我们应该使用密闭式还是开放式输液容器来预防血流感染？
Should we use closed or open infusion containers for prevention of bloodstream infections?
机构信息
Medical College of Buenos Aires, Argentina.
出版信息
Ann Clin Microbiol Antimicrob. 2010 Feb 2;9:6. doi: 10.1186/1476-0711-9-6.
BACKGROUND
Hospitalized patients in critical care settings are at risk for bloodstream infections (BSI). Most BSIs originate from a central line (CL), and they increase length of stay, cost, and mortality. Open infusion containers may increase the risk of contamination and administration-related (CLAB) because they allow the entry of air into the system, thereby also providing an opportunity for microbial entry. Closed infusion containers were designed to overcome this flaw. However, open infusion containers are still widely used throughout the world.The objective of the study was to determine the effect of switching from open (glass, burettes, and semi-rigid) infusion containers to closed, fully collapsible, plastic infusion containers (Viaflex) on the rate and time to onset of central line-associated bloodstream infections CLABs.
METHODS
An open label, prospective cohort, active healthcare-associated infection surveillance, sequential study was conducted in four ICUs in Mexico. Centers for Disease Control National Nosocomial Infections Surveillance Systems definitions were used to define device-associated infections.
RESULTS
A total of 1,096 adult patients who had a central line in place for >24 hours were enrolled. The CLAB rate was significantly higher during the open versus the closed container period (16.1 versus 3.2 CLAB/1000 central line days; RR = 0.20, 95% CI = 0.11-0.36, P < 0.0001). The probability of developing CLAB remained relatively constant in the closed container period (1.4% Days 2-4 to 0.5% Days 8-10), but increased in the open container period (4.9% Days 2-4 to 5.4% Days 8-10). The chance of acquiring a CLAB was significantly decreased (81%) in the closed container period (Cox proportional hazard ratio 0.19, P < 0.0001). Mortality was statistically significantly lower during the closed versus the open container period (23.4% versus 16.1%; RR = 0.69, 95% CI = 0.54-0.88, P < 0.01).
CONCLUSIONS
Closed infusion containers significantly reduced CLAB rate, the probability of acquiring CLAB, and mortality.
背景
重症监护病房的住院患者存在血流感染（BSI）的风险。大多数血流感染源于中央导管（CL），并会延长住院时间、增加成本和死亡率。开放式输液容器可能会增加污染和与管理相关的（CLAB）感染风险，因为它们允许空气进入系统，从而也为微生物进入提供了机会。密闭式输液容器旨在克服这一缺陷。然而，开放式输液容器在全球范围内仍被广泛使用。本研究的目的是确定从开放式（玻璃、注射器和半刚性）输液容器转换为密闭式、完全可折叠、塑料输液容器（Viaflex）对中心静脉相关血流感染（CLAB）的发生率和发病时间的影响。
方法
在墨西哥的四个 ICU 中进行了一项开放标签、前瞻性队列、主动医疗相关感染监测、连续研究。采用疾病控制与预防中心国家医院感染监测系统的定义来定义器械相关感染。
结果
共纳入了 1096 名成人患者，他们的中央导管留置时间超过 24 小时。在开放式与密闭式容器期间，CLAB 发生率明显更高（16.1 例/1000 导管日 vs. 3.2 例/1000 导管日；RR=0.20，95%CI=0.11-0.36，P<0.0001）。在密闭式容器期间，CLAB 的发病概率相对稳定（第 2-4 天为 1.4%，第 8-10 天为 0.5%），但在开放式容器期间增加（第 2-4 天为 4.9%，第 8-10 天为 5.4%）。在密闭式容器期间，获得 CLAB 的机会显著降低（81%）（Cox 比例风险比 0.19，P<0.0001）。与开放式容器期间相比，密闭式容器期间的死亡率显著降低（23.4% vs. 16.1%；RR=0.69，95%CI=0.54-0.88，P<0.01）。
结论
密闭式输液容器显著降低了 CLAB 发生率、获得 CLAB 的概率和死亡率。
Zotero 插件