Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Infect Control Hosp Epidemiol. 2010 May;31(5):522-7. doi: 10.1086/651668.
To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.
All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.
Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-infinity), catheter access (OR, 13.7 [95% CI, 1.8-infinity]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.
We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.
确定在一家儿童医院附属的新开设的诊所接受治疗的小儿骨髓移植（BMT）门诊患者中发生多种微生物血流感染（BSI）的危险因素。
2007 年 9 月 10 日至 21 日，在新开设的 BMT 诊所接受治疗的 30 名门诊患者全部纳入队列研究。该研究包括访谈、病历回顾、观察以及对患者和环境分离株进行细菌培养和分子分型。使用确切条件逻辑回归分析数据。
13 名患者发生了由 16 种不同的主要革兰阴性菌引起的 BSI。带隧道导管（比值比 [OR]，19.9 [95%置信区间 {CI}，2.4-无穷大）、导管进入（OR，13.7 [95% CI，1.8-无穷大）]）和用预抽生理盐水冲洗导管（OR，12.9 [95% CI，1.0-766.0]）与 BSI 独立相关。每次额外使用预抽生理盐水会使发生 BSI 的风险增加 16.8 倍（95% CI，1.8-827.0）。尽管未确定病原体的环境来源，但访谈显示存在违反推荐的感染预防实践和药物处理的情况。冲洗盐水是预先抽取的，并且从单个无防腐剂小瓶中获取多剂量以避免延迟患者治疗。
我们推测新诊所中存在感染预防挑战，加上对小瓶的连续针刺，促进了医疗保健相关病原体的外源性污染和传播。我们建议不要对无防腐剂的一次性使用小瓶进行多次穿刺。使用一次性预填充盐水注射器可能会防止多次使用一次性盐水小瓶。将盐水储存在药物供应系统之外可能是明智的。在开设新的诊所设施之前，医院应考虑进行模拟患者流程演练，以发现感染控制方面的挑战。
