重症监护病房中心静脉导管感染相关因素分析及病原菌分布调查

目的：了解中心静脉导管相关血行感染的相关因素和病原菌分布特点。方法：回顾性分析2012-01-2013-06收治ICU内行中心静脉置管患者的临床资料,对不同留置部位、留置时间的中心静脉导管感染率及病原菌分布进行分析。结果：不同留置部位、留置时间是CRBSI的独立危险因素,CRBSI与留置时间呈正相关（r=0.225,P〈0.01）。CRBSI的病原菌中革兰阳性菌（G＋菌）、革兰阴性菌（G-菌）、真菌各占67.16%、26.87%、5.97%,以耐药菌为主。结论：规范CVC无菌操作,加强导管护理,缩短导管留置时间,加强病原学监测,是控制CRBSI发生的关键。     

ICU患者发生导管相关性血流感染的原因分析及对策

目的 探讨ICU患者发生导管相关性血流感染(catheter related bloodstream infection,CRBSI)的原因,并制订相应的对策.方法 回顾性分析2010年5月～2011年5月本院实施中心静脉置管治疗的患者751例,其中发生CRBSI 21例,分析发生的原因并制订相应的对策.结果 21例患者发生CRBSI的原因与操作流程不当、患者个体因素、导管的类型和材料、置管部位和时间等有关;其中2例患者进行了导管更换,4例拔除了导管,其余15例感染得到控制,病情稳定转出ICU,1例患者死亡.结论 ICU应制订完善的预防机制,对医护人员进行正规的置管培训,同时加强无菌观念,落实血管内导管的管理与监测,以保证患者的置管安全,预防CRBSI的发生.     

Epidemiology and prevention of catheter‐related thrombosis in patients with cancer

Summary. Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to catheter‐related thrombosis (CRT). Contemporary studies have shown that the incidence of symptomatic CRT is ～ 5%, whereas the incidence of asymptomatic CRT is higher, at 14–18%. The significance and mechanisms of catheter design, material, insertion location and technique, position of the catheter tip and other risk factors in contributing to the development of CRT are not well understood. Efforts to reduce thrombotic complications, involving flushing the catheter with heparinized solutions, the use of heparin‐bonded catheters, and systemic anticoagulant prophylaxis, have been largely ineffective. More studies are needed to understand the pathophysiology of thrombotic complications, to help identify effective interventions to reduce this adverse outcome.     

Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review

BackgroundIn adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters.AimIdentify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.MethodsA systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion.ResultsNineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the ‘On the CUSP: Stop Blood Stream Infections' national programme.ConclusionsCentral venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.     

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     

应用乙醇封管技术预防中心静脉导管相关性血流感染的研究

综述了应用乙醇封管技术预防中心静脉导管相关性血流感染（CRBSI）的研究现状,提出乙醇封管技术还存在很多争议,如乙醇浓度、乙醇在管腔内保留的时间、是否联用抗凝剂、是否联合全身性抗生素治疗、乙醇的慢性中毒反应等。应用乙醇封管技术预防CRBSI还需要多中心、大样本的随机对照实验,为这项技术的应用提供强有力的证据。     

肿瘤患者外周中心静脉置管导管相关性感染的危险因素研究

目的探讨肿瘤患者外周中心静脉置管(PICC)导管相关性感染的危险因素。方法 348例行PICC的肿瘤患者根据是否发生导管相关性感染分为感染组61例和对照组287例,回顾性分析2组患者临床资料,筛选导管相关性感染的危险因素。结果单因素分析表明,年龄、文化程度、病程、是否应用高营养化疗药物、是否应用激素、白细胞计数(WBC)、是否掌握PICC自我护理知识、置管部位、导管类型、留置时间及操作者的经验等因素均与导管相关性感染相关(P0.01),Logistic回归分析显示,静脉高营养、应用激素、PICC自我护理知识掌握不良、导管留置时间长、留置部位为股静脉、操作者经验少、WBC降低为PICC导管相关性感染的危险因素(P0.05或P0.01)。结论 PICC导管相关性感染受多重因素影响,临床应针对上述因素进行干预,预防导管相关性感染的发生。     

血液透析患者导管感染原因分析与对策

目的分析血液透析患者留置导管感染的相关因素、常见致病菌,并探讨预防措施。方法对238例血液透析患者进行回顾性分析,观察置管方式、常见致病菌与导管相关性感染的关系。结果长期留置导管患者的感染率3.35例次/1 000导管日,明显低于临时留置导管患者的感染率9.22例次/1 000导管日,差异具有统计学意义(P0.05)。常见致病菌为金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌。结论血液透析护士严格无菌操作,并加强透析室环境及物品清洁消毒,可以减少导管相关性感染的发生。     

Risk factors for catheter‐related thrombosis (CRT) in cancer patients: a patient‐level data (IPD) meta‐analysis of clinical trials and prospective studies

Background: Knowledge of independent, baseline risk factors for catheter‐related thrombosis (CRT) may help select adult cancer patients who are at high risk to receive thromboprophylaxis. Objectives: We conducted a meta‐analysis of individual patient‐level data to identify these baseline risk factors. Patients/Methods: MEDLINE, EMBASE, CINAHL, CENTRAL, DARE and the Grey literature databases were searched in all languages from 1995 to 2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient‐level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results: A total sample of 5636 subjects from five RCTs and seven prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICCs), decreased CRT risk (OR, 0.43; 95% CI, 0.23–0.80), whereas past history of deep vein thrombosis (DVT) (OR, 2.03; 95% CI, 1.05–3.92), subclavian venipuncture insertion technique (OR, 2.16; 95% CI, 1.07–4.34) and improper catheter tip location (OR, 1.92; 95% CI, 1.22–3.02), increased CRT risk. Conclusions: CRT risk is increased with use of PICCs, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings.     

危重症患者经皮穿刺中心静脉插管术后感染因素分析

目的：分析经皮穿刺中心静脉插管术后感染因素，探讨有效防治感染的对策。方法：将７５例实施经皮穿刺中心静脉插管术的危重症患者根据导管留置时间分成３组：第１组（≤７天），第２组（８～１４天），第３组（＞１４天）。根据导管类型分为单腔中心静脉导管组及多腔中心静脉导管组。分别观察其术后感染发生率。结果：第１组、第２组和第３组术后感染发生率分别为２．８６％，１７．２０％和５４．５０％，均存在显著性差异（Ｐ均＜０．０５）。其中应用单腔、多腔中心静脉导管术后感染率分别１２．１％及１９．０％，无显著性差异（Ｐ＞０．０５）。结论：引起经皮穿刺中心静脉插管术后感染的因素，以寄生于穿刺伤口局部皮肤的微生物沿导管向体内迁移所致的术后感染最多见。随着导管留置时间的延长，其感染发生率相应增加；中心静脉导管留置时间以不超过７天为宜，需长期留置者，应及时更换导管。     

品管圈活动在提高医护人员中心静脉导管集束预防策略依从性中的应用

目的探讨品管圈活动在提高医护人员中心静脉导管集束预防策略依从性中的应用方法与效果。方法成立品管圈小组,选定主题,对中心静脉置管现状调查及要因分析,针对要因制订对策并实施。结果医护人员集束预防策略的依从性提高(P0.01);中心静脉导管相关性血流感染发生率下降(P0.05)。结论品管圈活动的开展可以提高医护人员集束预防策略依从性,降低导管相关性血流感染率。     

Presepsin: A new marker of catheter related blood stream infections in pediatric patients

Background

Catheter related blood stream infections (CRBSI) are mostly preventable hospital-acquired conditions. We aimed to investigate the value of presepsin in detection of CRBSI in hospitalized children.

The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

Introduction

The management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVCs has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVCs inserted by GWX (GWX-CVCs) with newly inserted triple lumen AST CVCs (NI-CVCs).

Methods

We studied a cohort of 145 consecutive patients with GWX-CVCs and contemporaneous site-matched control cohort of 163 patients with NI-CVCs in a tertiary intensive care unit (ICU).

Results

GWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean Acute Physiology and Chronic Health Evaluation (APACHE) III: 71.3 vs. 72.2). However, GWX patients had longer median ICU lengths of stay (12.2 vs. 4.4 days; P < 0.001) and median hospital lengths of stay (30.7 vs. 18.0 days; P < 0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVCs vs. NI-CVCs (5 (2.5%) vs. 6 (7.4%); P = 0.90). Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (P = 0.75). There was no significant difference in hospital mortality (35 (24.1%) vs. 48 (29.4%); P = 0.29).

Conclusions

GWX-CVCs and NI-CVCs had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVCs GWX may be an acceptable initial approach to line insertion.     

A nurse–family partnership intervention to increase the self‐efficacy of family caregivers and reduce catheter‐associated urinary tract infection in catheterized patients

The purpose of this study was to evaluate the effects of a nurse–family partnership model on the self‐efficacy of family caregivers (FCs) and the incidence of catheter‐associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse–family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self‐Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care.