Research Check 08/18-1

Ziel des Research Check ist es, Euch regelmässige Updates zu neuen und interessanten Forschungsthemen aus dem Bereich Simulation, Debriefing, Teamzusammenarbeit und Patientensicherheit zu geben und diese zu kommentieren. Das Thema heute lautet:

Significant Reduction of Catheter-associated Blood Stream Infections in Preterm Neonates After Implementation of a Care Bundle Focusing on Simulation Training of Central Line Insertion.
Steiner M, Langgartner M, Cardona F, Waldhör T, Schwindt J, Haiden N, Berger A.
Pediatr Infect Dis J. 2015 Nov;34(11):1193-6.
doi: 10.1097/INF.0000000000000841.

BACKGROUND:

Central line-associated blood stream infections (CLABSIs) are common problems in neonatal intensive care units (NICUs). Implementation of catheter care bundles has been shown to reduce CLABSI rates. We developed a care bundle aiming at establishing a uniform central line insertion technique and improving teaching practices focusing on simulation-based techniques. The purpose of this study was to assess the impact of this care bundle on CLABSI rates in very low birth weight infants (VLBWI).

METHODS:

In September 2010, a CLABSI prevention bundle was introduced in our NICU, consisting of simulation-based standardization and education of a peripherally inserted central catheter insertion technique. Data of all VLBWI admitted to our NICU during 2010-2012 were analyzed. Diagnosis of CLABSI required a positive blood culture in the presence of a central venous catheter and clinical signs of infection.

RESULTS:

Five hundred twenty-six VLBWI admitted during the study period were included into the analysis. CLABSI rates decreased significantly from 13.9 in 2010 to 9.5 in 2011 and 4.7 in 2012 (P < 0.0001). This significant reduction was true for the overall population and for subgroups separated by birth weight. Distribution of blood culture pathogens revealed a constant absolute and relative decline of infections with coagulase-negative staphylococci from 2010 (n = 43/50, 86%) to 2012 (n = 12/18, 67%), as opposed by a slight increase of Staphylococcus aureus infections (n = 1/50, 2% in 2010 versus n = 2/18, 11% in 2012).

CONCLUSION:

Our data provide evidence of a potential effect of simulation-based training of central line placement in decreasing CLABSI rates in VLBWI and encourage its implementation into care bundles.

KURZCHARAKTERISTIK:

In dieser Beobachtungsstudie war die Einführung einer Präventionsbündelmaßnahme unter Miteinbeziehung simulationsbasierten Trainings mit einer signifikanten Reduktion an Zentralvenenkathetern-assoziierten Infektionen bei very low birth weight infants assoziiert.

Während aus diese Studie der isolierte Effekt der Simulationsintervention im Vergleich zu den anderen getroffenen Maßnahmen (verbesserte Muttermilchhygiene, verpflichtendes Händedesinfektionstraining für medizinisches Personal) nicht herausgelesen werden kann, ist der Effekt der gebündelten Interventionen auf das Patientenoutcome von hoher klinischer Relevanz. (geschrieben von Lukas Mileder)