Reduction in Central Line Days, Central Line Utilization Ratio, and Central Line Associated Blood Stream Infections Through Hospital Based Intensivist Program

Michael Wilson
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Abstract

Purpose: We tracked the effect that a newly implemented intensivist program following a restrictive venous access policy emphasizing mid-lines and peripheral IVs over central lines had on central line days, central line utilization ratio, and central line associated blood stream infections in a non-academic hospital. Methods: Prior to June 2021, Mobile Infirmary’s intensive care units (ICU) were open units staffed with physicians with combined ICU, ward, and outpatient responsibilities. In June of 2021, an intensivist program was started to transition the hospital to a closed ICU model with intensivists whose sole responsibility was the ICU. Concurrently, a policy was implemented that emphasized avoidance of central lines unless indicated by defined criteria (MICAR Criteria). We tracked central line days (CLD), central line utilization ratio (CLUR) and central line associated blood stream infections (CLABSI) rates and compared it to these same unit for the 2 years prior to the start of the program. Results: There was a reduction in CLD from 628 per month to 425 per month (RRR of 32%), a reduction in CLUR from 0.62 to 0.46 (RRR of 26%), and a reduction in CLABSI rate from 1.65 to 0.78 (RRR of 51%). When looking at the number of central line infections per expected line days, there was a reduction from 20.2 to 6.6 (P=0.04). The central line infection rate relative to patient days showed a reduction from 10.3 to 3.6 (P=0.04). Conclusions: Over utilization of central lines and the subsequent increase in central line infections represents a major complication of ICU care. By combining an intensivist program with a venous access policy designed to reduce dependence on central lines, we showed a clinically significant reduction in central line infections and a reduction in central line days and central line utilization ratio without any significant increase in IV extravasations.
通过医院重症监护计划减少中心静脉输液天数、中心静脉使用率和中心静脉相关血流感染
目的: 在一家非学术性医院中,我们追踪了一项新实施的重症监护计划,该计划遵循限制性静脉通路政策,强调中线和外周静脉输液而非中心静脉置管,该计划对中心静脉置管天数、中心静脉置管使用率和中心静脉置管相关血流感染的影响。方法:在 2021 年 6 月之前,莫比尔医务所的重症监护病房(ICU)是开放式病房,配备的医生同时负责重症监护病房、病房和门诊工作。2021 年 6 月,医院启动了一项重症监护计划,将重症监护室转变为封闭式重症监护室模式,重症监护医生只负责重症监护室。与此同时,医院还实施了一项政策,强调除非有明确的标准(MICAR 标准),否则避免中心静脉置管。我们对中心静脉置管天数(CLD)、中心静脉置管使用率(CLUR)和中心静脉置管相关血流感染率(CLABSI)进行了跟踪调查,并将其与计划开始前两年的相同单位进行了比较。结果:中心管路使用率从每月 628 例降至 425 例(RRR 为 32%),中心管路相关血流感染率从 0.62 例降至 0.46 例(RRR 为 26%),中心管路相关血流感染率从 1.65 例降至 0.78 例(RRR 为 51%)。从每预期管路日中心管路感染次数来看,从 20.2 例降至 6.6 例(P=0.04)。相对于患者住院日的中心管路感染率从 10.3 降至 3.6(P=0.04)。结论过度使用中心静脉置管以及随之而来的中心静脉置管感染增加是重症监护室护理的主要并发症。通过将重症监护计划与旨在减少对中心静脉置管依赖的静脉通路政策相结合,我们发现中心静脉置管感染的临床显著减少,中心静脉置管天数和中心静脉置管使用率也有所下降,而静脉外渗却没有明显增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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