|
|
洗必泰洗浴和卫生保健相关感染
IMPORTANCE Daily bathing of critically ill patients with the broad-spectrum, topical
antimicrobial agent chlorhexidine is widely performed and may reduce health
care–associated infections.
OBJECTIVE To determine if daily bathing of critically ill patients with chlorhexidine decreases
the incidence of health care–associated infections
重要性每天洗澡的广谱,危重患者局部抗菌剂洗必泰被执行,可能会减少健康保健相关感染。目的确定每日洗澡洗必泰危重患者减卫生保健相关感染的发病率
DESIGN, SETTING, AND PARTICIPANTS A pragmatic cluster randomized, crossover study of
9340 patients admitted to 5 adult intensive care units of a tertiary medical center in
Nashville, Tennessee, from July 2012 through July 2013.
INTERVENTIONS Units performed once-daily bathing of all patients with disposable cloths
impregnated with 2%chlorhexidine or nonantimicrobial cloths as a control. Bathing
treatments were performed for a 10-week period followed by a 2-week washout period
during which patients were bathed with nonantimicrobial disposable cloths, before crossover
to the alternate bathing treatment for 10 weeks. Each unit crossed over between bathing
assignments 3 times during the study.
设计、设置和参与者一个务实的集群随机交叉研究9340名患者承认5****高等医学中心的重症监护病房田纳西州纳什维尔,从2012年7月到2013年7月。干预单位执行每日一次洗澡的患者一次性衣服
浸满2%洗必泰或nonantimicrobial布作为控制。洗澡治疗进行了为期10周时间,后跟一个缓冲期,2周这期间患者沐浴nonantimicrobial一次性抹布,在交叉替代治疗10周洗澡。每个单元之间跨越洗澡在研究作业3倍。
MAIN OUTCOMES AND MEASURES The primary prespecified outcomewas a composite of
central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract
infections (CAUTIs), ventilator-associated pneumonia (VAP), and Clostridium difficile
infections. Secondary outcomes included rates of clinical cultures that tested positive for
multidrug-resistant organisms, blood culture contamination, health care–associated
bloodstream infections, and rates of the primary outcome by ICU.
主要结果和措施的主要判断outcomewas复合中央line-associated血流感染(CLABSIs)catheter-associated尿路与机械通气相关肺炎(VAP)感染(CAUTIs),和艰难梭状芽胞杆菌感染。二次结果包括利率阳性的临床文化耐多药生物,血培养污染,卫生保健相关血液感染,ICU的主要结果。
RESULTS During the chlorhexidine bathing period, 55 infections occurred: 4 CLABSI, 21
CAUTI, 17 VAP, and 13 C difficile. During the control bathing period, 60 infections occurred:
4 CLABSI, 32 CAUTI, 8 VAP, and 16 C difficile. The primary outcome rate was 2.86 per
1000 patient-days during the chlorhexidine and 2.90 per 1000 patient-days during the
control bathing periods (rate difference, −0.04; 95%CI, −1.10 to 1.01; P = .95). After
adjusting for baseline variables, no difference between groups in the rate of the primary
outcome was detected. Chlorhexidine bathing did not change rates of infection-related
secondary outcomes including hospital-acquired bloodstream infections, blood culture
contamination, or clinical cultures yielding multidrug-resistant organisms. In a prespecified
subgroup analysis, no difference in the primary outcome was detected in any individual
intensive care unit.
结果洗必泰洗澡期间,55感染发生:4 CLABSI,21岁CAUTI、17 VAP和13 C固执的。控制洗澡期间,60感染发生:4 CLABSI、32 CAUTI VAP 8和16 C固执的。主要结果率为2.861000 patient-days洗必泰,每1000 patient-days 2.90控制洗浴时间(速度不同,−0.04;95%可信区间,1.10−1.01;P = .95)。后调整基线变量,没有差异率的主要群体
结果被发现。洗必泰洗澡并没有改变微生物感染的几率二次结果包括血液感染,血培养污染,或临床文化产生耐多药生物。在一个预定的
亚组分析,主要结果没有差异被发现在任何个人重症监护室。
CONCLUSION AND RELEVANCE In this pragmatic trial, daily bathing with chlorhexidine did not
reduce the incidence of health care–associated infections including CLABSIs, CAUTIs, VAP, or
C difficile. These findings do not support daily bathing of critically ill patients with
chlorhexidine.
TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02033187
结论和相关性在这种务实的试验中,用洗必泰没有每天洗澡减少卫生保健相关感染的发病率包括CLABSIs CAUTIs VAP,或C固执的。这些研究结果不支持病危患者的日常洗澡洗必泰。
Conclusions
In this pragmatic trial, daily bathingwith chlorhexidine did not
reduce the incidence of health care–associated infections including
CLABSI, CAUTI, VAP, or C difficile. These findings do
not support dailybathing of critically illpatientswith chlorhexidine. 论
在这种务实的审判,每日bathingwith洗必泰没有减少卫生保健相关感染的发病率包括CLABSI,CAUTI、VAP或C固执的。这些研究结果做不支持的dailybathing批判性illpatientswith洗必泰。
|
|
发表于 2015-5-25 17:02
