使用程序套件可减少计划外的中心静脉敷料更换:匹配的前后干预研究

IF 0.9 Q4 INFECTIOUS DISEASES
Amit Bahl, N. Mielke, S. M. Gibson, Julie George
{"title":"使用程序套件可减少计划外的中心静脉敷料更换:匹配的前后干预研究","authors":"Amit Bahl, N. Mielke, S. M. Gibson, Julie George","doi":"10.1177/17571774241232063","DOIUrl":null,"url":null,"abstract":"Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. This pre–post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) ( p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention ( p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day ( p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day ( p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The use of procedural kits may reduce unscheduled central line dressing changes: A matched pre–post intervention study\",\"authors\":\"Amit Bahl, N. Mielke, S. M. Gibson, Julie George\",\"doi\":\"10.1177/17571774241232063\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. This pre–post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) ( p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention ( p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day ( p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day ( p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.\",\"PeriodicalId\":16094,\"journal\":{\"name\":\"Journal of Infection Prevention\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2024-02-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infection Prevention\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/17571774241232063\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection Prevention","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/17571774241232063","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

摘要

研究表明,中心静脉置管 (CVL) 的不定期换药会增加血流感染的风险。本研究的目的是确定创新换药套件的使用是否能降低计划外换药率。这项前后干预研究在美国密歇根州底特律市的一家大型三级学术护理中心进行。我们评估了介入性换药程序套件对接受 CVL(包括中心导管、外周置入中心导管或血液透析导管)置入的成年患者计划外换药率的影响。干预前队列的数据通过电子健康记录(EHR)收集,而干预后队列的数据则由经过培训的研究人员结合 EHR 数据通过直接观察收集。主要结果是计划外换药率。次要结果包括基于入院楼层类型的计划外换药率、计划外换药的病因以及中心静脉相关血流感染(CLABSIs)。研究纳入了 2018 年 5 月至 2022 年 6 月期间置入的 1548 个 CVL 方便样本,并进行了匹配分析,包括干预前组和干预后组各 488 个导管。结果显示,未调整的计划外敷料评估率从干预前组(每天 0.21 次)显著降至干预后组(每天 0.13 次)(p < .001)。调整后的比率比也呈现出同样的趋势,干预前为 1.00,干预后为 0.60(P < .001)。根据最高护理级别进行的分层分析表明,干预措施有效降低了高级医疗楼层亚组和普通医疗楼层亚组干预前和干预后的未调整敷料评估率;高级医疗楼层亚组从每天 0.22 例降至 0.15 例 ( p = .001) ,而普通医疗楼层亚组从每天 0.21 例降至 0.09 例 ( p < .001)。在干预前和干预后,两组的 CLABSI 发生率相似(分别为 0.6% vs 0.8%; p = 1.00)。中心管路敷料更换程序套件能有效减少计划外敷料更换,并可能在减少 CLABSI 方面发挥作用。还需要进一步研究评估换药包对成本、程序依从性的影响以及对 CLABSI 的确切影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The use of procedural kits may reduce unscheduled central line dressing changes: A matched pre–post intervention study
Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. This pre–post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) ( p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention ( p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day ( p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day ( p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Infection Prevention
Journal of Infection Prevention Nursing-Advanced and Specialized Nursing
CiteScore
1.70
自引率
8.30%
发文量
46
期刊介绍: Journal of Infection Prevention is the professional publication of the Infection Prevention Society. The aim of the journal is to advance the evidence base in infection prevention and control, and to provide a publishing platform for all health professionals interested in this field of practice. Journal of Infection Prevention is a bi-monthly peer-reviewed publication containing a wide range of articles: ·Original primary research studies ·Qualitative and quantitative studies ·Reviews of the evidence on various topics ·Practice development project reports ·Guidelines for practice ·Case studies ·Overviews of infectious diseases and their causative organisms ·Audit and surveillance studies/projects
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信