maintenance gradually increased. Finally, ventilator-associated pneumonia prevention bundle adherence slightly decreased over time ( = 0.06).
CONCLUSIONS
The implementation of comprehensive multifaceted control intervention actions in an intensive care unit dedicated to KTR care was effective in significantly reducing device-associated infections. The impact was in line with the reductions observed in populations that have not undergone transplantation, underscoring the effectiveness of these interventions across different patient groups.
背景
医疗保健相关感染（HAIs）是可预防的并发症，给医疗保健系统带来了巨大压力。在重症监护环境中实施多方面的控制干预措施可改善临床结局，但尚未针对高危患者（如肾移植受者[KTRs]）对其有效性进行专门研究。
方法
这项观察性回顾性自然实验评估了多方面控制干预措施（组合措施）在降低KTR重症监护病房HAIs方面的有效性。我们还测量了后一时期16个月内组合措施的依从率。
结果
我们纳入了1257例KTRs，干预前684例，干预后573例。实施组合措施后，与设备相关的HAIs的发病密度从每1000患者日8.5例降至3.9例（相对风险[RR]=0.46；95%置信区间[CI]，0.25 - 0.85；P = 0.01），主要原因是中心静脉导管相关血流感染从每1000导管日8.0例降至3.4例（RR = 0.43；95%CI，0.22 - 0.83；P = 0.012）。导尿管相关尿路感染（每1000导管日2.5例对0.6例；RR = 0.22；95%CI，0.03 - 1.92；P = 0.17）和呼吸机相关性肺炎（每1000呼吸机日3.4例对1.0例；RR = 0.29；95%CI，0.03 - 2.63；P = 0.27）的减少不显著。中心静脉导管（P = 0.53）和导尿管（P = 0.47）插入的依从性在16个月内保持稳定，而中心静脉导管（P < 0.001）和导尿管（P = 0.004）维护的依从性逐渐增加。最后，呼吸机相关性肺炎预防组合措施的依从性随时间略有下降（P = 0.06）。
结论
在专门用于KTR护理的重症监护病房实施全面的多方面控制干预措施可有效显著降低与设备相关的感染。这一影响与未接受移植人群中观察到的感染减少情况一致，强调了这些干预措施在不同患者群体中的有效性。
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