导管捆绑 "对重症监护病房感染率和经济成本的影响：回顾性队列研究

IF 2.4 Q1 NURSING

Nursing Reports Pub Date : 2024-08-09 DOI:10.3390/nursrep14030145

A. Lucchini, M. Giani, E. Rezoagli, Giulia Favata, Annagiulia Andreani, Marta Spada, Luigi Cannizzo, Nicola Barreca, Matteo Cesana, Stefano Citterio, Stefano Elli

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引用次数: 0

摘要

导言：导管相关感染（CBRSIs）是一个普遍存在的问题，它增加了重症监护病房（ICU）患者的发病率和死亡率，也增加了管理成本。研究目的本研究的主要目的是评估重症监护病房中按照国际文献指南管理重症患者血管管路的 CBRSI 感染率。这些指南包括每 7 天更换一次血管管路、使用无针装置和端口保护器、标准化封闭输液管路、使用氯己定浸渍敷料以及使用无缝线装置固定导管。材料与方法：这项单中心回顾性观察研究在意大利一家普通重症监护病房进行。研究对象包括 2018 年 1 月至 2022 年 12 月期间入院的所有年龄大于 1 岁的合格患者。研究结果在研究期间，共有 1240 名患者入选，其中 9 人被诊断为 CRBSI。每1000个导管/天的感染率如下：股置入中心导管1.04；中心置入中心导管0.77；肺动脉导管0.71，动脉导管0.1；外周置入中心导管和连续静脉血液透析透析导管等于0.在纳入研究的年份之间未观察到CRBSI差异（P = 0.874）。多变量分析显示 CBRSI 诊断与护理活动评分（每增加一个点 β = 0.04-95%CI：-0.01-0.09，p = 0.048）、ICU 入院原因-创伤（β = 0.77-95%CI：-0.03-1.49，p = 0.039）和使用治疗性低温（β = 2.06，95%CI：0.51-3.20，p < 0.001）之间存在关联。实施研究方案的成本为 130.00 欧元/人，相当于每人每天 15.20 欧元。结论：本研究强调了在重症监护病房环境中实施导管护理捆绑方案以最大限度降低 CRBSI 风险和相关成本的重要性。每 7 天更换一次输液器的政策改变有助于将 CRBSI 感染率维持在建议感染率以下，从而显著降低成本并减少重症监护室废物的产生。

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Impact of a ‘Catheter Bundle’ on Infection Rates and Economic Costs in the Intensive Care Unit: A Retrospective Cohort Study

Introduction: Catheter-related infections (CBRSIs) are a widespread problem that increase morbidity and mortality in intensive care unit (ICU) patients and management costs. Objective: The main aim of this study was to assess the prevalence of CBRSIs in an intensive care unit following international literature guidelines for managing vascular lines in critically ill patients. These guidelines include changing vascular lines every 7 days, using needle-free devices and port protectors, standardising closed infusion lines, employing chlorhexidine-impregnated dressings, and utilising sutureless devices for catheter securement. Materials and Methods: This single-centre retrospective observational study was conducted in a general Italian ICU. This study included all eligible patients aged > 1 year who were admitted between January 2018 and December 2022. Results: During the study period, 1240 patients were enrolled, of whom 9 were diagnosed with a CRBSI. The infection rate per 1000 catheters/day was as follows: femorally inserted central catheter, 1.04; centrally inserted central catheter, 0.77; pulmonary arterial catheter 0.71, arterial catheter, 0.1; and peripherally inserted central catheter and continuous veno-venous haemodialysis dialysis catheters equal to 0. No difference in CRBSI was observed between the years included in the study (p = 0.874). The multivariate analysis showed an association between the diagnosis of CBRSI and Nursing Activities Score (per single point increase β = 0.04–95%CI: −0.01–0.09, p = 0.048), reason for ICU admission—trauma (β = 0.77–95%CI: −0.03–1.49, p = 0.039), and use of therapeutic hypothermia (β = 2.06, 95%CI: 0.51–3.20, p < 0.001). Implementing the study protocol revealed a cost of EUR 130.00/patient, equivalent to a daily cost of EUR 15.20 per patient. Conclusions: This study highlights the importance of implementing a catheter care bundle to minimise the risk of CRBSI and the associated costs in the ICU setting. A policy change for infusion set replacement every 7 days has helped to maintain the CRBSI rate below the recommended rate, resulting in significant cost reduction and reduced production of ICU waste

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来源期刊

Nursing Reports NURSING-

CiteScore

2.50

自引率

4.20%

发文量

期刊介绍： Nursing Reports is an open access, peer-reviewed, online-only journal that aims to influence the art and science of nursing by making rigorously conducted research accessible and understood to the full spectrum of practicing nurses, academics, educators and interested members of the public. The journal represents an exhilarating opportunity to make a unique and significant contribution to nursing and the wider community by addressing topics, theories and issues that concern the whole field of Nursing Science, including research, practice, policy and education. The primary intent of the journal is to present scientifically sound and influential empirical and theoretical studies, critical reviews and open debates to the global community of nurses. Short reports, opinions and insight into the plight of nurses the world-over will provide a voice for those of all cultures, governments and perspectives. The emphasis of Nursing Reports will be on ensuring that the highest quality of evidence and contribution is made available to the greatest number of nurses. Nursing Reports aims to make original, evidence-based, peer-reviewed research available to the global community of nurses and to interested members of the public. In addition, reviews of the literature, open debates on professional issues and short reports from around the world are invited to contribute to our vibrant and dynamic journal. All published work will adhere to the most stringent ethical standards and journalistic principles of fairness, worth and credibility. Our journal publishes Editorials, Original Articles, Review articles, Critical Debates, Short Reports from Around the Globe and Letters to the Editor.