Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Curr Opin Infect Dis. 2012 Dec;25(6):650-7. doi: 10.1097/QCO.0b013e32835a0d1a.
Central venous catheter (CVC)-associated bloodstream infections (CLABSIs) result in poorer patient outcomes and increased healthcare costs. Reduced reimbursement for CLABSI events is now provided for hospitalized patients in the United States. Although a zero target is proposed, the feasibility has not been evaluated. The objective of this review is to identify factors contributing to CLABSI and determine whether current evidence supports attainment of a zero infection rate.
Limitations of current surveillance methods and reporting of aggregate data impact on achieving target CLABSI rates. Standard prevention practices, including physician and patient preparation (e.g. hand hygiene), are frequently incorporated into bundles of care. CVC dwell time has been identified as means of risk stratification. Additional strategies (e.g. chlorhexidine-impregnated dressings, antimicrobial-coated devices) may be better used in patients with expected long dwell times. Non-ICU populations are increasingly targeted with prevention strategies, but expected rates of infection have not been proposed.
A zero CLABSI rate should be the target only for ICU populations having CVCs with a dwell time of 1-9 days following aseptic insertion. Additional measures should be reserved for patients with expected longer dwell time. Refinement and validation of surveillance methodology is required before target CLABSI rates can be proposed for non-ICU populations.
中心静脉导管（CVC）相关血流感染（CLABSIs）导致患者预后较差和医疗保健费用增加。目前，美国为住院患者提供与 CLABSI 相关事件的报销减少。尽管提出了零目标，但尚未评估其可行性。本综述的目的是确定导致 CLABSIs 的因素，并确定当前的证据是否支持实现零感染率。
当前监测方法和汇总数据报告的局限性影响实现目标 CLABSI 率。标准预防措施，包括医生和患者准备（例如手卫生），经常纳入护理包中。CVC 留置时间已被确定为风险分层的手段。其他策略（例如氯己定浸渍敷料、抗菌涂层装置）可能更适用于预期留置时间较长的患者。非 ICU 人群越来越多地采用预防策略，但尚未提出预期感染率。
只有在无菌插入后 1-9 天内留置时间为 1-9 天的 ICU 人群中，CLABSI 率应为零目标。对于预计留置时间较长的患者，应保留其他措施。在为非 ICU 人群提出目标 CLABSI 率之前，需要改进和验证监测方法。
