加强患者安全:跨学科团队在减少血培养污染中的作用。

HCA healthcare journal of medicine Pub Date : 2024-10-01 eCollection Date: 2024-01-01 DOI:10.36518/2689-0216.1892
Austin Patrick Eisenberg, Fady M Awad, Brian Watson, Mohammed Faris
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引用次数: 0

摘要

背景:血培养对许多住院病人的诊断工作至关重要,可提供有关血流感染 (BSI) 的宝贵信息,在北美和欧洲,每年约有 25 万人死于血流感染。尽管医疗保健取得了进步,但血液培养污染仍是一个严重问题,对患者死亡率、患者和医院成本以及微生物耐药性都有有害影响。本文回顾了血液培养污染对医疗系统的影响,并阐述了降低污染率的循证策略:为了降低血液培养污染率,我们的医疗机构采取了一项质量改进措施。我们成立了一个由实验室、抽血科、护理部、病理科、内科团队、急诊科等部门领导组成的工作组。采取的措施包括对员工进行全面培训、对各机构的操作规程和用品进行标准化,以及在备皮过程中使用废液管和较小容量的洗必泰敷贴。在实施前后收集了有关血液培养污染率的数据:结果:干预措施实施前,我们各医疗机构的月平均血培养污染率为 3.76%。干预措施实施后,这一比例大幅下降至 2.07%,降幅达 44.95%。统计分析表明,干预措施的实施与污染率的降低之间存在密切联系,其奇方值为 62.3,自由度为 1,P 值小于 0.001。这些结果表明,干预措施非常有效。此外,污染率的降低在随后的几个月中得以持续,始终保持在 2% 以下:该研究表明,通过有针对性的干预措施,血液培养污染率大幅降低,突出了将循证策略与跨学科团队合作相结合以改善患者护理效果的有效性。
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Enhancing Patient Safety: The Role of Interdisciplinary Teams in Reducing Blood Culture Contamination.

Background: Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates.

Methods: To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting of leadership from the laboratory, phlebotomy, nursing, pathology, internal medicine teams, emergency medical services, and others. Measures included comprehensive staff training, standardization of protocols and supplies across facilities, and the introduction of waste tubes and smaller-volume chlorhexidine applicators for skin preparation. Data on blood culture contamination rates were collected before and after implementation.

Results: Prior to the intervention, the average monthly blood culture contamination rate across our facilities was 3.76%. Following the intervention, this rate decreased significantly to 2.07%, representing a reduction of 44.95%. Statistical analysis revealed a strong association between the implemented interventions and the decreased contamination rates, with a chi-square value of 62.3, 1 degree of freedom, and a P value of less than .001. These results indicate that the interventions were highly effective. Furthermore, the reduced contamination rates were sustained in the subsequent months, consistently remaining below 2%.

Conclusion: The study demonstrated a substantial reduction in blood culture contamination rates through targeted interventions, highlighting the efficacy of combining evidence-based strategies with interdisciplinary teamwork to improve patient care outcomes.

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