Intravascular device-related infection

Intravascular device-related infection is one of the most important nosocomial infections. More than 200,000 cases with blood stream infection occur each year and most of them are related to the use of an intravascular device in United States. The microorganisms most frequently involved are Staphylococcus epidermidis, Staphylococcus aureus and Candida spp. It is very important to prevent and treat the catheter-related infections. Many researches have been done to develop methods for preventing and treating intravascular device-related infection. They include diagnosis of catheter-infections, appropriate barrier precautions during catheter insertion, intervals for replacement of catheters, catheter-site care, site of catheter insertion and type of catheter material. Furthermore novel approaches are needed for prevention and treatment of the intravascular device-related infection.     

Bloodstream infection

Bloodstream infection is the most serious disease and the third mortality rate among nosocomial infections. Recently, catheter-related bloodstream infection(CRBSI) is the major cause of the bloodstream infection, related to serious complication, leading to increase in morbidity and mortality. Coagulase-negative staphylococci, Staphylococcus aureus, enterococci and Candida spp. are most commonly causes of CRBSI. A variety of methods such as aseptic insertion techniques and appropriate catheter care have proved effective, which are also preferable to prevent CRBSI. If CRBSI occurs, empirical antimicrobial therapy should be immediately started after appropriate cultures of blood and catheter sample are performed.     

腹膜透析患者导管外口护理的研究进展

腹膜透析导管外口护理对于预防导管外口感染至关重要。本文就导管外口护理的内容、导管外口护理的重要性、导管外口护理实践现况等的研究进展进行综述,以期为改善腹膜透析导管外口护理实践提供依据。     

Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis

Title. Catheter‐related bloodstream infections in intensive care units: a systematic review with meta‐analysis Aim. This paper is a report of a systematic review and meta‐analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheter‐related bloodstream infections and catheter colonization in the intensive care unit setting. Background. Catheter‐related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter‐related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes. Methods. A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords ‘catheterization – central venous’ with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter‐related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta‐analyses. Results. Twenty‐three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter‐related bloodstream infection included staff education multifaceted infection control programmes and performance feedback. Conclusion. A range of interventions may reduce risks of catheter‐related bloodstream infection, in addition to antimicrobial catheters.     

老年患者留置尿管致院内泌尿系感染的相关因素分析

目的分析老年患者住院期间留置尿管发生泌尿系感染的相关因素,了解留置尿管老年患者泌尿系感染状况,为预防和控制泌尿系感染提供依据。方法通过查阅病历、护理记录、尿常规和尿培养等化验报告与科室院内感染小组成员填写的医院获得性感染资料相结合的方法,对某院老年科2008年2月至2010年2月留置尿管老年患者（年龄≥60岁）的泌尿系感染状况进行分析。结果本组224例留置尿管患者中发生泌尿系感染者82例,占36．5％。留置尿管的老年患者发生泌尿系感染情况与其年龄、性别、留置尿管的时间、尿管的护理措施等因素有关。结论严格掌握老年患者留置尿管指征,尽量减少老年患者的置管率,缩短置管时间,积极治疗原发病,针对不同感染情况加强管道护理是降低院内泌尿系感染的有效措施。     

Urinary catheters: selection,management and prevention of infection

Urinary catheterization is a common procedure for both hospital and community patients. Nurses make many of the decisions in regard to both catheter selection and subsequent catheter care. These decisions, for example, in the type of catheterization (intermittent, indwelling, urethral or suprapubic) should be made on an informed basis. Choosing the optimum catheter material and size can benefit catheter care. Encrustation can be a problem for some catheterized patients and nurses are often involved in trying to prevent or treat it. This and other aspects of catheter management including infection control, constipation and meatal hygiene are discussed.     

肿瘤患者PICC置管感染的条件Logistic回归分析

目的分析PICC置管感染相关的危险因素。方法对PICC置管后发生导管相关感染的32例恶性肿瘤患者,进行1∶3匹配的病例对照研究,调查患者文化程度、职业、居住地、伴发疾病种类、体质指数、住院期间主要治疗、PICC置管部位、置管静脉、导管类型、带管住院次数、均次住院留置时间、总留置时间等因素,分析置管后发生导管相关感染的危险因素。结果导管类型(BD PICC导管)、患者居住地(非城镇)是PICC置管后发生导管相关感染的危险因素,均次住院留置时间(14d)是保护因素。结论导管类型、均次住院留置时间、患者居住地是PICC置管后发生导管相关感染的相关因素。合理选择导管类型,规范进行导管维护,加强出院带管患者的健康教育,有利于预防和控制PICC置管后导管相关感染的发生。     

1.4%碳酸氢钠膀胱冲洗预防真菌性尿路感染的探讨

目的探讨1.4％碳酸氢钠膀胱冲洗预防重症监护患者尿管相关的真菌性尿路感染的效果和方法。方法42例患者,随机分两组。预防组以1．4％碳酸氢钠膀胱冲洗,2次／d;对照组不行膀胱冲洗。并监测1．4％碳酸氢钠膀胱冲洗前后动脉血中剩余碱（BE）值的变化及尿常规中红细胞数的变化。结果1．4％碳酸氢钠膀胱冲洗可显著减少重症监护患者尿管相关的真菌性尿路感染发生率（P〈0．01）,1．4％碳酸氢钠膀胱冲洗前后动脉血中BE值及尿常规中的红细胞数的变化差异无统计学意义。结论1．4％碳酸氢钠膀胱冲洗可有效预防尿管相关的真菌性尿路感染,未见不良反应。     

重症监护室患者侵袭性导管相关感染分析与护理

目的探讨重症监护室（ICU）内各种侵袭性导管监护治疗与导管相关性感染的关系及其护理干预对策。方法对我院2005年1月-2006年10月ICU收治的739例患者进行回顾性调查，了解ICU内侵袭性导管相关感染发生情况。结果739例患者在ICU住院期间发生医院感染129例，医院感染发病率17．45％；患者日医院感染发生率13．04‰；与尿道插管相关的泌尿道感染发生率11．57‰；与动静脉插管相关的血液感染发病率0．46‰；与使用呼吸机相关的肺部感染发病率9．78‰。侵袭性操作越多感染率相应增高。结论加强环境治理、避免交叉感染、严格洗手制度、严格管理侵袭性操作及合理使用抗生素等综合治理措施是预防和控制侵袭性导管相关感染的有效途径。     

长期深静脉留置透析导管的并发症及护理

目的 探讨长期深静脉留置透析导管患者相关并发症及护理方法.方法 回顾性分析我院2002年10月至2009年10月109例长期深静脉双腔透析导管的使用情况,随访留置导管的并发症及对症处理情况,记录导管使用时间及拔管原因.结果 本组患者导管平均使用时间为（19.8±10.7）个月,导管退出57例次,约占52.3%,导管退出时平均使用时间为（9.8±7.5）个月.109例患者中发生导管相关性感染22例,感染率为20.2%,其中17例为细菌感染,5例为真菌感染;11例导管内血栓形成,发生率为10.1%;导管位置不良4例,发生率为3.7%;3例导管cuff脱落,发生率为2.8%.结论 导管相关性感染、血栓形成及导管位置不良是其最为常见的并发症,良好的导管留置技术和精心的护理可减少并发症的发生,显著延长导管的使用寿命.     

经胸前区腋静脉穿刺置管导管相关性感染调查研究

目的探讨经胸前区腋静脉穿刺置管(IATAV)病人导管相关性感染情况。方法2001年10月～2003年10月对接受IATAV的707例病人进行导管相关性感染调查。结果发生导管相关性感染5例,感染率为0.71%,其中外科650例病人,感染1例,感染率0.15%,化疗科57例病人,感染4例,感染率7.02%;全组病人置管时间<20d者共646例,发生感染1例,感染率为0.15%,≥20d者共61例,发生感染4例,感染率6.56%。结论IATAV病人导管相关性感染的主要危险因素为机体免疫功能低下、置管时间长和导管护理欠妥,对有高危因素存在的病人要加强监测和护理,避免发生导管感染。     

胆道T管引流术后的观察与护理

目的:探讨胆道T管引流的术后护理方法。方法:对279例胆道探查T管引流术后患者做好管道护理,加强病情观察,预防术后并发症。结果:本组发生T管周围感染2例,T管滑脱造成胆汁漏入腹腔5例,窦道形成不全、拔管后致胆汁性腹膜炎2例,其余270例治疗效果满意。结论:加强胆道T管引流术后护理,减少并发症发生,是保证手术成功,促进患者康复的关键。     

A multicentred clinical improvement project among preterm population evaluation of current practices

Sepsis, a potentially life-threatening infection, is a common complication related to the use of central venous catheters (CVCs) in the preterm infant population. Best practice guidelines include successful strategies to prevent infections. Central venous catheter use is a fairly recent intervention in Finnish neonatal intensive care units (NICUs). As part of a quality improvement project to evaluate catheter-related care practices, 4 NICUs collaborated in a multicenter, multiprofessional study aimed at decreasing the incidence of catheter-related sepsis among a population of preterm infants. This article describes the initial phase that evaluated current protocols and practices. The findings were that current protocols need revision to include more detailed and accurately focused instructions on infection prevention associated with CVC. Many challenges in performing certain procedures with catheters were found. Precis CVC protocols and practices in 4 Finnish NICUs were reviewed for infection control measures.     

膀胱冲洗预防泌尿系感染的护理进展

临床上留置尿管的病人极易发生泌尿系感染,采取有效措施降低泌尿系感染是临床护理重要的研究课题。重点阐述了膀胱冲洗预防泌尿系感染的相关研究,为护理人员的临床实践提供科学的护理依据。     

膀胱冲洗预防泌尿系感染的护理进展

临床上留置尿管的病人极易发生泌尿系感染，采取有效措施降低泌尿系感染是临床护理重要的研究课题。重点阐述了膀胱冲洗预防泌尿系感染的相关研究．为护理人员的临床实践提供科学的护理依据。     

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:

Catheter-related infection (CRI) of the central vein is a common cause of nosocomial infection. This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit (EICU) in order to provide the beneficial reference.

METHODS:

From January 2008 to December 2010, a total of 1 363 patients were subjected to catheterization. In these patients, the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.

RESULTS:

CRI happened in 147 of the 1 363 patients using the central venous catheter. The peak rate of CRI was 10.79%, with an incidence of 3.05 episodes per 1 000 catheter days. Of the 147 patients, 46.94% had gram-negative bacilli, 40.14% had gram-positive cocci, and 12.92% had fungi. Unconditional logistic regression analysis suggests that multiple catheterization, femoral vein catheterization, the application of multicavity catheter, and the duration of catheterization were the independent risk factors for CRI.

CONCLUSION:

The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.KEY WORDS: Central venous, Cather related infection, Femoral vein catheter, Multiple lumen catheter, Long-term indwelling catheter, Long-term use of antibiotics, Emergency intensive care unit, Nosocomial infection     

ARROW中心静脉导管在肝癌病人合并胸腔积液引流中的应用及护理

[目的]探讨ARROW单腔中心静脉导管在肝癌病人合并胸腔积液引流中的应用及护理。[方法]对62例肝癌病人合并胸腔积液需行胸腔穿刺放液的病人应用ARROW中心静脉导管代替传统的胸腔穿刺放液、抽液,观察其疗效、并发症,并对整个细致有效的护理过程进行总结。[结果]本组62例病人均1次置管成功,导管留置时间为3d～21d,未发生导管相关性感染、导管阻塞及导管脱出等并发症,置管引流后胸腔积液逐渐减少,病人呼吸困难、胸闷、心悸、气促、咳嗽等症状明显改善,病情得到缓解。[结论]本组应用ARROW单腔中心静脉导管引流胸腔积液,无继发感染、血气胸等并发症发生,做好穿刺点的护理,预防感染是保证置管引流成功的关键。     

Correlation between “malfunctioning events” and catheter-related infections in pediatric cancer patients bearing tunneled indwelling central venous catheter: results of a prospective observational study

Aim of the study To evaluate the possible link between malfunctioning events and catheter related infections in indwelling central venous devices in children with cancer.Patients and methods Prospective observation of 418 devices inserted in 2 Italian tertiary care pediatric cancer centers. The presence of a relationship was identified if a malfunctioning event was followed by a catheter related infection within 10 days, or vice versa.Results The 418 catheters were followed for a period of 107,012 days. Among the malfunctioning events 2 out of 141 (1%) were followed by a catheter related infection while among infectious episodes 3 out of 93 (3%) were followed by a malfunctioning event.Conclusions Malfunctioning events followed by catheter related infections and catheter related infections followed by malfunctioning are both rare events in children with cancer.     

基层医院血液透析病人深静脉导管感染相关因素分析及预防对策

目的探讨分析基层医院血液透析病人深静脉置管引起导管感染的相关因素及预防措施。方法 1999年5月至2009年5月,深静脉置管维持性血液透析40例,发生严重感染6例,占15.0%,更换导管时取导管尖端进行细菌培养,并对结果分析。结果引起血液透析深静脉导管感染病原菌为表皮葡萄球菌。置管2、3、6月的感染率分别为16.7%、33.3%、50.0%,锁骨下静脉穿刺置管发生率为0,股静脉置管发生1例,占16.7%,其余5例均为颈内静脉置管,占83.3%。局部护理合理者感染机会少。6例感染者均有护理不得力因素存在。结论引起血液透析深静脉置管感染相关的病原菌为表皮葡萄球菌。导管留置时间越长及护理不得力,则导管感染率越高,锁骨下静脉置管深静脉导管感染发生率低于股静脉和颈内静脉置管。严格深静脉置管护理和缩短留置时间对防止相关性感染具有重要临床意义。