降低中心静脉导管相关血流感染的一项真实世界研究

A real-world study on reducing central line-associated bloodstream infection

摘要:

目的 探讨中心静脉导管相关血流感染(CLABSI)的发病风险及窗口期,分析应用多学科(MDT)管理方法降低CLABSI的效果,为CLABSI防控策略的制定提供依据。方法 选择2019年1月—2022年12月,某三级甲等医院重症监护病房(ICU)所有中心静脉导管(CVC)置管的住院患者。使用2个阶段的单中心前后对照真实世界研究,第1阶段(2019年1月—2020年12月)为基线对照阶段,第2阶段(2021年1月—2022年12月)为干预阶段,项目组运用MDT管理方法持续强化组织管理,完善工作流程,使用独立研发的"CLABSI吹哨系统"前瞻性监控CLABSI发病风险,并在CLABSI集束化防控策略中根据风险实际情况增加了CVC置管后7 d内医护间交互核查(cross-checklist)的机制。结果 基线期CLABSI发病率为9.16%,日发病率为10.75‰;干预期CLABSI发病率为5.99%,日发病率为6.48‰;干预前后CLABSI发病率、日发病率比较,差异均有统计学意义(均P＜0.001)。CVC置管后的第7~9天是CLABSI的急性发病期,急性期后发病风险趋于平缓,项目组在置管后的7 d内通过干预,成功降低了CLABSI发病风险(χ²=19.130,P＜0.001)。结论 CVC置管后第7~9天是降低CLABSI的机会窗口,把握住这个时期,可以有效降低CLABSI发病风险。

Abstract:

Objective To evaluate the risk and window period of the occurrence of central line-associated bloodstream infection (CLABSI), analyze the effect of applying multidisciplinary team (MDT) management to reduce CLABSI, and provide evidence for the formulation of prevention and control strategies for CLABSI. Methods All hospitalized patients with central venous catheter (CVC) in the intensive care unit (ICU) of a tertiary first-class hospital were selected from January, 2019 to December, 2022. A two-stage, single-center, pre- and post-control real-world study was adopted. The first stage (from January, 2019 to December, 2020) was the baseline control stage, and the second stage (from January, 2021 to December, 2022) was the intervention stage. The project team used MDT management method to continuously strengthen organizational management, improve work processes, and prospectively monitor the risk of the occurrence of CLABSI by using the independently developed "CLABSI whistle system". In addition, according to the actual risk situation, a mechanism of cross-checklist was added to CLABSI bundle prevention and control strategy within 7 days after CVC intubation. Results The incidence of CLABSI at baseline stage was 9.16% and the daily incidence was 10.75‰. The incidence of CLABSI in the intervention period was 5.99% and the daily incidence was 6.48‰. The incidence and daily incidence of CLABSI before and after intervention were statistically different (both P<0.001). The acute onset period of CLABSI was 7-9 days after CVC intubation, afterwards the risk turned stable. The project team successfully reduced the risk of CLABSI through intervention within 7 days after intubation (χ²=19.130, P＜0.001). Conclusion 7-9 days after CVC intubation is the window of opportunity to reduce CLABSI, and grasping this period can effectively reduce the risk of CLABSI.