使用氯己定包被透析导管帽降低中心静脉透析导管感染率:一项质量改进工程。

IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE
Rosemary Olivier, Claudia Skinner, Todd Bloom, Dana Rutledge
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引用次数: 0

摘要

背景:许多终末期肾病患者开始使用中心静脉透析导管进行透析治疗,显著增加了透析导管相关血流感染的风险。血液感染是影响透析患者最严重的危害事件之一。局部问题:2023年,南加州一家急症护理医疗中心的透析导管相关中心静脉血流感染(CLABSI)率是全国基准的三倍。本质量改进项目旨在通过在标准护理中添加氯己定包被透析导管帽来降低这一比率。方法:采用从知识到行动的模式,对医疗中心透析导管相关CLABSI降低实践进行改变。收集实施前和实施后每月透析导管相关clabsi、中心静脉透析导管天数和透析导管相关感染率的汇总数据。一对一的透析人员模拟培训和流程合规审核确保了干预的保真度。干预措施是对使用中心静脉透析导管的患者,将非氯己定透析导管帽替换为氯己定包被透析导管帽。结果:实施前8周共纳入119例患者,561例透析治疗,934中心透析置管日,2例透析置管相关clabsi(每1000置管日感染2.14例)。8周后随访期包括128例患者,583例透析治疗,897中心透析置管日,0例透析置管相关CLABSIs;在实施后可持续性评估期间(共24周)未发生与透析导管相关的clabsi。结论:在急症医疗中心接受中心导尿管透析的患者中,使用氯己定包被透析导管帽可获得显著的临床效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Using Chlorhexidine-Coated Dialysis Catheter Caps to Reduce Central Venous Dialysis Catheter Infection Rates: A Quality Improvement Project.

Background: Many patients with end-stage kidney disease begin dialysis therapy with central venous dialysis catheters, significantly increasing the risk of dialysis catheter-related bloodstream infection. Bloodstream infections are among the most severe harm events affecting patients receiving dialysis.

Local problem: In 2023, the dialysis catheter-related central line [catheter]-associated bloodstream infection (CLABSI) rate at an acute care medical center in southern California was thrice the national benchmark. This quality improvement project aimed to decrease this rate by adding chlorhexidine-coated dialysis catheter caps to standard care.

Methods: Using the Knowledge to Action model, the medical center made a dialysis catheter-related CLABSI reduction practice change. Preimplementation and postimplementation monthly aggregate data were collected for dialysis catheter-related CLABSIs, central venous dialysis catheter days, and dialysis catheter-related infection rates. One-on-one dialysis staff simulation training and process compliance audits ensured intervention fidelity. The intervention was replacement of nonchlorhexidine dialysis catheter caps with chlorhexidine-coated dialysis catheter caps for patients with central venous dialysis catheters.

Results: An 8-week preimplementation period included 119 patients, 561 dialysis therapies, 934 central dialysis catheter days, and 2 dialysis catheter-related CLABSIs (2.14 infections per 1000 catheter days). An 8-week postimplementation period included 128 patients, 583 dialysis therapies, 897 central dialysis catheter days, and 0 dialysis catheter-related CLABSIs; no dialysis catheter-related CLABSIs occurred during postimplementation sustainability assessment (24 weeks total).

Conclusions: Use of chlorhexidine-coated dialysis catheter caps led to clinically significant results among patients receiving dialysis with central catheters at an acute care medical center.

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来源期刊
Critical care nurse
Critical care nurse 医学-护理
CiteScore
2.80
自引率
0.00%
发文量
68
审稿时长
>12 weeks
期刊介绍: Critical Care Nurse (CCN) is an official publication of the American Association of Critical-Care Nurses (AACN). Authors are invited to submit manuscripts for consideration and peer review. Clinical topics must meet the mission of CCN and address nursing practice of acute and critically ill patients.
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