Nathaniel R. Payne, MD, of the Children’s Hospital and Clinics of Minnesota, and colleagues reported data from
a retrospective, observational study of the quality initiative.
Payne和她的研究团队通过回顾性观察性研究，分析了质量促进计划的的作用。The intervention consisted of quality intervention team members meeting monthly to discuss issues and develop campus-specific interventions.
The data included information on infection rates in the 5 years before the initiative and the 3 years after.
数据包括了质量计划前5年的感染率和后3年的感染率。
The researchers said nosocomial infections decreased by half between the two groups, even among very low birth weight babies.
研究人员说，院内感染下降了一半，甚至在低出生体重儿中也有显著降低。
The data also suggested reductions in
“bronchopulmonary dysplasia (30.2% vs. 25.5%, P=.001), median days to regain birth weight (9 vs. 8, P=.04), percutaneously placed central venous catheter use (54.8% vs. 43.9%, P=.002), median antibiotic days (8 vs. 6, P=.003), median total central line days (16 vs. 15, P=.01), and median ventilator days (7 vs. 5, P=.01).” 效应很显著啊！！
The researchers said there were some limitations to their study; notably, that their hospital has participated in a number of quality improvement programs and, therefore, has “probably increased the receptivity of our staff to changing treatment processes.”
Regardless, they said their findings suggested these types of interventions offer promise to address quality control measures in hospitals.
Disclosure: The researchers report no relevant financial disclosures.
Although recommendations for best practices to prevent infection exist, there are often systems-level barriers that make it more difficult for physicians and nurses to adhere to these recommendations. This study emphasized the importance of eliminating or minimizing systems-level barriers such as availability of supplies that made it much easier for practitioners to follow the appropriate guidelines and recommendations. Sometimes, changing the environment can be a key factor in improving adherence to best practices.
Another important aspect of this study was a clear emphasis on how clear demonstration of the organization's commitment to change can influence behavior. The publicity surrounding health care-acquired infection rates and the inclusion of paid time for education of nurses seemed to play a major role in overcoming the inertia of previous practice patterns.
For the daily practice of the hospital-based physician, I believe that this study provides proof, as well as inspiration, that adherence to proven multifaceted interventions, including attempts to demonstrate organizational commitment to change and removing systems-level barriers, can lead to sustained reductions in health care-acquired infections. Reduction of these infections was associated with overall improvements in patient outcomes.
尽管有最佳的预防操作指南的推荐以防止感染，但是由于常常出现系统级的障碍，反而使得医生和护士更难以坚持这些建议。本项研究强调了消除或最小化系统级的障碍的重要性，例如供应的可用性，这使得从业人员更容易遵循恰当的指导方针和建议。有时，环境改变，可以成为改善最佳实践依从性的关键因素。
这项研究的另一个重要方面是如何清楚地表明该组织改变可以影响行为的承诺，重点清晰，明确。周围医疗感染率和纳入护士教育时间的宣传也克服了以往的惯例模式的惯性。
对于以医院日常实践为基础的的医生，我认为，这项研究提供的证据，以及灵感，坚持证明多方面的干预，包括试图证明组织的承诺，改变和消除系统级障碍，可以持续降低医疗相关感染。而这些感染的降低则可以从总体上显著改善病患预后。
Samir S. Shah, MD, MSCE
Infectious Diseases in Children Board Member
Disclosure: Dr. Shah reports no relevant financial disclosures.
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