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一种针对导管相关血流感染的多学科综合护理管理方法。

A multidisciplinary comprehensive nursing Management Approach for Catheter-related bloodstream infections.

作者信息

Xu Lingli, Tang Leiwen, Qin Jianfen, Pan Hongying

机构信息

Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.

Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.

出版信息

Eur J Clin Microbiol Infect Dis. 2025 Feb;44(2):365-373. doi: 10.1007/s10096-024-05002-7. Epub 2024 Dec 10.

Abstract

BACKGROUND

Catheter-related bloodstream infection (CR-BSI) stands as one of the leading causes of hospital-acquired infections, often resulting in high healthcare expenditure and mortality rates. Despite efforts, reducing the incidence of CR-BSI remains a significant challenge.

OBJECTIVE

This study aimed to assess the impact of a multidisciplinary organizational intervention on reducing intravenous CR-BSI.

METHODS

A quality improvement team was established to implement various interventions, utilizing the FOCUS-PDCA continuous quality improvement model and fishbone diagram for analysis and improvement.

RESULTS

After the interventions, operational indicators for catheter insertion, maintenance, and removal improved from 82.50% ± 1.15%, 83.60% ± 1.60%, and 81.60% ± 1.80-95.30% ± 1.00%, 96.20% ± 1.62%, and 97.25% ± 0.50%, respectively. Additionally, catheter dwell time decreased from 7.50 ± 0.85 days to 3.50 ± 0.75 days, and the quarterly infection rate was reduced from 2.328% ± 1.85-0.305% ± 0.95% following the implementation of the intervention.

DISCUSSION

Despite the available evidence, there remains a noticeable gap between the ideal evidence-based practices and their practical implementation. We aim to eradicate CR-BSIs within the surgical intensive care units (ICUs) of hospitals. To achieve this goal, we have introduced a comprehensive quality improvement framework designed not only to benefit our own ICU but also to serve as a model for implementation in other similar healthcare settings.

摘要

背景

导管相关血流感染(CR-BSI)是医院获得性感染的主要原因之一,常常导致高昂的医疗费用和死亡率。尽管已做出诸多努力,但降低CR-BSI的发生率仍是一项重大挑战。

目的

本研究旨在评估多学科组织干预对减少静脉CR-BSI的影响。

方法

成立了一个质量改进团队来实施各种干预措施,利用FOCUS-PDCA持续质量改进模型和鱼骨图进行分析和改进。

结果

干预后,导管插入、维护和拔除的操作指标分别从82.50%±1.15%、83.60%±1.60%和81.60%±1.80%提高到95.30%±1.00%、96.20%±1.62%和97.25%±0.50%。此外,导管留置时间从7.50±0.85天降至3.50±0.75天,实施干预后季度感染率从2.328%±1.85%降至0.305%±0.95%。

讨论

尽管有现有证据,但理想的循证实践与其实际实施之间仍存在明显差距。我们旨在消除医院外科重症监护病房(ICU)内的CR-BSI。为实现这一目标,我们引入了一个全面的质量改进框架,该框架不仅有利于我们自己的ICU,还可作为在其他类似医疗环境中实施的典范。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b438/11754313/c87d274d5a51/10096_2024_5002_Fig1_HTML.jpg

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