Rosenthal Victor D, Maki Dennis G
Infection Control and Infectious Diseases Department, Bernal Medical Center and Colegiales Medical Center, Arengreen 1366, (1405) Buenos Aires, Argentina.
Am J Infect Control. 2004 May;32(3):135-41. doi: 10.1016/j.ajic.2003.12.002.
We sought to ascertain the effect of switching from an open infusion system to a closed system on rates and sequelae of central venous catheter (CVC)-associated bloodstream infection in the intensive care department (ICU) of 2 hospitals in Argentina.
A prospective, controlled, time-series, cohort trial was undertaken in adult patients admitted to 4 level-III adult ICUs in Buenos Aires, Argentina, who had a CVC in place for at least 24 hours. Rates of CVC-associated bloodstream infection during a period of active surveillance with an open system (baseline; externally vented, semirigid, noncollapsible, 1-port plastic bottles) were compared with rates after switching to a closed system (intervention; nonvented, collapsible, 2-port plastic bags).
Between August 1999 and March 2002, 992 patients in the ICU with CVCs were enrolled. Patients during each study period (open system, 608; closed system, 384) were similar with respect to sex, severity-of-illness score, and prevalence of diabetes and cancer. Compliance with handwashing and CVC site care was also similar during the 2 study periods. The incidence of CVC-associated bacteremia during use of the closed system was significantly lower than during use of the open system (2.36 vs 6.52/1000 catheter-days, relative risk=0.36, 95% confidence interval=0.14-0.94, P=.02); bacteremias caused by gram-negative bacilli declined by 64%. In all, 17 patients with catheter-associated bacteremia died during the period when the open system was in use (2.8%), versus only 1 (0.2%) during use of the closed system (relative risk 0.09, P=.003). The calculated cost savings in the 20 hospital-month intervention period was $53,768 and 130.9 ICU days.
Adoption of a closed infusion system resulted in major reductions in the incidence of catheter-associated bacteremia, related mortality, and cost. Because most Latin American hospitals still use externally vented fluid containers, switching to nonvented bags could substantially reduce rates of nosocomial bacteremia.
我们试图确定在阿根廷两家医院的重症监护病房（ICU）中，从开放输液系统转换为封闭系统对中心静脉导管（CVC）相关血流感染的发生率和后遗症的影响。
在阿根廷布宜诺斯艾利斯的4个三级成人ICU中，对入住且CVC留置至少24小时的成年患者进行了一项前瞻性、对照、时间序列队列试验。将开放系统（基线；外部通气、半刚性、不可折叠、单端口塑料瓶）主动监测期间的CVC相关血流感染率与转换为封闭系统（干预；无通气、可折叠、双端口塑料袋）后的感染率进行比较。
1999年8月至2002年3月期间，992例ICU中有CVC的患者入组。每个研究期间的患者（开放系统608例；封闭系统384例）在性别、疾病严重程度评分以及糖尿病和癌症患病率方面相似。两个研究期间洗手和CVC部位护理的依从性也相似。封闭系统使用期间CVC相关菌血症的发生率显著低于开放系统使用期间（2.36比6.52/1000导管日，相对风险=0.36，95%置信区间=0.14 - 0.94，P = 0.02）；革兰氏阴性杆菌引起的菌血症下降了64%。总共，17例导管相关菌血症患者在开放系统使用期间死亡（2.8%），而封闭系统使用期间仅1例（0.2%）死亡（相对风险0.09，P = 0.003）。在20个医院月的干预期内计算得出的成本节省为53768美元和130.9个ICU日。
采用封闭输液系统可大幅降低导管相关菌血症的发生率、相关死亡率和成本。由于大多数拉丁美洲医院仍使用外部通气的液体容器，转换为无通气袋可大幅降低医院内菌血症的发生率。
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