PDF(Pubmed)
Abstract：
Although evidence-based interventions can reduce the incidence of central line-associated bloodstream infection (CLABSI), there is a large gap between evidence-based interventions and the actual practice of central venous catheter (CVC) care. Evidence-based interventions are needed to reduce the incidence of CLABSI in intensive care units (ICU) in China. Professional association, guidelines, and database websites were searched for data relevant to CLABSI in the adult ICUs from inception to February 2020. Checklists were developed for both CVC placement and maintenance. Based on the Integrated Promoting Action on Research Implementation in Health Services framework, a questionnaire collected the cognition and practice of ICU nursing and medical staff on the CLABSI evidence-based prevention guidelines. From January 2018 to December 2021, ICU CLABSI rates were collected monthly. Ten clinical guidelines were included after the screening and evaluation process and used to develop the best evidence-based protocols for CVC placement and maintenance. The CLABSI rates in 2018, 2019, and 2020 were 2.98‰ (9/3021), 1.83‰ (6/3276), and 1.69‰ (4/2364), respectively. Notably, the CLABSI rate in 2021 was 0.38‰ (1/2607). In other words, the ICU CLABSI rate decreased from 1.69‰ to 0.38‰ after implementation of the new protocols. Additionally, our data suggested that the use of ultrasound-guidance for catheter insertion, chlorhexidine body wash, and the use of a checklist for CVC placement and maintenance were important measures for reducing the CLABSI rate. The evidence-based processes developed for CVC placement and maintenance were effective at reducing the CLABSI rate in the ICU.
摘要：
尽管以证据为基础的干预措施可以降低中线相关血流感染（CLABSI）的发生率，循证干预措施与中心静脉导管(CVC)护理的实际实践之间存在很大差距.在中国，需要采取循证干预措施来降低重症监护病房（ICU）中CLABSI的发生率。专业协会,指导方针,从开始到2020年2月，在成人ICU中搜索与CLABSI相关的数据。为CVC放置和维护制定了清单。基于卫生服务研究实施综合促进行动框架，问卷收集了ICU护理人员和医务人员对CLABSI循证预防指南的认知和实践.从2018年1月到2021年12月，每月收集ICUCLABSI费率。在筛选和评估过程后纳入了十项临床指南，用于制定CVC放置和维护的最佳循证方案。2018年、2019年和2020年的CLABSI利率为2.98‰（9/3021），1.83‰(6/3276)，和1.69‰(4/2364)，分别。值得注意的是,2021年CLABSI率为0.38‰（1/2607）。换句话说,实施新协议后，ICUCLABSI率从1.69‰下降到0.38‰。此外,我们的数据表明，使用超声引导导管插入，洗必泰沐浴露,使用检查表进行CVC放置和维护是降低CLABSI率的重要措施。为CVC放置和维护开发的循证流程可有效降低ICU中的CLABSI率。
