University of Wisconsin School of Medicine and Public Health, Madison, USA.
Infect Control Hosp Epidemiol. 2011 Jan;32(1):50-8. doi: 10.1086/657632. Epub 2010 Dec 1.
We report a meta-analysis of 4 identical time-series cohort studies of the impact of switching from use of open infusion containers (glass bottle, burette, or semirigid plastic bottle) to closed infusion containers (fully collapsible plastic containers) on central line-associated bloodstream infection (CLABSI) rates and all-cause intensive care unit (ICU) mortality in 15 adult ICUs in Argentina, Brazil, Italy, and Mexico.
All ICUs used open infusion containers for 6-12 months, followed by switching to closed containers. Patient characteristics, adherence to infection control practices, CLABSI rates, and ICU mortality during the 2 periods were compared by χ(2) test for each country, and the results were combined using meta-analysis.
Similar numbers of patients participated in 2 periods (2,237 and 2,136). Patients in each period had comparable Average Severity of Illness Scores, risk factors for CLABSI, hand hygiene adherence, central line care, and mean duration of central line placement. CLABSI incidence dropped markedly in all 4 countries after switching from an open to a closed infusion container (pooled results, from 10.1 to 3.3 CLABSIs per 1,000 central line-days; relative risk [RR], 0.33 [95% confidence interval {CI}, 0.24-0.46]; P <.001). All-cause ICU mortality also decreased significantly, from 22.0 to 16.9 deaths per 100 patients (RR, 0.77 [95% CI, 0.68-0.87]; P <.001).
Switching from an open to a closed infusion container resulted in a striking reduction in the overall CLABSI incidence and all-cause ICU mortality. Data suggest that open infusion containers are associated with a greatly increased risk of infusion-related bloodstream infection and increased ICU mortality that have been unrecognized. Furthermore, data suggest CLABSIs are associated with significant attributable mortality.
我们报告了一项元分析，该分析纳入了阿根廷、巴西、意大利和墨西哥的 15 个成人重症监护病房（ICU）进行的 4 项相同的时间序列队列研究，评估了从使用开放式输注容器（玻璃瓶、滴定管或半刚性塑料瓶）切换为密闭式输注容器（完全可折叠塑料容器）对中心静脉导管相关血流感染（CLABSI）发生率和全因 ICU 死亡率的影响。
所有 ICU 均使用开放式输注容器 6-12 个月，然后切换为密闭式容器。通过 χ(2)检验比较每个国家在两个时期的患者特征、感染控制实践的依从性、CLABSI 发生率和 ICU 死亡率，然后使用荟萃分析对结果进行合并。
两个时期的患者数量相似（2237 例和 2136 例）。每个时期的患者的平均严重程度评分、CLABSI 的危险因素、手卫生依从性、中心静脉导管护理和中心静脉导管放置时间的平均值均具有可比性。在所有 4 个国家，从开放式输注容器切换为密闭式输注容器后，CLABSI 的发生率均明显下降（汇总结果，从每 1000 个中心静脉导管日 10.1 例降至 3.3 例；相对风险 [RR]，0.33 [95%置信区间 {CI}，0.24-0.46]；P<0.001）。全因 ICU 死亡率也显著下降，从每 100 例患者 22.0 例降至 16.9 例死亡（RR，0.77 [95% CI，0.68-0.87]；P<0.001）。
从开放式输注容器切换为密闭式输注容器可显著降低 CLABSI 的总体发生率和全因 ICU 死亡率。数据表明，开放式输注容器与输注相关血流感染和 ICU 死亡率增加的风险显著增加有关，而这些风险此前尚未被认识到。此外，数据表明 CLABSI 与显著的归因死亡率有关。
