减少不适当使用导管的撤销战略的五年可持续性:一个多中心,混合方法的研究研究
Tessa M Z X K van Horrik1, Eva W Verkerk1, Suzanne E Geerlings1
1Amsterdam UMC, University of Amsterdam, Department of Internal Medicine-Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health, the Netherlands.
EClinicalMedicine
|January 7, 2025
概括
一项撤销策略显著减少了五年后不适当的外周静脉导管 (PIVC) 使用. 通过最小的投资实现了对PIVC使用的持续减少,这是由预防感染的内在动机驱动的.
科学领域:
- 与医疗保健相关的感染
- 医疗器械的利用 医疗器械的利用
- 质量改善策略 质量改善策略
背景情况:
- 周围静脉导管 (PIVC) 是医疗相关感染的来源.
- 2017年的一项撤销策略成功减少了7家荷兰医院不适当使用PIVC的情况 (RICAT-1研究).
- 在实施5年后,研究了该战略的可持续性及其贡献因素.
研究的目的:
- 评估对外围静脉导管 (PIVCs) 的多方面撤销战略的长期可持续性.
- 确定影响不适当PIVC使用持续减少的因素.
- 评估该战略对医疗保健相关感染的影响.
主要方法:
- 一项多中心混合方法研究 (RICAT-2),包括对患有PIVC的成年患者的观察性查和与医疗保健专业人员的采访.
- 从2022年5月到2023年6月在荷兰五家医院收集的数据,不包括选择性短期住院和绝症患者.
- 后勤回归分析将当前数据与RICAT-1基线进行了比较;用于定性数据,使用了主题和框架分析.
主要成果:
- 不适当的PIVC使用从基线 (RICAT-1) 的22.0%下降到随访 (RICAT-2) 的13.8%,表明持续的影响 (OR 0.76,p < 0.001).
- 维持战略组件数量与持续效应之间没有发现任何关联.
- 减少感染的内在动机是关键促进因素,而相互竞争的优先事项,时间限制和缺乏临床冠军是障碍.
结论:
- 撤销策略在五年内在减少不适当的PIVC使用方面表现出持续的有效性.
- 对退出实施策略的最小的,暂时的投资可以产生持久的结果.
- 应鼓励医疗保健专业人员采用此类策略,以尽量减少与导管相关的感染.
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