Abstract：
BACKGROUND: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden.
METHODS: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs.
RESULTS: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months.
CONCLUSIONS: The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.
METHODS: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs.
RESULTS: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months.
CONCLUSIONS: The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.
摘要：
背景：ICU中发生的中心线（CL）相关血流感染（CLABSI）很常见，并且与高负担相关。
方法：我们实施了一种多维方法，包含一个11元素的束，教育,监测CLABSI率和临床结果，监控捆绑组件的合规性，CLABSI率和临床结果的反馈，以及30个低收入和中等收入国家(LMICs)的316个ICU的绩效反馈。我们的因变量是每1,000-CL天的CLABSI和ICU中的全因死亡率。这些变量在基线和干预期间进行了测量，特别是在第二个月，第三个月,4-16个月,17-29个月。使用双样本t检验进行比较。为了探索暴露与结果的关系，我们使用具有泊松分布的广义线性混合模型对CLABSI的数量进行建模。
结果：在1,837,750个患者日期间，283,087名患者，使用了1,218,882个CL天。CLABSI每1,000个CL天的发生率从基线期的15.34下降到第2个月的7.97（RR=0.52；95％CI=0.48-0.56；P<0.001），第3个月为5.34（RR=0.35；95％CI=0.32-0.38；P<0.001），17-29个月为2.23（RR=0.15；95％CI=0.13-0.17；P<0.001）。ICU内全因死亡率从基线时的16.17%降至17-29个月时的13.68%(RR=0.84;p=0.0013)。
结论：实施的方法是有效的，类似的干预措施可应用于其他LMICs的ICU,以降低CLABSI和ICU内全因死亡率.
方法：我们实施了一种多维方法，包含一个11元素的束，教育,监测CLABSI率和临床结果，监控捆绑组件的合规性，CLABSI率和临床结果的反馈，以及30个低收入和中等收入国家(LMICs)的316个ICU的绩效反馈。我们的因变量是每1,000-CL天的CLABSI和ICU中的全因死亡率。这些变量在基线和干预期间进行了测量，特别是在第二个月，第三个月,4-16个月,17-29个月。使用双样本t检验进行比较。为了探索暴露与结果的关系，我们使用具有泊松分布的广义线性混合模型对CLABSI的数量进行建模。
结果：在1,837,750个患者日期间，283,087名患者，使用了1,218,882个CL天。CLABSI每1,000个CL天的发生率从基线期的15.34下降到第2个月的7.97（RR=0.52；95％CI=0.48-0.56；P<0.001），第3个月为5.34（RR=0.35；95％CI=0.32-0.38；P<0.001），17-29个月为2.23（RR=0.15；95％CI=0.13-0.17；P<0.001）。ICU内全因死亡率从基线时的16.17%降至17-29个月时的13.68%(RR=0.84;p=0.0013)。
结论：实施的方法是有效的，类似的干预措施可应用于其他LMICs的ICU,以降低CLABSI和ICU内全因死亡率.
