Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units.

BACKGROUND: Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs. METHODS: We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years. RESULTS: A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days; P = .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by "float" nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P = .0001), patient cared for by a float nurse for more than 60% of CVC-days (P = .0019), no antibiotics administered to the patient within 48 hours of insertion (P = .0001), and patient unarousable for 70% or more of the duration of the CVC (P = .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P = .0001). CONCLUSIONS: Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.     

ICU中心静脉置管血流真菌感染的相关因素分析

目的探讨重症监护病房(ICU)中心静脉置管相关性血流真菌感染(CVC-RBFI)的临床特点及影响预后的因素。方法选择2010年1月-2012年12月ICU中发生导管相关性真菌血流感染的63例患者为研究对象,运用多因素logistic回归分析CVC-RBFI临床特点和主要生化指标与预后的关系,数据使用SPSS18.0软件进行统计分析。结果 ICU CVC-RBFI患者基础疾病前4位分别为肿瘤、神经系统疾病、肺部疾病、腹部疾病,分别占34.9%、19.0%、14.3%、14.3%;诱发因素主要有广谱抗菌药物使用>5d、静脉营养≥10d、中心静脉导管留置>5d等,其分别占96.8%、95.2%、93.7%;共检出真菌63株,其中白色假丝酵母菌26株占41.27%,非白色假丝酵母菌占58.73%,多因素logistic回归分析显示,合并细菌菌血症、APACH EⅡ评分>18分是CVCRBFI死亡的独立危险因素。结论 ICU CVC-RBFI病原菌以白色假丝酵母菌为主,病死率高,加强对上述危险因素及真菌药敏监测、及早撤除医源性侵入因素,可以改善CVC-RBFI患者的预后。     

24家综合医院ICU中心静脉导管(CVC)置管感染防控措施依从性的前瞻性研究

目的了解中心静脉导管(CVC)置管临床实践(CLIP)依从性。方法采用前瞻性研究设计,对2017年3月1日-2017年3月31日期间的江苏省12个省辖市开展调查,选择依从性较好的三级和二级医院。观察均在成人ICU中开展,通过统一培训的观察员观察CLIP依从性结果,通过手机软件调查,调查结果自动上传终端数据库。结果共有24家医院参与本次调查,共观察CVC置管572次;其中三级综合医院487次占85.14%和二级医院85次占14.86%;置管前手卫生和皮肤消毒依从性较高,分别为94.41%和100.00%,最大无菌屏障依从性最低为77.27%,其中无菌隔离衣的依从性最低为87.9%;穿刺前消毒剂干燥和最大无菌屏障依从性医生分别为90.16%、75.79%,低于护士的98.44%、89.06%(P=0.028、P=0.017)。结论 ICU中CVC置管CLIP依从性不高,尤其是医生,需要加强培训、督查和反馈,从而预防导管相关血流感染,保障患者安全。     

ICU患者中央导管相关血流感染风险预测模型的构建

目的构建中央导管相关血流感染(CLABSI)风险预测模型,为制定及时有效且针对性强的CLABSI防控措施提供依据支持。方法选择2014年7月-2015年6月期间徐州地区综合重症监护病房(ICU)留置中心静脉导管的患者为研究对象,建立ICU患者CLABSI医院感染风险预测模型。结果共1 276例留置中心静脉导管的ICU患者纳入研究,总置管天数为43 993天,导管使用率为46.69%,发生CLABSI的患者为89例,CLABSI感染发生率为6.97%,千日感染率为2.02/千导管日;多因素Logistic分析结果显示,抗菌药物的使用、基础疾病类型、导管类型、股静脉穿刺、置管天数为ICU患者发生CLABSI的独立影响因素(P0.05);预测模型判别敏感度82.05%,特异度69.25%,模型ROC的AUC为0.804(95%CI:0.764~0.844)。结论本研究建立的Logistic回归风险预测模型对ICU患者CLABSI的发生风险预测拟合度较好,能够针对CLABSI进行事前监测,为及时有效地制定相关防控措施提供依据支持,保障患者安全,节约医疗成本,避免医疗资源的浪费。     

综合重症监护病房中心静脉导管相关性血流感染监测与控制效果分析

目的降低重症监护病房导管相关性血流感染(CRBSI)的发生率。方法 A组采取回顾性调查方法,查阅出院病历,逐项填写记录表;B组采取目标性监测方法,由两名深静脉导管专职护理护士负责具体操作,采取一系列感染控制措施,将两组资料分别进行汇总统计、分析判断、计算感染率并做比较。结果 A组导管相关性血流感染率为20.9‰,B组实行目标性监测落实感染控制各项措施后,导管相关性血流感染率下降至5.4‰,差异有统计学意义(P<0.05)。结论在综合控制措施中,提高医护人员在医疗活动中的技术水平和执行力,设专业导管护理小组进行中心静脉置管全过程质量管理,是降低导管相关性血流感染非常有效的措施。     

重症监护病房中心静脉导管相关血流感染控制与干预的多中心研究

目的通过对多中心重症监护病房(ICU)中心静脉导管相关血流感染(CLABSI)情况的调查,采取相应的控制与干预方法,以降低其感染率。方法 2015年4月-2015年9月对全军19家医院的22个ICU的患者进行基线调查作为干预前的资料;2015年9月对相关人员进行干预措施培训;2015年10月-2016年5月进行插管干预和维护干预方法作为干预后资料,对干预前后资料进行比较。结果干预前后中央静脉导管使用率,置管部位构成比,手卫生的依从性和正确率,皮肤消毒剂构成,每日评估并记录,使用无菌大铺巾、置管者着装合格、端口消毒合格率的比较,差异有统计学意义(P<0.05);干预前后CLABSI千日发病率比较,差异无统计学意义。结论插管干预组合和维护干预组合两者结合,提高中心静脉置管使用过程中的安全性,对降低CLABSI的发生还有待更进一步研究。     

Reduction in central line-associated bloodstream infections among patients in intensive care units--Pennsylvania, April 2001-March 2005

Each year, an estimated 250,000 cases of central line-associated (i.e., central venous catheter-associated) bloodstream infections (BSIs) occur in hospitals in the United States, with an estimated attributable mortality of 12%-25% for each infection. The marginal cost to the health-care system is approximately 25,000 dollars per episode. In 2001, CDC was invited by the Pittsburgh Regional Healthcare Initiative (PRHI) to provide technical assistance for a hospital-based intervention to prevent central line-associated BSIs among intensive care unit (ICU) patients in southwestern Pennsylvania. During a 4-year period, BSI rates among ICU patients declined 68%, from 4.31 to 1.36 per 1,000 central line days. The results suggest that a coordinated, multi-institutional infection-control initiative might be an effective approach to reducing health-care-associated infections.     

Reducing central venous catheter-associated primary bloodstream infections in intensive care units is possible: data from the German nosocomial infection surveillance system.

BACKGROUND AND OBJECTIVE: The German Nosocomial Infection Surveillance System (KISS) began in 1997 as a nationwide surveillance project for voluntary registration of nosocomial infections in intensive care units (ICUs). This study investigates trends in the rates of central venous catheter (CVC)-associated primary bloodstream infections (BSIs) in ICUs since participation in KISS. METHODS: Eighty-four ICUs that had participated in KISS for at least 24 months were considered for more detailed analysis. Monthly rates of primary BSI for the 84 ICUs were pooled for the 24 months. The best model for describing the curve of reduction was sought. Additionally, incidence densities were compared using the z test. RESULTS: For the 212 ICUs participating, a relative 25.7% decrease (from 2.1 to 1.6 primary BSIs per 1,000 CVC-days) was observed from January 1997 to June 2001. The 84 ICUs that participated in KISS for a minimum of 24 months accumulated 552,359 patient-days and 404,897 CVC-days during their 24 months. A linear regression model was selected to explain the curve of primary BSI reduction in the 84 ICUs. It showed a decrease from 2.1 to 1.5 primary BSIs per 1,000 CVC-days, meaning an overall relative reduction of 28.6% during the 2-year observation period. These results were significant (Student's t test for the monthly reduction coefficient; P = .04). The reduction of primary BSIs was shown for both clinical sepsis and laboratory-confirmed, CVC-associated primary BSIs. CONCLUSION: Performing surveillance with KISS was associated with a reduction of the rates of CVC-associated primary BSIs in ICU patients.     

Unnecessary use of central venous catheters: the need to look outside the intensive care unit.

We developed criteria for justifiable CVC use and evaluated CVC use in a public hospital. Unjustified CVC-days were more common for non-ICU patients compared with ICU patients. Also, insertion-site dressings were less likely to be intact on non-ICU patients. Interventions to reduce CVC-associated bloodstream infections should include non-ICU patients.     

Contamination of central venous catheters in immunocompromised patients: a comparison between two different types of central venous catheters

Catheters impregnated with silver have been proposed as a means of reducing catheter-related infection. We therefore performed a prospective randomized study to compare a new silver-impregnated central venous catheter (CVC) with a commercially available CVC in a cohort of immunocompromised patients. We studied 157 patients of whom 97 could be analysed. The median indwelling time in the study group (SC) was 10.5 days and 11 days in the control group (CC). The incidence of contamination in the SC group was 15.6 vs 24.6 in the CC group referring to 1000 catheter days. In both groups, we found 6% of catheter-related infections according to the definitions of a published scoring system. The differences between the two groups were not significant. We conclude that the SC decrease the incidence of catheter contamination and may have a positive effect on the reduction of CVC-related infections.     

Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters.

OBJECTIVE: Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion. DESIGN: A time-sequence nonrandomized intervention study. SETTING: Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center. PATIENTS: All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days). INTERVENTION: Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion. RESULTS: The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 + 1.1 days to 4.6 +/- 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 +/- 3.1 to 8.3 +/- 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from 4021 dollars +/- 1800 dollars to 1220 dollars +/- 941 dollars; P = .004). CONCLUSION: This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.     

NICU医院感染危险因素分析

目的探讨新生儿危重症监护病房(NICU)医院感染的危险因素。方法回顾性调查医院NICU住院患儿临床资料,分析引起医院感染的危险因素。结果医院感染发生率为12.7%;感染部位以呼吸道为主,占54.2%,其次为血液、皮肤软组织,分别占22.4%、8.4%;共培养出病原菌255株,以革兰阴性杆菌为主,占73.7%,以肺炎克雷伯菌最为多见,占14.5%,真菌占5.9%;早产儿、低出生体重儿、暖箱保暖及侵入性操作、全胃肠外营养、抗菌药物应用时间≥2周与医院感染显著相关,共有3个变量进入多元logistic回归方程:胎龄、机械通气≥3 d、抗菌药物应用时间≥2周可作为医院感染发生的独立危险因素。结论 NICU医院感染的危险因素众多,应针对危险因素采取相应的预防措施和对策。     

急诊重症监护病房中心静脉导管相关感染的病原学及危险因素分析

目的了解急诊重症监护病房（ICU）中心静脉导管相关感染（CVC-RI）的病原菌特点和危险因素。方法对急诊ICU 2006年1月至2008年12月放置中心静脉导管并符合CVC—RI诊断标准,细菌学检查均阳性的103例患者进行回顾性调查分析。结果CVC—RI病原菌中革兰阳性菌（37．9％,39／103）和革兰阴性菌（42．7％,44／103）发生感染的比例差异无统计学意义。CVC—RI与使用导管腔数、置管时间、置管部位有关。锁骨下静脉置管发生感染的比例最低。结论应尽量选择在锁骨下静脉置管,控制置管时间和导管腔数,注意监测病原菌菌谱的变化。预防重点是避免导管腔内外的污染。     

急诊重症监护病房中心静脉导管相关感染的病原学及危险因素分析

目的 了解急诊重症监护病房(ICU)中心静脉导管相关感染(CVC-RI)的病原菌特点和危险因素.方法 对急诊ICU 2006年1月至2008年12月放置中心静脉导管并符合CVC-RI诊断标准,细菌学检查均阳性的103例患者进行回顾性调查分析.结果 CVC-RI病原菌中革兰阳性菌(37.9%,39/103)和革兰阴性菌(42.7%,44/103)发生感染的比例差异无统计学意义.CVC-RI与使用导管腔数、置管时间、置管部位有关.锁骨下静脉置管发生感染的比例最低.结论 应尽量选择在锁骨下静脉置管,控制置管时间和导管腔数,注意监测病原菌菌谱的变化.预防重点是避免导管腔内外的污染.