2023年CLABSItoolkit（教学课件）.ppt

Central Line-Associated Bloodstream Infections(CLABSI)in Non-Intensive Care Unit(non-ICU)Settings Toolkit Activity C:ELC Prevention Collaboratives Draft-1/22111/09-Disclaimer:The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.Alex Kallen,MD,MPH and Priti Patel,MD,MPH Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Outline Background Impact HHS Prevention Targets Pathogenesis Epidemiology Prevention Strategies Core Supplemental Measurement Process Outcome Tools for Implementation/Resources/References Background:Impact Bloodstream infections(BSIs)are a major cause of healthcare-associated morbidity and mortality Up to 35%attributable mortality BSI leads to excess hospital length of stay of 24 days Central Line(CL)use a major risk factor for BSI More than 250,000 central line-associated BSIs(CLABSIs)in US yearly Rates of CLABSI appear to vary by type of catheter Pittet et al.JAMA 1994;271 1598-1601.Klevens et al.Public Health Reports 2022;122:160-6.Background:HHS Prevention Targets Prevention of CLABSIs in Intensive Care Units(ICUs)and other locations have 2 associated goals in HHS HAI Prevention Plan:-Reduce CLABSIs by 50%-100%adherence with CL insertion practices in non-emergent situations Background:Impact Outside the ICU Most work aimed at reducing CLABSIs in the hospital has been done in ICUs Many CLs are found outside ICUs In one study 55%of ICU patients had CL;24%of non-ICU patients had CL However,as more patients are located outside of the ICU,70%of hospitalized patients with CLs were outside the ICU Climo et al.ICHE 2003;24:942-5.Background:Impact CLABSI Rates CLABSI rates outside ICUs may be similar to rates of these infections in ICUs Although data are sparse,in one study CLABSI rates were:5.7 per 1,000 catheter-days in 4 inpatient wards 5.2 per 1,000 catheter-days for medical ICU Marschall et al.Infect Control Hospital Epidemiol 2022;28:905-9.Background:Impact National Healthcare Safety Network(NHSN)CLABSI Rates From 2022 2022 NHSN report,pooled mean CLABSI rates were:Medical-Surgical ICUs=1.5 to 2.1 per 1,000 catheter-days Medical-Surgical wards=1.2 per 1,000 catheter-days Edwards JR,et al.Am J Infect Control 2022;37:783-805.:/cdc.gov/nhsn/PDFs/dataStat/2022NHSNReport.PDF Background:Impact CLABSI in Outpatient Settings A number of patient groups may have long-term CLs as outpatients Hemodialysis Malignancy Gastrointestinal tract disorders Pulmonary hypertension Rates of CLABSI may be as high as those seen in ICUs In hemodialysis-1 to 4 per 1,000 catheter-days Background:Pathogenesis CLABSI More Common Mechanisms 1.Pathogen migration along external surface -more common early (10 days Less Common Mechanisms 1.Hematogenous seeding from another source 2.Contaminated infusates HICPAC.Guideline for Prevention of Intravascular Device-Related Infections.1996 Hub Contamination Contaminated Infusate Hematogenous spread Extraluminal Contamination Healthcare Personnel Hand Contamination Contamination of insertion site 00.10.20.30.40.50.60.70.819971998199920002001200220032004200520062007YearPooled Mean CLABSI Rate per 1,000 Central Line Days or%MRSA*No 200-49.6%xx-70.1%x xP=0.02 xxP elective Skill of inserter General specialized Insertion site Femoral subclavian Skin antisepsis 70%alcohol,10%povidone-iodine 2%chlorhexidine Catheter lumens Multilumen single lumen Duration of catheter use Longer duration of use greater risk Barrier precautions Submaximal maximal Background:Prevention Strategies Interventions Pittsburgh Regional Health Initiative Decrease in CLABSIs in 66 ICUs(68%decrease)Interventions Promotion of best practices Maximal barrier precautions Use of chlorhexidine for skin cleansing prior to insertion Avoidance of femoral site for CL Use of recommended insertion-site dressing practices Removal of CL when no longer needed Educational module about BSI prevention Engagement of leadership and clinicians Standard tools for recording adherence to best practices Standardizing catheter insertion kits Measurement of CLABSI and reporting of rates back to facilities CDC.MMWR 2022;54:1013-6.Background:Prevention Strategies Interventions Michigan Keystone Project Decrease in CLABSI in 103 ICUs in Michigan(66%reduction)Basic interventions:Hand hygiene Full barrier precautions during CL insertion Skin cleansing with chlorhexidine Avoiding femoral site Removing unnecessary catheters Use of insertion checklist Promotion of safety culture Pronovost et al.NEJM 2022;355:2725-32.Background:On the CUSP:Stop BSI project This national program is a collaboration between Health Research and Educational Trust Johns Hopkins University Quality and Safety Research Group Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality Builds on successes in Michigan Keystone project CLABSI prevention bundle Collaborative model Promotion of safet