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Bloodstream infection related to catheter connections: a prospective trial of two connection systems 导管相关菌血症:两个导管连接系统的预试验
Summary
Bloodstream infections (BSIs) related to central venous catheters (CVCs) and arterial catheters (ACs) are an increasing problem in the management of critically ill patients. Our objective was to assess the efficacy of a needle-free valve connection system (SmartSite®, Alaris Medical Systems, San Diego, CA, USA) in the prevention of catheter-related bloodstream infection (CR-BSI). Patients admitted to an intensive care unit were prospectively assigned to have a CVC and AC connected with either a needle-free valve connection system (NFVCS) or a three-way stopcock connection (3WSC). The characteristics of the patients were similar in the two groups. Before manipulation, the NFVCS was disinfected with chlorhexidine digluconate 0.5% alcoholic solution. The 3WSC was not disinfected between use but it was covered with a protection cap. A total of 799 patients requiring the insertion of a multilumen CVC or AC for >48 h from 1 April 2002 to 31 December 2003 were included. CR-BSI rates were 4.61 per 1000 days of catheter use in the disinfected NFVCS group and 4.11 per 1000 days of catheter use in the 3WSC group (P = 0.59). When CVC-BSIs and AC-BSIs were analysed separately, the rate of CVC-BSI was 4.26 per 1000 days of catheter use in the NFVCS group, compared with 5.27 in the 3WSC group (P = 0.4). The incidence rate of AC-BSI was 5.00 per 1000 days of catheter use in the NFVCS group, compared with 2.83 in the 3WSC group (P = 0.08). The use of NFVCS does not reduce the incidence of catheter-related bacteraemia. The arterial catheter (AC) is a significant source of infection in critically ill patients.
Keywords: Catheter-related bloodstream infection; Prevention; Intensive care unit; Critical care
Journal of Hospital Infection
Volume 67, Issue 1, September 2007, Pages 30-34
编译:
题目:导管相关菌血症:两个导管连接系统的预试验
中央静脉导管和动脉导管引起菌血症在危重病人中是一个日益严重的问题。研究者的目的是评价无针连接系统(smartsite商标,艾力斯医疗系统,圣地亚哥,美国)防止导管相关菌血症的效果。在重症监护室病人接受被安排好的用无针开关连接系统或者用三通开关连接系统连接中央静脉导管和动脉导管,在这两组中的病人病情相似。在使用前无针开关连接系统用0.5%葡萄糖酸洗必泰酒精溶液消毒。三通开关连接系统在使用前没有消毒但是用防护罩盖住。从2002年4月到2003年12月,799例病人被插入多重静脉和动脉导管超过48小时。使用消毒的无针连接系统导管相关菌血症的发生率是千分之4.61每天,而使用三通开关系统的发生率是千分之4.11每天(P=0.59)。把中心静脉导管和动脉导管分别分析发现使用无针连接系统中心静脉导管菌血症的发生率是千分之4.26每天,而使用三通连接系统的发生率是千分之5.27每天(P=0.4)。使用无针连接系统的动脉导管菌血症的发生率是千分之5每天而使用三通连接系统的发生率是千分之2.83(P=0.08)。研究者得出结论认为使用无针连接系统不能降低导管相关菌血症的发生率,动脉导管是危重病人发生感染的危险因素。 |