'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

被引：197

作者：

Bion, Julian ^{[1
]}

Comm, Writing

Richardson, Annette ^{[2
,3
]}

Hibbert, Peter ^{[3
]}

Beer, Jeanette

Abrusci, Tracy ^{[1
]}

McCutcheon, Martin ^{[4
]}

Cassidy, Jane ^{[2
]}

Eddleston, Jane ^{[5
]}

Gunning, Kevin ^{[6
]}

Bellingan, Geoff ^{[7
]}

Patten, Mark ^{[8
]}

Harrison, David ^{[9
]}

机构：

[1] Univ Birmingham, Birmingham B15 2UN, W Midlands, England

[2] Freeman Rd Hosp, Newcastle Upon Tyne NE7 7DN, Tyne & Wear, England

[3] Natl Patient Safety Agcy, London, England

[4] Dept Hlth, London SE1 6TE, England

[5] Manchester Royal Infirm, Manchester M13 9WL, Lancs, England

[6] Addenbrookes Hosp, Cambridge, England

[7] UCL, London, England

[8] Luton & Dunstable Hosp, Luton, Beds, England

[9] Intens Care Natl Audit & Res Ctr, London, England

来源：

BMJ QUALITY & SAFETY | 2013年 / 22卷 / 02期

关键词：

QUALITY-IMPROVEMENT; EDUCATION-PROGRAM; SAFETY; SURVEILLANCE; REDUCTION; HOSPITALS; IMPACT; RECOMMENDATIONS; BACTEREMIA; BEHAVIOR;

D O I：

10.1136/bmjqs-2012-001325

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. Methods We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. Results Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (kappa 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. Conclusions The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

引用

页码：110 / 123

页数：14

共 56 条

[1]

[Anonymous], 2008, HIGH QUALITY CARE AL

[2]

[Anonymous], 1979, Quasi-experimentation: Design analysis issues for field settings

[3]

[Anonymous], 2005, MMWR Morb Mortal Wkly Rep

[4] Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department [J].

Backman, Lauren A. ;

Melchreit, Richard ;

Rodriguez, Richard .

AMERICAN JOURNAL OF INFECTION CONTROL, 2010, 38 (10) :832-838

[5] Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase [J].

Benning, Amirta ;

Dixon-Woods, Mary ;

Nwulu, Ugochi ;

Ghaleb, Maisoon ;

Dawson, Jeremy ;

Barber, Nick ;

Franklin, Bryony Dean ;

Girling, Alan ;

Hemming, Karla ;

Carmalt, Martin ;

Rudge, Gavin ;

Naicker, Thirumalai ;

Kotecha, Amit ;

Derrington, M. Clare ;

Lilford, Richard .

BMJ-BRITISH MEDICAL JOURNAL, 2011, 342 :370

[6] Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach [J].

Bhutta, Adnan ;

Gilliam, Craig ;

Honeycutt, Michele ;

Schexnayder, Stephen ;

Green, Jerril ;

Moss, Michele ;

Anand, K. J. S. .

BRITISH MEDICAL JOURNAL, 2007, 334 (7589) :362-365

[7] National Efforts to Improve Door-to-Balloon Time Results From the Door-to-Balloon Alliance [J].

Bradley, Elizabeth H. ;

Nallamothu, Brahmajee K. ;

Herrin, Jeph ;

Ting, Henry H. ;

Stern, Amy F. ;

Nembhard, Ingrid M. ;

Yuan, Christina T. ;

Green, Jeremy C. ;

Kline-Rogers, Eva ;

Wang, Yongfei ;

Curtis, Jeptha P. ;

Webster, Tashonna R. ;

Masoudi, Frederick A. ;

Fonarow, Gregg C. ;

Brush, John E., Jr. ;

Krumholz, Harlan M. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (25) :2423-2429

[8] An epistemology of patient safety research: a framework for study design and interpretation. Part 2. Study design [J].

Brown, C. ;

Hofer, T. ;

Johal, A. ;

Thomson, R. ;

Nicholl, J. ;

Franklin, B. D. ;

Lilford, R. J. .

QUALITY & SAFETY IN HEALTH CARE, 2008, 17 (03) :163-169

[9] Aseptic insertion of central venous lines to reduce bacteraemia The Central Line Associated Bacteraemia in NSW Intensive Care Units (CLAB ICU) Collaborative [J].

Burrell, Anthony R. ;

McLaws, Mary-Louise ;

Murgo, Margherita ;

Calabria, Eda ;

Pantle, Annette C. ;

Herkes, Robert .

MEDICAL JOURNAL OF AUSTRALIA, 2011, 194 (11) :583-587

[10] National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004 [J].

Cardo, D ;

Horan, T ;

Andrus, M ;

Dembinski, M ;

Edwards, J ;

Peavy, G ;

Tolson, J ;

Wagner, D .

AMERICAN JOURNAL OF INFECTION CONTROL, 2004, 32 (08) :470-485

← 1 2 3 4 5 6 →