Data from: Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey

Background: Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines.

Methods: Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates.

Results: Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available.

Conclusions: This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.

背景：中心静脉导管相关血流感染（Central line-associated bloodstream infections, CLABSI）会增加患者的发病率与死亡率，且此类感染大多可被预防。本研究于2015年针对全球重症监护病房（intensive care units, ICU）内的医护人员开展态度与实践调研，旨在评估其对CLABSI预防指南的依从性。

方法：2015年6月至10月期间，本研究面向全球范围内重症监护病房在岗的医师与护士发放了在线调查问卷。本研究以SHEA指南为标准，调研了与中心静脉导管（central line, CL）置管、维护以及CLABSI相关数据统计相关的临床实践。本研究以各国人口为权重，针对高、中、低收入国家计算了加权估计值，仅纳入至少提供10份完整有效回复的国家的相关数据。

结果：共计95个国家提供了3407份独立回复；其中无低收入国家，14个中等收入国家（middle income country, MIC）与27个高收入国家（high income country, HIC）提供了至少10份完整回复。在全部受访者中，80%（中等收入国家，标准误（standard error, SE）=1.5）与81%（高收入国家，标准误SE=1.0）表示其所在重症监护病房配有书面的CLABSI预防临床指南；23%（中等收入国家，标准误SE=1.7）与62%（高收入国家，标准误SE=1.4）表示其遵守了以下关于中心静脉导管置管的联合推荐措施：手卫生、全屏障防护、使用浓度＞0.5%的氯己定，以及不使用局部或全身抗菌预防；60%（中等收入国家，标准误SE=2.0）与73%（高收入国家，标准误SE=1.2）表示会每日评估中心静脉导管的留置必要性。多数受访者认为CLABSI数据统计是质量改进的关键环节，但仅有少数机构能够报告其CLABSI感染率。各国之间的实践差异显著，本研究已公开各国的专项研究结果。

结论：本研究明确了与中心静脉导管置管及维护相关的CLABSI预防实践中有待改进的领域。不同国家的临床干预优先级存在差异。