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| Influencing factors and the prevention strategies for CRBSI in patients with CVC |
| Dou Xin-man, Ma Pei-fen, Nan Rui-ling, Zhou Lin-lin, Zhang Ya-bin, Li Yu-min |
| Lanzhou University Second Hospital, Lanzhou 730000, China |
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Abstract Objective Analyzing the influencing factors of catheter related blood stream infections (CRBSI) in patients with central venous catheter (CVC) catheterization. A series of prevention strategies were applied to clinical research to provide scientific basis for effective clinical prevention and treatment of CRBSI. Methods ①The incidence and the influencing factors of CRBSI in 16 841 patients with CVC one hospital from 2012 to 2015 were retrospectively analyzed. ②From January to December 2016, 5804 patients with CVC in our hospital were randomly divided into experimental group (n=3127) and control group (n=2677). A series of prevention strategies for CRBSI were used to evaluate the incidence of infection. Results ①During 2012 to 2015, the total number of CVC catheterization increased year by year, and the incidence of CRBSI decreased year by year. They were 7.9 cases/thousand catheter day, 7.6 cases/thousand catheter days, 6.9 cases/thousand catheter days, 6.4 cases/thousand catheter days. CRBSI related factors: patients with a variety of complications (88.0%), poor compliance of catheter operators (5.4%), poor assessment before placement (4.2%). Univariate logistic regression analysis showed that six risk factors for CRBSI were circulatory disease (P=0.016), age (P=0.01), APACHEⅡ score (P=0.001), gastrointestinal bleeding (P=0.016), catheterization time (P=0.042), and long-term immunosuppressive therapy (P=0.006). The probability of CRBSI in silicone CVC is significantly higher than that of polyurethane CVC (P=0.00). Analysis of local infection factor of CRBSI showed that it was correlated with age (P=0.013), catheterization time (P=0.014) and diabetes (P=0.001). Analysis of systemic infection factor showed that it was related to age (P=0.002), catheterization time (P=0.001), diabetes (P=0.012), circulatory disease (P=0.023), APACHEⅡ score (P=0.018), and long-term immunotherapy (P=0.003). ②The incidence of CRBSI in the experimental group (4.2 cases/thousand catheter days) was significantly lower than the control group (6.0 cases/thousand catheter days)(P<0.05). Conclusion Due to pathogen infection or patients with multiple complications and other factors, patients with CVC catheter are very prone to concurrent CRBSI situation. According to the influencing factors of CRBSI, the prevention strategies adopted in this study can effectively decrease the clinical incidence of CRBSI, and provide scientific basis and guidance for the effective prevention of CRBSI.
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Corresponding Authors:
Li Yu-min, E-mail:drliyumin@163.com
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| ［1］韩艳丽，吴清余，陈丹丹，等.ICU中心静脉导管相关性感染系统性护理干预的研究［J］. 中华医院感染学杂志, 2015， 25(6): 1336-1338.
［2］Sammut D, Elliot C, Kiely D, et al. Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension［J］. Eur J Clin Microbiol Infect Dis, 2013, 32(7): 883-889.
［3］McKnight S. Nurse′s guide to understanding and treating thromboticocclusion of central venous access devices［J］. Medsurg Nurs, 2004, 13(6): 377-382.
［4］YY, Yen DH, Yang YG, et al. Comparison betweenreplacement at 4 days and 7 days of the infection rate for pulmonary artery catheters in an intensive care unit［J］. Crit Care Med, 2003, 31(5): 1353-1358.
［5］Suzuki M, Satoh N, Nakamura M, et al. Bacteremia in hemodialysis patients［J］. World J Nephrol, 2016, 5(6): 489-496.
［6］中华医学会重症医学分会. 血管内导管相关感染的预防与治疗指南 (2007)［J］. 中华急诊医学杂志, 2008, 17(6): 597-605.
［7］Vallés J, Ferrer R. Bloodstream infection in the ICU［J］. Infect Dis Clin North Am, 2009, 23(3): 557-569.［8］马靓，张立元，许勤. 维持性血液透析患者中心静脉导管相关性血流感染及预防的研究进展［J］. 中华护理杂志，2010，45(1): 85-88.
［9］Gupta V, Yassin MH. Infection and hemodialysis access: anupdated review［J］. Infect Disord Drug Targets, 2013, 13(3): 196-205.
［10］Huet O, Chin-Dusting JP. Septic shock: desperately seeking treatment［J］. Clin Sci(Lond), 2014, 126(1):31-39.
［11］梁建峰，李智勇，董海山，等. 影响IC U脓毒症患者预后的多因素分析［J］. 中国急救医学， 2018， 38(1): 46-52.
［12］O′ Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S［J］. Pediatrics, 2002, 110(5): e51.
［13］Kodama Y, Okamoto Y, Tanabe T, et al.Central venous catheter related blood stream infection with pyomyositis due to Stenotrophomonas maltophilia after allogeneic bone marrow transplantation in a patient with aplastic anemia［J］. Pediatr Transplant, 2016, 20(2): 329-332.
［14］Conti-Patara A, de Araujo Caldeira J, de Mattos-Junior E, et al. Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome［J］. J Vet Emerg Crit Care (San Antonio), 2012, 22(4): 409-418.
［15］Galbois A, Aegerter P, Martel-Samb P, et al. Improved prognosis of septic shock in patients with cirrhosis: a multicenter study［J］. Crit Care Med, 2014, 42(7): 1666-1675.
［16］Yaseen M, Al-Hameed F, Osman K, et al. A project to reduce the rate of central line associated bloodstream infection in ICU patients to a target of zero［J］. BMJ Qual Improv Rep, 2016, 5(1): u212 545.
［17］Palomar M, lvarezLerma F, Riera A, et al. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience［J］. Crit Care Med, 2013, 41(10): 2364-2372.
［18］Blot K, Bergs J, Vogelaers D, et al. Prevention of Central Line-Associated Bloodstream Infections Through Quality Improvement Interventions: A Systematic Review and Meta-analysis［J］. Clin Infect Dis, 2014, 59(1): 96-105.
［19］Miller DL, O′Grady NP, Society of Interventional Radiology. Guidelines for the prevention of intravascular catheter-related infections:recommendations relevant to interventional radiology for venous catheter placement and maintenance［J］. J Vasc Interv Radiol, 2012, 23(8): 997-1007.
［20］Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014update［J］. Infect Control Hosp Epidemiol, 2014, 35(7): 753-771.
［21］Olmos C, Vilacosta I, Fernandez C, et al. Contemporary epidemiology and prognosis of septic shock in infective endocarditis［J］. Eur Heart J, 2013, 34(26): 1999-2006.
［22］Kimmoun A, Ducrocq N, Mory S, et al. Cardiac contractile reserve parameters are related to prognosis in septic shock［J］. Biomed Res Int, 2013, 2013: 930673.
［23］Perin DC, Erdmann AL, Higashi GD, et al. Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review［J］. Rev Lat Am Enfermagem, 2016, 24: e2787.
［24］Moreno CA, Rosenthal VD, Olarte N, et al. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the intermational Nosoeomial Infection Control Consortium［J］. Infect Control Hosp Epidemiol, 2006, 27(4): 349-356.
［25］Mehall JR, Saltzman DA, Jackson RJ, et al. Fibrin sheath enhances central venous catheter infection［J］. Crit Care Med, 2002, 30(4):908-912.
［26］孙雪东，陈建东，严一核，等. 床旁B超在减少深静脉置管导管相关性感染中的应用［J］. 中国全科医学， 2013， 16(33): 3973-3975.
［27］Wu S, Ren S, Zhao H, et al. Risk factors for central venous catheter-related bloodstream infections after gastrointestinal surgery［J］. Am J Infect Control, 2017, 45(5): 549-550.
［28］喻莉，李骏. 导管相关性血流感染的预防新进展［J］. 医学与哲学(B)， 2017， 38 (4): 35-39.
［29］董磊，刘壮，段美丽，等. 最大化无菌屏障在预防导管相关血流感染中的作用［J］. 中国感染控制杂志， 2017， 16(7): 627-630.［30］Ishikawa Y, Kiyama T, Haga Y, et al. Maximal sterile barrier precautions do not reduce catheter-related bloodstream infections in general surgery units: a multi-institutional randomized controlled trial［J］. Ann Surg, 2010, 251(4): 620-623. |
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