Crnich Christopher J, Maki Dennis G
Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, WI, USA.
Clin Infect Dis. 2002 May 1;34(9):1232-42. doi: 10.1086/339863. Epub 2002 Apr 2.
Intravascular devices (IVDs) are widely used for vascular access but are associated with substantial risk of development of IVD-related bloodstream infection (BSI). The development of novel technologies, which are based on an understanding of pathogenesis, promises a quantum reduction in IVD-related infections in an era of growing nursing shortages. Infections of short-term IVDs (that is, those in place <10 days), including peripheral venous catheters, noncuffed and nontunneled central venous catheters (CVCs), and arterial catheters, derive mainly from microorganisms colonizing the skin around the insertion site, which most often gain access extraluminally. More-effective cutaneous antiseptics, such as chlorhexidine, a chlorhexidine-impregnated sponge dressing, CVCs with an anti-infective coating, anti-infective CVC hubs, and novel needleless connectors, have all been shown to reduce the risk of IVD-related BSI in prospective randomized trials. The challenge for the future will be to identify new preventative technologies and to begin to adapt more widely those technologies already shown to be efficacious and cost-effective.
血管内装置（IVD）广泛用于血管通路，但与发生IVD相关血流感染（BSI）的重大风险相关。基于对发病机制的理解而开发的新技术，有望在护理短缺日益严重的时代大幅减少IVD相关感染。短期IVD（即留置时间<10天）的感染，包括外周静脉导管、非带袖套和非隧道式中心静脉导管（CVC）以及动脉导管，主要源于定植在插入部位周围皮肤的微生物，这些微生物大多经腔外途径进入。在前瞻性随机试验中，更有效的皮肤消毒剂，如氯己定、含氯己定的海绵敷料、具有抗感染涂层的CVC、抗感染CVC接头以及新型无针连接器，均已显示可降低IVD相关BSI的风险。未来的挑战将是识别新的预防技术，并开始更广泛地应用那些已被证明有效且具有成本效益的技术。
