AJKD：改进操作或可减少血液透析者血流感染

　　2009年，美国疾病预防控制中心（CDC）启动一项计划，以减少门诊透析机构血流感染（BSI）的发生。近日，研究者对报告至CDC国家卫生安全网的BSI数据进行分析发现，通过改进操作，可降低门诊透析机构BSI和导管相关BSI发生率，且在透析期间保持这一状况。论文5月13日在线发表于《美国肾脏病杂志》（Am J Kidney Dis）。

　　研究者分析了17家门诊透析中心12个月干预前期和15个月干预期数据。这些机构在CDC指导下实施循证干预措施（用氯己定清洗导管出口、对操作人员进行导管护理和无菌操作培训和技能评估、检查手卫生和血管通路护理情况以及反馈感染和员工依从率）。

　　结果为，多数（65%）参与机构隶属于医院。集合平均BSI和导管相关BSI发生率在干预前期分别为1.09 次/100人-月和0.73 次/100人-月；在干预期分别0.89 次/100人-月和0.42 次/100人-月。干预期开始时，基于分段回归分析的总体线性混合模型估计的BSI和导管相关BSI发生率分别减少了32%（P=0.01）和54%（P＜0.001）。

Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report.
BACKGROUND
Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC's National Healthcare Safety Network (NHSN).
STUDY DESIGN
Quality improvement project.
SETTING & PARTICIPANTS
Patients in 17 outpatient hemodialysis facilities that volunteered to participate.
QUALITY IMPROVEMENT PLAN
Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff.
OUTCOMES
Crude and modeled BSI and access-related BSI rates.
MEASUREMENTS
Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods.
RESULTS
Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P = 0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period.
LIMITATIONS
Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project.
CONCLUSIONS
Facilities participating in a collaborative successfully decreased their BSI and access-related BSI rates. The decreased rates appeared to be maintained in the intervention period. These findings suggest that improved implementation of recommended practices can reduce BSIs in hemodialysis centers.