采用一线员工驱动的方法减少中心静脉相关血流感染

IF 1.2 Q3 PEDIATRICS
Joanne Pasinski, Johanna Young, Nicole Leone, Kaitlyn Philips
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引用次数: 0

摘要

背景:感染是新生儿重症监护室(NICU)中婴儿发病和死亡的主要原因。1 尽管我们坚持循证最佳实践,但要持续改善我们的中心静脉相关血流感染(CLABSI)率仍具有挑战性。2-4 因此,我们采用了多学科方法来重振我们的改进工作并降低 CLABSI 感染率。我们的目标是将 36 个月内所有出生体重婴儿每 1000 个中心管路日的 CLABSI 感染率从 2.97 例降至 1.49 例(降低 50%)。方法:我们将 "改进模式 "和 "计划、实施、研究、行动 "周期作为改进工作的框架。5 来自一线护理人员、护理领导、医生、进修医师、管理人员和家属的利益相关者组成了一个多学科团队。一名一线护士领导着这个团队,并对员工负责。干预措施是多因素的,由利益相关者团队共同商定,包括所有员工主动承担生产线维护工作。双人无菌操作流程(如更换管路和管帽)的视频在整个科室实现了标准化操作。教育材料向家属介绍了中央管路维护和感染预防的重要性。床旁护士和新生儿科医生每天都要对闭塞性中央管路敷料进行检查,这鼓励了多学科对中央管路护理的责任感。我们制作了一份通讯,以保持有关流程变更的沟通,并向一线员工提供绩效反馈。根据当前的肠外营养指南调整我们的做法,从而增加了更换管道的频率,从每 96 小时更换一次改为每 24 小时更换一次。工作人员采用了粘合剂和敷料等新产品,减少了整体换药次数。结果衡量标准是 CLABSI 感染率。过程测量指标是对管路维护中 CLABSI 预防包的合规性。每月收集这些数据,并通过统计过程分析特殊原因的变化
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reducing Central Line-associated Bloodstream Infections Using a Frontline Staff-driven Approach
Background: Infections are a major source of morbidity and mortality for infants in the neonatal ICU (NICU). 1 Sustainable improvement in our central line-associated bloodstream infection (CLABSI) rate was challenging, despite adherence to evidence-based best practices. 2–4 Therefore, we leveraged a multidisciplinary approach to reinvigorate our improvement efforts and reduce the CLABSI rate. We aimed to decrease the CLABSI rate from 2.97 to 1.49 infections (a 50% reduction) per 1000 central line days for infants of all birth weights over 36 months. Methods: We used the Model for Improvement and plan, do, study, act cycles as the framework for our improvement effort. 5 Stakeholders from frontline nursing, nursing leadership, physician staff, advanced practitioners, administrators, and families formed a multidisciplinary team. A frontline nurse led this team and held staff accountable. Interventions were multi-factorial, agreed upon by the stakeholder team, and included all staff members taking ownership of line maintenance. Videos demonstrating two-person sterile procedures, such as line and cap changes, standardized practice throughout the unit. Educational materials introduced the importance of central line maintenance and infection prevention to families. Daily verification of occlusive central line dressings by the bedside nurse and neonatologist encouraged multidisciplinary accountability for central line care. A newsletter was created to maintain communication about process changes and provide performance feedback to frontline staff. Aligning our practice with current parenteral nutrition guidelines led to increased frequency of tubing changes, from every 96 to every 24 hours. Staff incorporated new products, such as adhesives and dressings to reduce the number of dressing changes overall. The outcome measure was the CLABSI rate. The process measure was compliance with the CLABSI prevention bundle for line maintenance. These data were collected monthly and analyzed for special cause variation on a statistical process
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来源期刊
CiteScore
2.20
自引率
0.00%
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审稿时长
20 weeks
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