Raveena D Singh, Bardia Bahadori, Tom Tjoa, Mohamad N Alsharif, Shereen Nourollahi, Justin Chang, Amarah Mauricio, Jessica Bethlahmy, Syma Rashid, Raheeb Saavedra, Isabel Y Ashbaugh, Steven Tam, Shruti K Gohil
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引用次数: 0
摘要
目的：评估基于移动应用程序的中心线相关血流感染（CLABSI）预防计划对周围插入中心导管（picc）的养老院居民的影响。设计：前后前瞻性队列研究，包括基线研究（2015年9月- 2016年12月）、分期研究（2017年1月- 2017年4月）和干预研究（2017年5月- 2018年12月）。广义线性混合模型比较了干预与局部炎症/感染、敷料剥落和感染相关住院的基线频率。Cox比例风险模型比较了局部炎症/感染系的切除天数。背景：加州奥兰治县的六家养老院。患者：患有picc的成年养老院居民。干预措施：CLABSI预防计划包括一个可操作的评分系统，用于识别插入部位感染/炎症，再加上一个移动应用程序，可以进行照片评估和远程响应的自动医生警报。结果：我们在719名居民中完成了817项picc的8131项评估(基线：4865项评估，422项picc， 385名居民；干预：4,264项评估，395名picc， 334名居民)。干预与57%的剥脱敷料发生率降低（OR 0.43, 95% CI 0.28-0.64, P < 0.001）， 73%的局部炎症/感染发生率降低（OR = 0.27, 95% CI: 0.13-0.56, P < 0.001）， 41%的感染相关住院风险降低（OR = 0.59, 95% CI: 0.42-0.83, P = 0.002）相关。医生的移动应用程序警报和响应使识别出炎症/感染后的细胞株残留风险降低62% (HR 0.38, CI: 0.24-0.62, P < 0.001)，并且从平均（SD） 19（20）到1(2)天内将感染细胞株清除的速度提高95%。结论：基于移动应用程序的CLABSI预防程序减少了中心线插入部位发炎/感染的频率，改善了敷料的完整性，增加了发现炎症/感染时的移除速度，并降低了感染相关的住院风险。
A telehealth approach to central line-associated bloodstream infection prevention activities in nursing homes: the SAFER lines program.
Objectives: To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in nursing home residents with peripherally inserted central catheters (PICCs).
Design: Pre-post prospective cohort study with baseline (September 2015-December 2016), phase-in (January 2017-April 2017), and intervention (May 2017-December 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection, dressing peeling, and infection-related hospitalizations. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection.
Setting: Six nursing homes in Orange County, California.
Patients: Adult nursing home residents with PICCs.
Intervention: CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.
Results: We completed 8,131 assessments of 817 PICCs in 719 residents (baseline: 4,865 assessments, 422 PICCs, 385 residents; intervention: 4,264 assessments, 395 PICCs, 334 residents). The intervention was associated with 57% lower odds of peeling dressings (OR 0.43, 95% CI 0.28-0.64, P < .001), 73% lower local inflammation/infection (OR = 0.27, 95% CI: 0.13-0.56, P < .001), and 41% lower risk of infection-related hospitalizations (OR = 0.59, 95% CI: 0.42-0.83, P = .002). Physician mobile-app alerting and response enabled 62% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.38, CI: 0.24-0.62, P < .001) and 95% faster removal of infected lines from mean (SD) 19 (20) to 1 (2) days.
Conclusions: A mobile-app-based CLABSI prevention program decreased the frequency of inflamed/infected central line insertion sites, improved dressing integrity, increased speed of removal when inflammation/infection were found, and reduced infection-related hospitalization risk.
期刊介绍：
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