降低ICU院内感染发生措施的探索

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Program Seeks to Reduce ICU Infections
An estimated 250,000 such illnesses occur each year, CDC says
By Steven Reinberg
WEDNESDAY, Oct. 1 (HealthDay News) -- U.S. health officials are giving nearly $3 million to the American Hospital Association to help reduce so-called central line-associated bloodstream infections in hospital intensive care units.

Each year, an estimated 250,000 intensive care unit (ICU) patients suffer these infections, and 30,000 to 62,000 of them die, according to the U.S. Centers for Diseases Control and Prevention. The grant from the U.S. Agency for Healthcare Research and Quality (AHRQ) will be used over three years to roll out a program designed to reduce these infections nationwide.

"When we go to a hospital, we expect to leave healthier, not sicker," Dr. Carolyn M. Clancy, AHRQ's director, said during a Wednesday teleconference. "Unfortunately, it does not always work out that way. Too often, care provided in a hospital leads to infection. These infections are among the greatest risk that patients face."

These infections are largely preventable, Clancy said. "We are simply not doing nearly enough to prevent them. Changing behavior in health-care settings is challenging and isn't as simple as handing clinicians a checklist," she said.

Although infections occur in other parts of hospitals, concentrating on the ICU is a first step in trying to bring down infection rates throughout hospitals, Dr. Peter J. Pronovost, a professor at Johns Hopkins University School of Medicine, said during the teleconference.

The program was started by Johns Hopkins University in Baltimore and the Michigan Health & Hospital Association. It's designed to be a comprehensive unit-based patient safety program to help prevent infections related to central line catheters. Central line catheters, also called central venous catheters, are tubes placed into a large vein in the neck, chest or groin to supply medications or fluids or to collect blood samples.

When the safety program was tested in more than 100 Michigan intensive care units, infection rates dropped dramatically -- over three months, more than 50 percent of the participating hospitals saw their ICU infection rates drop to zero.

"Far too many people suffer preventable harm, suffering and death, and excess costs as a result of our health care system," Pronovost said. "The public deserves much safer health care than they are currently getting."

Using the program in Michigan has saved 1,500 to 1,800 lives a year and $200 million in costs, Pronovost said. "We now have the bold idea to spread the program throughout the rest of the country," he said.

The program is designed to survey and improve ICU safety by changing the "culture" of the ICU. It includes tools to help identify opportunities to reduce infections and policies to make care safer.

The grant program will involve hospitals in 10 states, with at least 10 hospitals in each state participating, Pronovost and Clancy said.
降低ICU院内感染发生措施的探索

疾控中心数据显示每年均有大约250,000例上述院内感染事件发生。
作者：史蒂文·冉伯格

十月一日星期三（健康报）——美国卫生部门官员每年要给美国医学协会拨款将近300万美元以用来减少医院重症监护病房内中心静脉置管相关的败血症（院内感染）。
根据美国疾病预防与控制中心的统计结果每年ICU中有 250,000例病人发生院内感染，其中有大约30,000到62,000治疗无效死亡。
一项由美国卫生保健研究和质控机构(AHRQ)授权的研究设计将探索三年内在全国范围内减少ICU院内感染发生的方法。
AHRQ的负责人卡罗琳·M·克兰西教授在周三的远程电话会议中指出：我们去医院就诊的目的是为了治好病而不是更加越看越糟糕。
很不幸的是并不是所有人都能在医院里获益，在很多情况下医疗相关性措施可以招致感染，并已经成为了病人需要面对的高危险对象之一。
克兰西教授指出这些感染在很大程度上是可以预防和避免的，只是我们在这方面还做得不够。改变卫生保健行为的模式是很艰巨的，这远比临床医生开具检查单要来的复杂得多。
在远程电话会议中，约翰霍普金斯大学医学院的皮特·J·普罗维斯特教授指出，虽然医院各个科室均有院内感染发生，但是致力于控制ICU的院内感染将是降低全院性院内感染几率的第一步。
这项研究有约翰霍普金斯大学和密西根州健康医疗协会共同发起。
此设计系为关于广泛性单一病人安全性的研究以预防深静脉置管相关性的感染。深静脉置管又被称作为中心静脉置管，是将导管插入颈部、胸部、腹股沟等处的较大静脉以便于给药、补液扩容以及采集血液标本。
随着这项安全性研究的深入，我们可以戏剧性地发现密西根州超过100家ICU的院内感染发生率显著下降——一半以上的综合性医院ICU病区在短短三个月内感染率下降到0。
普罗维斯特教授指出，通过此研究我们发现相当多的病人群还在面临伤害甚至是死亡并给卫生医疗系统造成了过大的经济负担，而这些原本是可以避免的。民众应该得到比现在更好更安全的卫生医疗。
普罗维斯特教授还指出在密西根州进行的研究每年能够挽救1,500到1,800例病人的生命并节省200万美元的开支，基于此我们将大胆的致力于将此研究在全国范围内推广。
此研究设计通过改变传统ICU监护文化来调查和证明ICU监护的安全性。它包含了识别降低感染发生率的工具和增加监护安全性的措施。
普罗维斯特和克兰西教授指出此项授权的研究将推广到10个州，并且每个州至少有10家以上的综合性医院。
转自丁香园，关注研究成果！