Esteve F, Pujol M, Limón E, Saballs M, Argerich M J, Verdaguer R, Mañez R, Ariza X, Gudiol F
Hospital Universitario de Bellvitge Hospitalet de Llobregat, Spain.
J Hosp Infect. 2007 Sep;67(1):30-4. doi: 10.1016/j.jhin.2007.05.021. Epub 2007 Aug 27.
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 >48h 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.
在重症患者管理中，与中心静脉导管（CVC）和动脉导管（AC）相关的血流感染（BSI）问题日益严重。我们的目的是评估一种无针瓣膜连接系统（SmartSite，美国加利福尼亚州圣地亚哥的Alaris Medical Systems公司）在预防导管相关血流感染（CR-BSI）方面的效果。入住重症监护病房的患者被前瞻性地分配为使用无针瓣膜连接系统（NFVCS）或三通旋塞连接（3WSC）来连接CVC和AC。两组患者的特征相似。操作前，NFVCS用0.5%葡萄糖酸氯己定酒精溶液消毒。3WSC在使用期间不进行消毒，但用保护帽覆盖。纳入了2002年4月1日至2003年12月31日期间共799例需要插入多腔CVC或AC且使用时间超过48小时的患者。消毒的NFVCS组每1000天导管使用的CR-BSI发生率为4.61，3WSC组每1000天导管使用的发生率为4.11（P = 0.59）。当分别分析CVC-BSI和AC-BSI时，NFVCS组每1000天导管使用的CVC-BSI发生率为4.26，而3WSC组为5.27（P = 0.4）。NFVCS组每1000天导管使用的AC-BSI发生率为5.00，3WSC组为2.83（P = 0.08）。使用NFVCS并不能降低导管相关菌血症的发生率。动脉导管（AC）是重症患者感染的一个重要来源。
