Simon A, Fleischhack G, Wiszniewsky G, Hasan C, Bode U, Kramer M H
Dept. of Paediatric Hematology and Oncology, Children's Hospital, Medical Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
Infection. 2006 Oct;34(5):258-63. doi: 10.1007/s15010-006-5646-y.
To assess the effects of extending the routine intravenous administration set (IVAS) change-interval from 72 h (group 1) to 7 days (group 2) on the incidence density for central venous access device (CVAD)-related bloodstream infections (BSIs) and on resource expenditures in a singlecentre pilot study.
Prospective pre-/post-intervention comparison of two consecutive 12-month surveillance periods (2001-2003) in a 17-bed paediatric oncology tertiary care unit. IVAS changes and nosocomial infections (NIs) were prospectively analysed using a standardized unit-based surveillance system (Oncopaed NI).
All 175 eligible patients were enrolled, 96 in group 1 and 79 in group 2. Both groups had similar distributions of primary diagnoses and risk factors. The proportion of IVAS changes performed after 3 days increased from 5.6% to 22.5%, but only 8% of IVASs in group 2 were changed after 7 days. Most IVAS changes (64.8% in group 1 and 92.9% in group 2) were done because of therapeutic interventions (blood products, parenteral nutrition [TNP]) before the scheduled endpoint. Overall, the rates and incidence densities of NIs were significantly lower during the second period. The corresponding results for CVAD-related BSIs did not show significant differences. No death attributable to a NI occurred. The '7-day' strategy resulted in cost savings for devices (3,300 dollars/year) and of nursing time (23 working days/year).
Extending the routine IVAS change-interval from 3 days to 7 days appears to be safe and cost-effective in a paediatric oncology unit with high infection control standards and continuous surveillance for NIs. These results do not prove that 7-day intervals prevent infections, but they do suggest that this policy probably is not harmful and that a prospectively randomized study with sufficient power is needed.
在一项单中心试点研究中，评估将常规静脉输液装置（IVAS）更换间隔从72小时（第1组）延长至7天（第2组）对中心静脉通路装置（CVAD）相关血流感染（BSI）的发病密度以及资源消耗的影响。
在一家拥有17张床位的儿科肿瘤三级护理病房，对两个连续的12个月监测期（2001 - 2003年）进行干预前/后的前瞻性比较。使用标准化的基于单位的监测系统（Oncopaed NI）对IVAS更换和医院感染（NI）进行前瞻性分析。
共纳入175例符合条件的患者，第1组96例，第2组79例。两组的主要诊断和危险因素分布相似。3天后进行的IVAS更换比例从5.6%增加到22.5%，但第2组中只有8%的IVAS在7天后更换。大多数IVAS更换（第1组为64.8%，第2组为92.9%）是由于在预定终点前的治疗干预（血液制品、肠外营养[TNP]）。总体而言，第二阶段NI的发生率和发病密度显著降低。CVAD相关BSI的相应结果未显示出显著差异。未发生因NI导致的死亡。“7天”策略节省了设备成本（每年3300美元）和护理时间（每年23个工作日）。
在具有高感染控制标准并持续监测NI的儿科肿瘤病房，将常规IVAS更换间隔从3天延长至7天似乎是安全且具有成本效益的。这些结果并未证明7天的间隔能预防感染，但确实表明该政策可能无害，需要进行一项有足够效力的前瞻性随机研究。
