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Antonio Sitges-Serra 《Supportive care in cancer》1999,7(6):391-395
Prevention of catheter-related bloodstream infections is critically dependent on an accurate knowledge of the two main routes by which intravascular devices become contaminated: the extraluminal (skin-related) and the intraluminal (hub-related) routes. Extraluminal catheter seeding results from infection of the catheter entry site by microorganisms and leads to bacteremia most often during the week following catheter placement. The main ways of preventing it are appropriate skin disinfection and the adoption of maximal antiseptic barriers at the time of catheter insertion. Avoiding the internal jugular and the femoral veins, whenever possible, will reduce the likelihood of bacteremia. Intraluminal contamination is the consequence of improper handling of the catheter hub at the time of connection and disconnection of the administration set. It is the most common origin of catheter infections after the first week of catheter placement. Multiple-lumen catheters, side-ports and multipurpose catheters particularly increase the risk of endoluminal contamination. To prevent it, strict asepsis should be observed in hub handling and hubs should be protected against environmental soiling with an antiseptic impregnated gauze at all times. New technology is available for prevention of catheter infections: antibiotic and antiseptic-coated catheters, antiseptic hubs, disinfecting caps and flushing solutions are currently undergoing scientific assessment. Published online: 22 July 1999 相似文献
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O'Grady NP 《Journal of critical care》2002,17(2):114-121
BACKGROUND: Catheter-related bloodstream infection (CR-BSI) remains a leading cause of nososcomial infection, despite the fact that many CR-BSIs are preventable. Simple principles of infection control and the use of novel devices to reduce these infections are not uniformly implemented. OBJECTIVE: To review and summarize the evidence that promotes strategies to prevent CR-BSIs. DATA SOURCES: The Medline database and bibliographies of review articles and book chapters were searched for relevant articles. STUDIES INCLUDED: In vitro and in vivo laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations. OUTCOME MEASURES: Reduction in CR-BSI, catheter colonization, tunnel infection, or local site infection. SYNTHESIS: The recommended prevention strategies with strong supportive evidence include educating and training of health care providers who insert and maintain catheters; using full barrier precautions during central venous catheter insertion; using a 2% chlorhexidine preparation for skin antisepsis; eliminating the practice of scheduled replacement of central venous catheters for prevention of infection; and using antiseptic/antibiotic impregnated short-term central venous catheters. CONCLUSION: Simple interventions can reduce the risk for serious catheter-related infection. Health care provider awareness and adherence to these prevention strategies is critical to reducing the risk for CR-BSI, improving patient safety, and promoting quality health care. 相似文献
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Leonardo Lorente 《World Journal of Critical Care Medicine》2016,5(2):137-142
Central venous catheters are commonly used in critically ill patients. Such catheterization may entail mechanical and infectious complications. The interest in catheter-related infection lies in the morbidity, mortality and costs that it involved. Numerous contributions have been made in the prevention of catheter-related infection and the current review focuses on the possible current role of antimicrobial impregnated catheters to reduce catheter-related bloodstream infections (CRBSI). There is evidence that the use of chlorhexidine-silver sulfadiazine (CHSS), rifampicin-minocycline, or rifampicin-miconazol impregnated catheters reduce the incidence of CRBSI and costs. In addition, there are some clinical circumstances associated with higher risk of CRBSI, such as the venous catheter access and the presence of tracheostomy. Current guidelines for the prevention of CRBSI recommended the use of a CHSS or rifampicin-minocycline impregnated catheter in patients whose catheter is expected to remain in place > 5 d and if the CRBSI rate has not decreased after implementation of a comprehensive strategy to reduce it. 相似文献
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Clinical review: new technologies for prevention of intravascular catheter-related infections 总被引:5,自引:0,他引:5
Intravascular catheters have become essential devices for the management of critically and chronically ill patients. However, their use is often associated with serious infectious complications, mostly catheter-related bloodstream infection (CRBSI), resulting in significant morbidity, increased duration of hospitalization, and additional medical costs. The majority of CRBSIs are associated with central venous catheters (CVCs), and the relative risk for CRBSI is significantly greater with CVCs than with peripheral venous catheters. However, most CVC-related infections are preventable, and different measures have been implemented to reduce the risk for CRBSI, including maximal barrier precautions during catheter insertion, catheter site maintenance, and hub handling. The focus of the present review is on new technologies for preventing infections that are directed at CVCs. New preventive strategies that have been shown to be effective in reducing risk for CRBSI, including the use of catheters and dressings impregnated with antiseptics or antibiotics, the use of new hub models, and the use of antibiotic lock solutions, are briefly described. 相似文献
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Clinical review: New technologies for prevention of intravascular catheter-related infections 下载免费PDF全文
Stefania Cicalini Fabrizio Palmieri Nicola Petrosillo 《Critical care (London, England)》2003,8(3):157
Intravascular catheters have become essential devices for the management of critically and chronically ill patients. However,
their use is often associated with serious infectious complications, mostly catheter-related bloodstream infection (CRBSI),
resulting in significant morbidity, increased duration of hospitalization, and additional medical costs. The majority of CRBSIs
are associated with central venous catheters (CVCs), and the relative risk for CRBSI is significantly greater with CVCs than
with peripheral venous catheters. However, most CVC-related infections are preventable, and different measures have been implemented
to reduce the risk for CRBSI, including maximal barrier precautions during catheter insertion, catheter site maintenance,
and hub handling. The focus of the present review is on new technologies for preventing infections that are directed at CVCs.
New preventive strategies that have been shown to be effective in reducing risk for CRBSI, including the use of catheters
and dressings impregnated with antiseptics or antibiotics, the use of new hub models, and the use of antibiotic lock solutions,
are briefly described. 相似文献
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中心静脉导管相关性感染 总被引:41,自引:0,他引:41
目的:探讨导管相关性感染(CRI)的病原学及临床特点。方法:回顾分析2001年1月-2003年6月期间我院1327例次中心静脉置管病例中确诊的24例CRI病例,分析其病原体分布,感染与静脉导管留置类型、时间的关系。结果:CRI病例中,留置单腔导管者9例,留置双腔导管者15例。共分离菌株25株,其中革兰阳性菌12株.革兰阴性菌7株.真菌6株。金黄色葡萄球菌最多见(7株),其次是真菌(6株)。CRI以置管后第8~14天发生率最高(56%)。结论:预防的重点在于避免导管腔内及腔外的污染。重视穿刺点皮肤的消毒,选用单腔导管,减少不必要的间置装置,操作者水平的提高以及抗生素的合理应用均能有效减少CRI的发生。对怀疑CRI者不应立即拔管,可先试行抗生素锁治疗,在24~48h后无效者应立即拔除导管。对于免疫功能低下、感染不易控制、病情严重以及金黄色葡萄球菌或真菌感染的病例。应及时拔除导管。 相似文献
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Hollenbeak CS 《Journal of infusion nursing》2011,34(5):309-313
Catheter-related bloodstream infections (CRBSIs) are frequently observed in the intensive care unit (ICU) and are a serious cause of morbidity and mortality in the United States. This article summarizes what is currently known about the cost of CRBSIs in the ICU setting. The cost of CRBSIs is between $33,000 and $44,000 in the general adult ICU, between $54,000 and $75,000 in the adult surgical ICU, and approximately $49,000 in the pediatric ICU. Finally, CRBSIs are associated with reimbursement that is more than $26,000 less than costs. Hospital and clinical decision makers should be aware of the high cost of CRBSIs in the ICU, the relatively poor reimbursement, and the implied high value of prevention efforts. 相似文献
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Gould D 《Nursing standard (Royal College of Nursing (Great Britain) : 1987)》2011,25(33):38-47; quiz 48
Most fungi live harmlessly in the environment, but some species can cause disease in the human host. Nurses working in primary care are likely to see patients with superficial fungal infections and are well placed to offer advice about treatment and measures to prevent the spread of infection in the home. Patients with weakened immune function admitted to hospital are at high risk of developing serious, invasive fungal infections. Systemic fungal infections are a major problem among critically ill patients in acute care settings and are responsible for an increasing proportion of healthcare-associated infections. 相似文献
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目的 系统评价集束化护理干预对预防深静脉导管相关性血流感染的效果.方法 应用计算机检索国内相关文献,采用RevMan5.2软件进行统计处理.结果 共纳入13篇符合条件的文献.其合并OR值为0.33,95%CI为(0.26,0.43),说明集束化护理干预可以显著降低深静脉导管相关性血流感染的发生率.结论 集束化护理是一种切实可行的干预措施,值得在临床上推广. 相似文献
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Susanne Janum Walter Zingg Volker Classen Arash Afshari 《Critical care (London, England)》2013,17(4):238
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. 相似文献
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Clinical criteria alone are insufficient to allow a diagnosis of intravascular catheter-related sepsis (CRS). A definite diagnosis of CRS usually requires removal of the catheter for quantitative catheter tip culture. However, only about 15-25% of central venous catheters (CVC) removed because infection is suspected actually prove to be infected, and the diagnosis is always retrospective. Other diagnostic tests, such as differential quantitative blood cultures from samples taken simultaneously from the catheter and a peripheral vein, have been proposed to avoid unjustified removal of the catheter and the potential risks associated with the placement of a new catheter at a new site: a central-to-peripheral blood culture colony count ratio of 5:1 to 10:1 is considered indicative of CRS. Despite its high specificity, the latter diagnostic technique is not routinely used in clinical practice because of its complexity and cost. The measurement of the differential time to positivity between hub blood (taken from the catheter port) and peripheral blood cultures might be a reliable tool facilitating the diagnosis of CRS in situ. In an in vitro study, we found a strong relationship between the inoculum size of various microorganisms and the time to positivity of cultures. When the times to positivity of cultures of blood taken simultaneously from central and peripheral veins in patients with and without CRS were examined, we found that earlier positivity of central vs peripheral vein blood cultures was highly correlated with CRS. Using a cut-off value of +120 min, the "differential time to positivity" of the paired blood samples, defined as time to positivity of the peripheral blood minus that of the hub blood culture, had 91% specificity and 94% sensitivity for the diagnosis of CRS. This method may be coupled with other techniques that have high negative predictive value, such as skin cultures at the catheter exit site. This diagnostic test can be proposed for routine clinical practice in most hospitals using automatic devices for blood cultures positivity detection. Endoluminal brushing of the catheter is considered sensitive and specific for the diagnosis of CRS, but the risk of embolisation or subsequent bacteraemia should be considered. Gram staining and the acridine-orange leucocyte cytospin test on through-catheter blood culture have been proposed for rapid diagnosis of CRS without catheter removal. The technique, which requires 100 microl catheter blood and the use of light and ultraviolet microscopy, is considered simple, rapid (30 min) and inexpensive. In conclusion, diagnostic tools such as paired blood cultures or Gram staining and the acridine-orange leucocyte cytospin test should allow a diagnosis of CRS without catheter removal in cancer patients. 相似文献
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Defining and monitoring infection rates in home care is of major importance with the implementation of Adverse Event Outcome Reports. This study identifies the collective effort of home care quality improvement nurses in defining standard indicators for urinary tract infections and the ways to monitor these infections within and across home care agencies for evaluation and benchmarking. 相似文献
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《Expert review of anti-infective therapy》2013,11(11):1239-1249
The increased use of tunneled cuffed catheters in children on chronic hemodialysis is the result of their relative ease of insertion, pain-free dialysis and immediate use. The disadvantage of their use is that they are associated with catheter-related bacteremia (CRB), which in turn is related with increased morbidity, access loss and occasionally metastatic infections and even death. A CRB might be difficult to diagnose and is often associated with a previous history of CRB, exit-site infection, low serum albumin and long duration of catheter use. There is evidence that the use of arteriovenous fistulae is associated with lower infection rates. The implementation of effective strategies for the prevention of CRBs include the adoption of policies for improving arteriovenous fistula rates, appropriate surgical catheter insertion and optimal nursing care of the exit site, and a safe connection technique. Recently, the effectiveness of antimicrobial catheter solutions for preventing CRB has been documented in a number of randomized clinical trials. In addition, the application of antibiotic ointments at the exit sites of tunneled cuffed catheters might be significant for the reduction of Staphylococcus-related CRB. The upside is that education-based programs combining specific preventive measures can significantly reduce CRBs. 相似文献