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AHRQ安全项目使得导管相关尿路感染下降54%
发布日期：2017-07-27来源：SIFIC热点团队 SIFIC感染官微发布人：梦缘徽州
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翻译丨饶俊莉审稿丨周超群、陈志锦
据《美国医学会内科杂志》近期天发表的一项研究显示，在由美国医疗研究和质量署（AHRQ）资助的一项超过400家长期护理机构参与的患者安全项目中，导管相关尿路感染（CAUTIs）发生率下降了54%。
该项目采用了美国医疗研究和质量署的综合性单位安全计划(CUSP)，适用于长期护理机构。新分析中纳入了38个州疗养院的数据。此前，美国医疗研究和质量署在医院实施CUSP及其他安全项目的努力，已经使得导管相关性尿路感染和中央导管相关血流感染显著减少。
美国医疗研究和质量署质量改进和患者安全中心主任Jeffrey Brady博士说：“目前，在疗养院和医院，我们继续看到AHRQ的工具在帮助前线员工解决安全问题方面发挥着作用。这意味着，那些居住在长期护理机构和疗养院的最脆弱人群因感染而受到伤害的风险的减少。”
CAUTI是一种在长期护理设施中常见的医院（HAI），因为有高达10%的住户使用了导尿管。CAUTI有时会导致严重的疾病需要住院，并产生大量的抗菌药物和住院治疗费用。虽然这种感染通常可以用抗菌药物治疗，但长期或反复使用抗菌药物会增加其他感染的风险，并导致抗菌药物耐药性的发展。
CUSP旨在促使领导力、团队精神、沟通和安全文化的改善，以促进感染预防措施的持续使用。在项目期间，CAUTI发生率从大约每千个导管日6.4减至3.3。四分之三的机构显示CAUTI发生率降幅至少40%，表明这种方法可以使大多数长期护理机构受益。
研究人员还发现，通过测试发现尿培养医嘱单在研究期间减少了15％，因为项目鼓励的最佳实践包括避免大多数没有症状的患者进行尿培养。
该项目不仅仅是研究尿培养、抗菌药物和导尿管，还对改善疗养院住户护理质量有帮助。为了帮助所有长期护理机构的医生和护士预防导管相关性尿路感染（CAUTI），AHRQ发布了一套减少长期护理机构中导管相关性尿路感染（CAUTI）和其他医院感染（HAI）的“工具包”。这些实用办法是基于参与该项目机构的经验，它包括检查清单和其他工具以及教育材料，以指导寻求应用感染控制方案的机构。
AHRQ是美国卫生和人类服务部(HHS)的一个分支机构，它与其他联邦机构、研究人员及供应商合作，以预防和减少医院感染（HAI），并对抗耐药性细菌。美国卫生和人类服务部的使命是提供证据，使医疗保健更安全、更高质量、更容易获得、更公平和更廉价。
原文：Study Shows 54 Percent Drop in Infections Among Nursing Home Patients AHRQ safety program leads to fewer catheter-associated urinary tract infections
Rates of catheter-associated urinary tract infections (CAUTIs) dropped by 54 percent across more than 400 long-term care facilities that participated in a patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ), according to a study published today in JAMA Internal Medicine.
The project adapted AHRQ's Comprehensive Unit-based Safety Program (CUSP) for use in long-term care facilities. Data from nursing homes in 38 states were included in the new analysis. Previous AHRQ efforts to implement CUSP and other safety programs in hospitals have led to significant reductions in CAUTIs and bloodstream infections associated with central line catheters.
"We continue to see the power of AHRQ tools to help front-line staff tackle safety problems, now in nursing homes as well as hospitals," said Jeffrey Brady, M.D., M.P.H., director of AHRQ's Center for Quality Improvement and Patient Safety. "This means that some of the most vulnerable members of society – those who reside in long-term care facilities and nursing homes – are less likely to be harmed as a result of infections."
CAUTI is a type of healthcare-associated infection (HAI) that is common in long-term care facilities, where up to 10 percent of residents have urinary catheters. CAUTI can sometimes lead to severe illness and hospitalization and generates significant expenses for antibiotics and hospitalizations. The infections are generally treatable with antibiotics, but long-term or repeated use of antibiotics can increase the risk of other infections as well as lead to development of antibiotic resistance.
CUSP is designed to promote improvement in leadership, teamwork, communication and safety culture to facilitate consistent use of evidence-based practices for infection prevention. During the project, CAUTI rates dropped from about 6.4 to 3.3 per 1,000 catheter days. Three-quarters of the facilities showed a CAUTI rate reduction of at least 40 percent, indicating that this approach could benefit a majority of long-term care facilities.
Researchers also found that orders for urine cultures – tests to find germs in the urine – decreased by 15 percent during the study period. Best practices encouraged in the project included avoiding urine cultures for most patients without symptoms.
"This project is an example of translating research into practice using innovative implementation strategies and by empowering front-line teams," said Lona Mody, M.D., of the University of Michigan and VA Ann Arbor Healthcare System, lead author of the study.
The study of CAUTI-prevention strategies was part of a multiyear national implementation project. The reductions took place during rolling 12-month periods from 2014 to 2016 in participating community-based nursing homes. Funded by AHRQ, the contract was led by the Health Research & Educational Trust of the American Hospital Association and a team of partners.
"This project was much more than just learning about urine cultures, antibiotics and catheters," said Amanda Calhoun, R.N., Assistant Director of Nurses and CAUTI Team Leader at Belle View Estates Rehabilitation and Care Center, one of the facilities that participated in the project. "It gave me the confidence to help improve the care of the people in our community."
To help doctors, nurses and other leaders in all long-term care facilities prevent CAUTIs, AHRQ has released a Toolkit to Reduce CAUTIs and Other HAIs in Long-Term Care Facilities. This practical resource is based on the experiences of facilities that participated in the project. It includes checklists and other tools and educational materials to guide facilities that seek to apply infection-reduction programs.
AHRQ, part of the Department of Health and Human Services (HHS), works with other federal agencies, researchers, and providers to prevent and reduce HAIs and combat antibiotic-resistant bacteria. AHRQ's mission is to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable and to work within HHS and with other partners to make sure that the evidence is understood and used. For more information about AHRQ's work to prevent HAIs, visit www.ahrq.gov/hais.
上一篇:重庆市XX人民医院泌尿外科2017年一季度CAUTI目标性监测分析下一篇:Nature:抵抗尿路感染新方法
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发表于 2017-7-31 16:26:00
发表于 2017-7-31 16:26:01
