BUNDLE降低中央导管血流感染实例——来自阿根廷一家医院的研究报道

蓝鱼o_0

Evidence based BUNDLE被认为是控制和预防CLABSI的有效策略和措施。在阿根廷的这家医院，研究者和他的团队报道了，通过这些干预有效地降低了CLABSI的发病率，节省了成本，促进患者安全。Bundle approach reduced CLABSIs, costs in Argentina hospital

Implementing a multimodal bundle approach reduced central line-associated bloodstream infections and resulted in overall net savings at the Hospital Universitario Austral in Pilar, Argentina. Rodolfo Ernesto Quirós, MD, of the prevention and infection control department at the hospital, presented these findings at the International Conference on Prevention and Infection Control in Geneva.

“Because the rates of central line-associated bloodstream infections were above international standards at our institution, it was decided to implement a specific bundle through a multimodal approach,” the researchers wrote in the study abstract. Between March 2010 and February 2011, Quirós and colleagues implemented preventive measures in the ICUs:

BUNDLE：

• Use central venous catheters only if strictly necessary.
• Avoid femoral site if possible.
• Hand hygiene with alcohol-gel before insertion.
• Use full-barrier precautions during the insertion of central venous catheters.
• Clean the skin with chlorhexidine (2%).
• Remove unnecessary catheters.

Implementation was based on the “5E” model (engage, education, execution, evaluation and encouragement).

干预的执行基于"5E"模型！（预期，教育，执行，评估和鼓励）

Compared with the 1-year average of 6.84 central line-associated bloodstream infections (CLABSIs) per device-days before implementation, the incidence rate during the intervention period was 2.70 CLABSIs per device-days (RR=0.40; 95% CI, 0.22-0.69). In addition, adherence was more than 90% across all bundle components during the intervention period, and the overall net savings was $130,500.

通过“证据为基础”的干预措施，CLABSI发生率显著降低，通过干预可以降低60%的CLABSI发病风险(RR=0.40; 95% CI, 0.22-0.69)。所有的BUNDLE 成分执行率达到90%以上，并且降低了130500美元的成本。

Disclosure: The researchers report no relevant financial disclosures.

青城山

蓝鱼老师，我有个问题请教：
在ICU 的目标性监测中发现，我们的ICU 中的CR-BSI  例次日感染率只有 千分之2-3；
高收入国家基本也就是这个水平；
是我们的诊断标准不一样，还是有其他原因？
还有就是对于这几个率的具体叫法，我已经迷惑了；
有的叫例次千日感染率、例次日感染率、例次床日感染率；是不是在不同的地方需要运用不同的说法，还是我们的翻译不一样；
谢谢！

蓝鱼o_0

huiqing.li 发表于 2011-8-2 19:23

                               
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蓝鱼老师，我有个问题请教：
在ICU 的目标性监测中发现，我们的ICU 中的CR-BSI  例次日感染率只有 千分之2 ...

千分之2-3不知道，我本人不是很相信的。
目前为止，还没有设计非常严密的前瞻性的结果。回顾性的研究偏倚比较大。其暴露结果不能外推到我国的情况。

你下面说的那几个都是发病密度。至于例次千日感染率、例次日感染率、例次床日感染率，不同的研究报道不一致，所以翻译过来就不尽相同。数量级跟他们的要求有关，也跟他们往年的数据有关系。