集束化护理在预防中心静脉导管相关性血流感染中的循证实践

目的 探讨集束化护理在预防中心静脉导管相关性血流感染中的应用并评价其效果。方法 纳入重症医学科在岗护士76名。选取2019年3-6月入住重症医学科留置中心静脉导管(central venous catfeter,CVC)的87例患者为对照组,2019年11月-2020年2月入住重症医学科留置CVC的83例患者为观察组,对照组采用常规护理,观察组采用基于循证实践的集束化护理,比较证据应用前后,ICU护士对CRBSI预防及管理的认知水平及2组中心静脉置管患者CRBSI的发生率。结果 最佳证据应用后,ICU护士对CRBSI预防及管理的相关知识得分高于应用前(t=16.367,P＜0.001),观察组导管相关性血流感染的发生率为明显低于对照组(χ²=4.088,P=0.043)。 结论 基于最佳证据的集束化护理措施的应用,可提升护理人员对证据相关知识的掌握程度,提高规范执行率,降低中心静脉导管相关性血流感染发生率,提高护理质量。     

Incidence,risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit

Although there are many studies about catheter related infection in industrialized countries, very few have analyzed it in emerging countries. The aim of our study was to determine the incidence, microbiological profile and risk factors for catheter-related bloodstream infection (CRBSI) in a Tunisian medical intensive care unit. Over eight months (1 January 2012–30 August 2012) a prospective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. Two hundred sixty patients, with a total of 482 CVCs were enrolled. The mean duration of catheterization was 9.6 ± 6.2 days. The incidence for CRBSI and catheter colonization (CC) was 2.4 and 9.3 per 1000 catheter days, respectively. Risk factors independently associated with CRBSI were diabetes mellitus, long duration of catheterization, sepsis at insertion and administration of one or more antibiotics before insertion. The mortality rate among the CRBSI group was 21.8%. The predominant microorganisms isolated from CRBSI and CC episodes were Gram negative bacilli. All Gram negative organisms isolated among dead patients in CRBSI group were Extensive Drug Resistant (XDR). In our study the mortality rate among patients with CRBSI was high despite a low incidence of CRBSI. This high rate can be explained by the high-virulent status of Gram negative bacteria involved in CRBSI.     

Enterococcal intravascular catheter-related bloodstream infection: management and outcome of 61 consecutive cases

Enterococci are an increasingly important cause of intravascular catheter-related bloodstream infection (CRBSI), but the evidence base for treating such cases is limited. Successful antimicrobial treatment of CRBSI while leaving the central venous catheter (CVC) in situ has been reported for some bacteria, such as coagulase-negative staphylococci, but the effectiveness of this approach for treating enterococcal CRBSI is unknown. We aimed to determine the effectiveness of treatment options for enterococcal CRBSI and whether CVC removal is mandatory. Treatment and outcome was determined in a 3 year cohort of patients with enterococcal CRBSI from a university teaching hospital. All episodes of enterococcal bacteraemia during the study (n = 268) were examined to identify the cohort of 61 CRBSIs. Outcomes were determined for various antimicrobial regimens with or without CVC removal. Forty-eight episodes were managed with CVC removal and 13 were managed with the CVC in situ. Forty of 48 (83%) and five of 13 (38%) episodes were cured with the CVC removed or left in situ, respectively. All five episodes cured with the CVC in situ were treated with a cell wall-acting antimicrobial plus an aminoglycoside. This antimicrobial combination was significantly more effective than either ampicillin or vancomycin monotherapy (P < 0.05), or antimicrobials to which isolates were not susceptible (P < 0.01) when the CVC remained in situ. We conclude that enterococcal CRBSI can be treated successfully without CVC removal. The combination of a cell wall-acting antimicrobial with an aminoglycoside was the most effective regimen when the CVC remained in situ in this small group of patients. Although CVC removal was associated with a high cure rate, it did not guarantee treatment success.     

Each lumen is a potential source of central venous catheter-related bloodstream infection

OBJECTIVE: To determine the relative rates of microbial colonization of individual lumens in triple-lumen central venous catheters (CVCs) and calculate the chance of detecting catheter-related blood stream infection (CRBSI) if only one lumen is sampled. DESIGN: Prospective evaluation of CVCs from suspected and nonsuspected CRBSI cases. SETTING: University teaching hospital. PATIENTS: Triple-lumen CVCs from 50 cases of suspected CRBSI (a raised peripheral white blood cell count, temperature >37 degrees C, and/or local signs of infection at the catheter skin entry site) were evaluated. For comparison, 50 triple-lumen CVCs routinely removed at the end of use were evaluated. MEASUREMENTS: In both groups, peripheral blood cultures were taken before CVC removal. After CVC removal, each lumen was sampled in vitro using the endoluminal brush, and the tip was then cultured using the Maki roll technique. MAIN RESULTS: CVCs causing CRBSI had significant microbial colonization in one, two, or three lumens in ten (40%), ten (40%), or five (20%) cases, respectively. Overall, random sampling of only one lumen in CVCs causing CRBSI had a 60% chance of detecting significant colonization. CONCLUSIONS: If only one CVC lumen is sampled, a negative result does not reliably rule out infection. Each lumen of multiple-lumen CVCs should be considered as a potential source of CRBSI.     

Correlation between early clinical response after catheter removal and diagnosis of catheter-related bloodstream infection

We conducted a retrospective post hoc analysis of prospectively collected data of cancer patients with central venous catheters (CVCs) who developed bacteremia with positive quantitative blood cultures (QBCs) drawn simultaneously through peripheral vein and CVC and which grew the same microorganisms from both blood cultures. We investigated whether clinical response of bacteremia, within 24, 48, or 72 h post-CVC removal, could be diagnostic of catheter-related bloodstream infection (CRBSI) when compared with microbiologic methods. Clinical response to antimicrobial therapy within 24 h of CVC removal in a patient with bacteremia was found to be highly suggestive of CRBSI, a finding that correlated well with semiquantitative catheter cultures and differential QBCs. However, response to antimicrobial therapy at >or=48 h after CVC removal was less likely to be diagnostic of CRBSI and could reflect a response to antimicrobial therapy irrespective of the source of the bloodstream infections.     

基于循证医学的综合护理预防外科住院患者导管相关性血行感染的效果

目的 评价实施基于循证医学的临床护理方案对降低外科住院患者导管相关性血行感染（CRBSI）的作用.方法 将本院普外科病房留置中心静脉导管进行治疗的患者随机分为常规护理组和加强护理组.每组患者根据导管留置时间分为短期置管组（导管留置时间≤28 d）和长期置管组（导管留置时间＞28 d）两个亚组.对于加强护理组患者,根据中华医学会和欧洲肠外肠内营养学会指南的推荐意见,修订了以＂加强无菌隔离和消毒技术＂为中心的中心静脉导管临床护理方案.对于常规护理组患者根据现行护理常规进行护理.分别比较两组患者导管留置及CRBSI发生情况.结果 在常规护理组中,长期置管患者CRBSI发生率较短期置管患者轻度增高（6.37 vs.5.77/千导管留置日）,其增高幅度为10.40%;在加强护理组中,长期置管患者CRBSI发生率较短期置管患者显著增高（5.18 vs.2.48/千导管留置日）,其增高幅度为108.87%.与常规护理组的短期置管患者相比,加强护理组的短期置管患者CRBSI发生率明显降低（5.77 vs.2.48/千导管留置日）,其下降幅度约为57.02%,差异有统计学意义（P＜0.05）;而与常规护理组的长期置管患者相比,加强护理组的长期置管患者CRBSI发生率轻度降低（6.37 vs.5.18/千导管留置日）,其下降幅度约为18.68%,差异无统计学意义（P＞0.05）.结论 基于循证医学的以＂加强无菌隔离和消毒技术＂为中心的中心静脉导管综合护理方案可以降低短期留置深静脉导管患者CRBSI的发生率,但并不能降低导管留置时间超过28 d患者的CRBSI的发生率.     

集束干预策略预防中心静脉导管相关性血流感染的效果观察

目的探讨集束干预策略预防中心静脉导管相关性血流感染(catheter related blood stream infection,CRBSI)的效果。方法将实施集束干预策略之前(2011年1～10月)留置中心静脉导管186例患者设为对照组,在实施集束干预策略之后(2012年1～10月)留置中心静脉导管193例患者设为集束组。比较实施集束干预措施前后两组患者CRBSI发生率及时间,置管情况。结果采用集束干预策略后CRBSI发生率由实施前8.31‰下降至1.67‰,前后比较,差异具有统计学意义(P<0.001);CRBSI发生时间由(7.47±2.44)d延长至(13.75±1.92)d,前后比较,差异具有统计学意义(P<0.05);锁骨下静脉置管率从39.78%上升至71.50%,股静脉置管率从45.70%下降至18.65%,前后比较,差异具有统计学意义(均P<0.05)。结论集束干预策略可有效降低中心静脉置管患者CRBSI发生率。     

Maintenance antisepsis in reducing the rate of late-onset central venous catheter-related bloodstream infection: A comparison of 0.05% and 1% chlorhexidine

BackgroundBundled measures have been recommended to reduce the risk of central venous catheter (CVC)-related bloodstream infection. However, the importance of each procedure involved in CVC insertion/management for preventing catheter-related bloodstream infection (CRBSI) has not been thoroughly assessed. We aimed to analyze the effectiveness of maintenance antisepsis at the CVC insertion site in reducing the CRBSI risk through comparing the use of 0.05% chlorhexidine to 1% chlorhexidine.Patients and methodsIn the South Miyagi Medical Center, Japan, 372 patients with a CVC who had undergone antisepsis maintenance using 0.05% chlorhexidine swabs 12 months prior to implementing 1% chlorhexidine swabs, and 344 patients at 12 months post-implementation of 1% chlorhexidine swabs, were followed prospectively for the development of CRBSI and signs of infection, and their data compared.ResultsPost-implementation of the 1% chlorhexidine swabs, the CRBSI rate decreased from 3.64/1000 catheter-days to 1.77/1000 catheter-days. The risk of CRBSI decreased to 0.465 (95% confidence interval [CI]: 0.216–1.001). Furthermore, the risk of CRBSI ≥20 days after CVC insertion decreased to 0.200 (95% CI: 0.049–0.867); however, we found no difference between 0.05% and 1% chlorhexidine use within 19 days of CVC insertion. The increased number of patients with insertion site tenderness after implementing 1% chlorhexidine indicated a possible adverse effect of chlorhexidine.ConclusionMaintenance antisepsis with 1% chlorhexidine decreased the risk of developing CRBSI ≥20 days after CVC insertion, indicating the effectiveness of antisepsis with 1% chlorhexidine. Our data highlight the importance of maintenance antisepsis in reducing the rate of late-phase CRBSI.     

Bench-to-bedside review: Challenges of diagnosis,care and prevention of central catheter-related bloodstream infections in children

Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may be difficult. Technology such as CVC impregnation or catheter locking with antimicrobial substances has been shown less effective than anticipated. Despite encouraging results in CRBSI prevention among adults, the goal of zero infection in children is still not in range. More high-quality research is needed in the field of prevention, accurate and reliable diagnostic measures and effective treatment of CRBSI in children.     

Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections

Purpose

To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators.

Methods

Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance.

Results

Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions.

Conclusions

This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.

     

超声引导中长导管置入可降低导管相关血流感染发生率

目的探讨超声引导置入中长导管对急诊重症患者导管相关血流感染(CRBSI)发生率的影响。方法选取2018年3月至2019年12月急诊重症医学科收治529例患者为研究对象,按是否开展超声引导中长导管(MC)置入技术分为MC组(n=278)和对照组(n=251),MC组应用超声引导置入MC作为早期拔除中心静脉导管(CVC)的序贯方法,对照组采用留置针作为CVC拔除后的静脉序贯治疗方法。统计CVC、MC、留置针留置时间,比较两组CVC使用率,绘制Kaplan-Meier生存曲线描述两组的CVC留置时间并进行Log-rank检验,Cox回归分析CVC留置时间的影响因素,比较CRBSI和其他导管相关并发症发生率。结果MC组CVC留置时间显著短于对照组(8 d vs.13 d,P=0.000),CVC使用率显著低于对照组(49.83%vs.80.45%,P=0.000);Cox回归分析显示困难静脉、ICU住院时间延长、置管部位和未开展超声引导MC置入均是CVC留置时间延长的独立危险因素(P=0.000);MC组CRBSI发生率显著低于对照组(0.571‰vs.3.802‰,P=0.038),两组其他导管相关并发症发生率差异无统计学意义(P=0.403)。结论开展超声引导置入MC可缩短CVC留置时间,减少CVC使用率,降低CRBSI发生率,值得临床推广。     

Central venous catheter infection in adults in acute hospital settings

As well as the human cost, central venous catheter (CVC)-related bloodstream infections significantly inflate hospital costs, mainly through increased length of stay in hospital, particularly in intensive care. This literature review appraises recent research on measures used to minimize CVC-related infection and compares it with current best practice. Randomized controlled trials and systematic reviews published on the subject between 2000 and 2005 were reviewed, concentrating on non-tunnelled, short-term CVCs in the acute hospital setting. The new evidence mainly backs up current best practice. However, skin disinfection could be improved by using alcoholic chlorhexidine followed by aqueous povidone-iodine before CVC insertion. Also, alcoholic chlorhexidine is the preferred solution for cleaning the hubs/connectors before accessing the CVC. Good hand hygiene and quality control and education programmes are vital to improve patient care. More research is needed to clarify the effectiveness of certain interventions and technologies, such as antimicrobial CVCs.     

One percent chlorhexidine-alcohol for preventing central venous catheter-related infection during intensive chemotherapy for patients with haematologic malignancies

A central venous catheter (CVC) is a catheter placed into a large vein, and is used for chemotherapy administration. However, there is little confirmatory data on which antiseptic—such as chlorhexidine or povidone-iodine (PI) —is more protective against CVC-related infectious complications in patients receiving intensive chemotherapy. We aimed to compare the effectiveness of 1% chlorhexidine gluconate in 70% alcohol (CH) vs. PI for skin disinfection before CVC insertion in patients receiving intensive chemotherapy. Methods We used either CH or 10% PI as skin antiseptics before CVC insertion, and assessed which agent was more protective against CVC-related infection. The participants were 112 patients with haematologic malignancies who underwent chemotherapy; a total of 292 CVCs were inserted over this period. Blood cultures were obtained when febrile neutropenia occurred. The CVC was removed and the catheter-tip qualitatively cultured when catheter-related infection was suspected. The cumulative incidence of febrile neutropenia, microbial growth from blood or catheter-tip culture, and catheter-related blood stream infection (CRBSI) was evaluated retrospectively. A univariate Cox proportional hazards model showed that CH significantly alleviated infectious complications. Notably, no case of CRBSI occurred in the CH group. Multivariate analysis, adjusted for prolonged neutropenia (>15 days) and older age (>52 years), also showed significant reduction in the cumulative incidence of microbial growth from catheter-tips in the CH group (hazard ratio = 0.146, 95% confidence interval: 0.023–0.502, p = 0.0008). Disinfection using CH, compared with PI, can potentially decrease catheter-related infection without causing adverse skin reactions in patients with haematologic malignancies.     

Clinical epidemiology of central venous catheter–related bloodstream infections in an intensive care unit in China

Background

Central venous catheters (CVCs) are universally used during the treatment of critically ill patients. Their use, however, is associated with a substantial infection risk. At present, there are few studies on catheter-related bloodstream infections (CRBSIs) that are comparable with international similar research. The aim of this study was to determine the rate, risk factors, and outcomes of CRBSIs in patients of an intensive care unit (ICU) in China.

Methods

A prospective study was performed in the Affiliated Shengjing Hospital of China Medical University. All patients admitted to the ICU from June 2007 to May 2008 who had a central line placed were monitored for the development of BSI from insertion until 48 hours after removal. One hundred seventy-four patients with 178 admissions to the ICU, 219 CVCs and 1913 CVC days, 21 episodes of CRBSI in 21 patients were enrolled.

Results

The mean rate of CRBSI was 11.0 per 1000 CVC days with a catheter utilization rate of 72.8%. Analyses of the pathogens showed that gram-negative organisms were predominant. The univariate analysis showed that 3 things seemed to directly impact the occurrences of CRBSI. These were the number of lines insertion, the applications of antibiotics before CRBSI, and the duration of catheter. In a multiple logistic regression analysis of the risk factors, patients with multiple central lines (odds ratio = 5.981; 95% confidence intervals, 1.660-21.547; P = .006) and with the applications of multiple antibiotics before CRBSI (odds ratio = 6.335; 95% confidence interval, 2.001-20.054; P = .002) were more likely to develop CRBSI.

Conclusions

The CRBSI rate in our ICU is higher compared with that reported by the National Nosocomial Infection Surveillance and was associated with the applications of antibiotics before CRBSI and with the number of placed CVCs. Catheter-related bloodstream infections may be associated with a higher mortality rate and a higher incidence of ventilator-associated pulmonitis, which might lead to an increase in the total costs and medicine expenditures.     

Catheter-related infection in critically ill patients

Objective To describe the incidence of the catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) of central venous catheters (CVCs) and arterial catheters (ACs).Design Prospective, observational study.Setting A 24-bed medical-surgical intensive care unit of a 650-bed university hospital.Patients We included 988 consecutive patients admitted to the ICU during 18 months.Measurements The incidence density of CRLI and CRBSI, per 1000 catheter-days, of CVC and AC.Results Central venous catheters had a significantly higher incidence density of CRLI (4.74 vs 0.97/1,000 catheter-days; p<0.001) than ACs. Femoral venous access had a higher incidence density of CRLI than subclavian (13.15 vs 1.81/1,000 catheter-days, p=0.003) and than peripheral access (13.15 vs 2.30/1,000 catheter-days, p<0.001). Jugular venous access had a higher incidence density of CRLI (6.29 vs 1.81/1,000 catheter-days, p<0.001) than subclavian access. We found no significant differences in the incidence density of CRLI and CRBSI between the different AC accesses.Conclusions In the CDC guidelines, catheter insertion at the subclavian site is recommended in preference to femoral and jugular accesses, and there is no recommendation about AC site insertion. Our data support these recommendations about CVCs. Because the AC infection rate was very low, our study suggests that the access site is probably not of major importance for this type of catheter.     

The safety of prolonging the use of central venous catheters: a prospective analysis of the effects of using antiseptic-bonded catheters with daily site care

OBJECTIVE: To determine rates of catheter colonization and catheter-related bloodstream infection (CRBSI) when antiseptic-bonded central venous catheters (CVCs) and standardized daily site care are used with no predetermined interval for removal. DESIGN: Prospective observational study. SETTING: Two major trauma centers. PATIENTS: All trauma patients admitted to two major trauma centers that received a CVC from May 1996 through May 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Catheters were semiquantitatively cultured to identify bacterial colonization and CRBSI. Monitored variables included total catheter days, anatomical site of catheter insertion, and area in hospital of catheter insertion. CVC tips and intracutaneous segments were semiquantitatively cultured. A total of 460 (92%) of 501 catheters placed in 324 trauma patients were evaluable, representing 95.5% of all catheter days during the study period. Rates of catheter colonization and CRBSI were 5% (5/1000 catheter days) and 1.5% (1.511000 catheter days), respectively. Subclavian catheters were in place longer than femoral or internal jugular catheters (p < .0001), but the colonization rate was significantly lower (p = .03; relative risk, 0.34; 95% confidence interval, 0.15-0.77). No differences in CRBSI rates among anatomical sites or between catheters used < or =14 days and those used >14 days were identified. CONCLUSION: Femoral and internal jugular antiseptic-bonded CVCs develop bacterial colonization earlier than subclavian CVCs. Subclavian antiseptic-bonded CVCs combined with standardized daily site care may be safely used >14 days in trauma patients.     

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。     

Central venous catheter use

Central venous catheters (CVCs) are used with increasing frequency in the intensive care unit and in general medical wards. Catheter infection, the most frequent complication of CVC use, is associated with increased morbidity, mortality, and duration of hospital stay. Risk factors in the development of catheter colonisation and bloodstream infection include patient factors (increased risk associated with malignancy, neutropenia, and shock) and treatment-related factors (increased risk associated with total parenteral nutrition, ICU admission for any reason, and endotracheal intubation). Other risk factors are prolonged catheter indwelling time, lack of asepsis during CVC insertion, and frequent manipulation of the catheter. The most important factor is catheter care after placement. Effects of CVC tunnelling on infection rates depend to a large extent on indwelling time and the quality of catheter care. Use of polyurethane dressings can increase the risk of colonisation compared to regular gauze dressing. Thrombus formation around the CVC tip increases the risk of infection; low-dose anticoagulants may decrease this risk. New developments such as CVC impregnation with antibiotics may reduce the risk of infection. Reducing catheter infection rates requires a multiple-strategy approach. Therefore, ICUs and other locations where CVCs are used should implement strict guidelines and protocols for catheter insertion, care, and maintenance.     

三级医院 ICU 中心静脉导管相关血流感染预防与控制现状调查及防控策略

目的：了解某市三级医院ICU中心静脉导管（CVC）相关性血流感染（CRBSI）预防与控制质量安全管理现状,探讨其对策。方法用自行设计的问卷,调查某市8家三级医院ICU CRBSI防控现状,分析252名ICU护士CRBSI预防和控制相关知识认知、赞同度及行为情况。结果8家医院中6家医院具有预防CRBSI标准操作规程,2家医院有CVC导管维护专用记录单。基于美国CDC《指南》推荐的循证支持的CRBSI特殊预防措施,各家医院执行不佳。252名ICU护士对导管感染相关知识、组合干预与维护措施赞同度、导管相关感染预防和控制行为得分分别为（55．88±7．46）,（20．21±1．48）,（72.59±6．83）分。结论某市三级医院ICU缺乏统一的CRBSI预防与控制标准操作规程及CVC置管核查表和维护核查表,应加强医护人员CRBSI防控知识的培训,提升行为依从性,降低CRBSI的发生率,提高危重患者的救治成功率。     

A continuous quality-improvement program reduces nosocomial infection rates in the ICU

Objective To assess the impact of a continuous quality-improvement program on nosocomial infection rates.Design and setting Prospective single-center study in the medical-surgical ICU of a tertiary care center.Patients We admitted 1764 patients during the 5-year study period (1995–2000); 55% were mechanically ventilated and 21% died. Mean SAPS II was 37±21 points and mean length of ICU stay was 9.7±16.1 days.Interventions Implementation of an infection control program based on international recommendations. The program was updated regularly according to infection and colonization rates and reports in the literature.Measurements and results Prospective surveillance showed the following rates per 1000 procedure days: ventilator-associated pneumonia (VAP) 8.7, urinary tract infection (UTI) 17.2, central venous catheter (CVC) colonization 6.1, and CVC-related bacteremia and2.0; arterial catheter colonization did not occur. In the 5 years following implementation of the infection control program there was a significant decline in the rate per patient days of UTI, CVC colonization, and CVC-related bacteremia but not VAP. Between the first and second 2.5-year periods the time to infection increased significantly for UTI and CVC-related colonization.Conclusions A continuous quality-improvement program based on surveillance of nosocomial infections in a nonselected medical-surgical ICU population was associated with sustained decreases in UTI and CVC-related infections.Electronic Supplementary Material Supplementary material is available in the online version of this article at .