Multicenter Clinical Translational Study of ICU-NO CRBSI Based on Improvement Science

Study Overview
=================
Brief Summary
-----------------
The goal of this type of study is to construct the continuous quality promotion project ICU-NO CRBSI(Catheter-Related Bloodstream Infection , CRBSI) based on improvement science, and to verify its effect in the prevention of central venous catheter-related bloodstream infection and continuous quality improvement in ICU ( Intensive Care Unit , ICU) through multi-center implementation and two rounds of improvement. The main question[s] it aims to answer are: What is the incidence of catheter-related bloodstream infection in the ICU of participating units? How compliant are health care providers in the ICU with evidence-based sensory control practices for the prevention of catheter-associated bloodstream infection? Participants will be provided with the hospital's routine CVC (Central Venous Catheter ,CVC) care practices and CVC quality improvement measures based on evidence-based guidelines What technical and cultural support is needed to implement quality and safety improvement measures?

Detailed Description
-----------------
A multicenter, cluster-randomized controlled trial was conducted to verify the effect of the intervention scheme and the improvement strategy. A continuous sample was taken based on subjects that met the inclusion criteria. This study was a multicenter cluster randomized controlled trial involving 23 research centers/medical institutions, including the Evidence-Based Nursing Center of Fudan University and Zhongshan Hospital affiliated to Fudan University. Co-led by the Pediatric Hospital Affiliated to Fudan University, a total of 23,000 catheter days (about 8050 people) were included, and each center planned to include 1,000 catheter days (about 350 people). Patients admitted to ICU from October to December 2023 were taken as baseline study objects, and ICU patients from January to March 2024 were entered into the control phase of the study experiment. ICU patients from April 2024 to June 2024 were included in the continuous observation group, and from July 2024 to September 2024 were included in the continuous observation period. According to the study design characteristics, the intervention will be performed on the control group after the randomized controlled trial phase and the sustainability of the initial intervention group after 3 months will be assessed. The intervention group started in January 2024, implemented the validated intervention protocol and quality promotion implementation strategy, and entered the second phase three months later (April 2024), and the control group became the second intervention group after the intervention in April 2024. In Phase I (the randomized controlled trial phase, January 2024 to March 2024), the effect of the intervention and the improvement strategy was examined by comparing the change in BSI at baseline between the two groups. The control group started the intervention (January 2024) and began reporting bloodstream infection data. In the second phase (April 2024 to June 2024), both groups received the intervention and were followed up until September 2024. Therefore, it is possible to observe the first intervention group for 9 months and also to verify whether the results of the second intervention group (the phase I control group) can be replicated. Control group: According to hospital catheterization, maintenance and central venous catheter extraction routine care. Intervention group: On the basis of routine care, the evidence-based intervention Program for the Prevention of Catheter Related bloodstream infection (CRBSI) in ICU patients was implemented for intervention. Primary outcome: incidence of CRBSI, ratio of CRBSI incidence (quarterly comparison) Secondary outcome ：length of stay in ICU, BSI-related mortality in ICU, hospitalization cost in ICU, knowledge and practice score of adherence to evidence-based sensory control in ICU, adherence to evidence-based practice of central venous catheter placement, maintenance and extubation.

Official Title
-----------------
A Multicenter Clinical Translational Study of ICU-NO CRBSI Based on Improvement Science in China

Conditions
-----------------
CRBSI - Catheter Related Bloodstream Infection, Evidence-based Nursing Practice, Central Venous Catheter Related Bloodstream Infection, Central Venous Catheter Associated Bloodstream Infection, Central Line Infection, CLABSI - Central Line Associated Bloodstream Infection, Quality Improvement

Intervention / Treatment
-----------------
* Behavioral: evidence-based intervention Plan for the Prevention of CRBSI in ICU patients


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: ICU stay over 48 hours CVC was placed for more than 24 hours Exclusion Criteria: Pregnant patients Patients with a history of CRBSI infection Patients with central venous catheterization were brought in from other hospitals
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Existing central venous catheters in the hospital or ICU maintain routine care procedures<br>According to the hospital or ICU catheterization, maintenance and removal of central venous catheter routine care | |
| Experimental: evidence-based intervention Plan for the Prevention of CRBSI in ICU patients<br>On the basis of routine nursing, the evidence-based intervention Plan for the Prevention of CRBSI in ICU patients was implemented for intervention. | Behavioral: evidence-based intervention Plan for the Prevention of CRBSI in ICU patients<br>* On the basis of routine nursing, the evidence-based intervention Plan for the Prevention of CRBSI in ICU patients was implemented for intervention.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of CRBSI |  | 1year | 
| CRBSI incidence ratio | Ratio of CRBSI incidence per quarter (IRR) | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of ICU stay | Length of ICU stay | 1 year | 
| Related Mortality | ICU CRBSI-related mortality | 1 year | 
| ICU hospitalization cost |  | 1 year |