Trépanier Pascale, Quach Caroline, Gonzales Milagros, Fortin Elise, Kaouache Mohammed, Desmeules Simon, Rocher Isabelle, Ngenda-Muadi Muleka, Frenette Charles, Tremblay Claude
Infection Prevention and Control, Department of Medical Microbiology, Centre Hospitalier Universitaire (CHU) de Québec Pavillon Hôtel-Dieu de Québec, Quebec City, Quebec, Canada.
Infect Control Hosp Epidemiol. 2014 Jul;35(7):833-8. doi: 10.1086/676862. Epub 2014 May 8.
Despite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no improvement in vascular access-associated bloodstream infections in hemodialysis (HD). We aimed to determine the infection control measures recommended and implemented in Quebec's HD units, compliance of local protocols to infection control practice guidelines, and reasons behind the low prevalence of arteriovenous fistulas.
An online survey was elaborated on the basis of the Centers for Disease Control and Prevention (CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in Quebec (n = 40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression.
Thirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack of surgical resources (39%; P = .01).
Improvement in standardization of care according to practice guidelines is necessary. Fistula rate could be increased by improving access to surgical resources and patient education. Strategies are now being elaborated to address these findings.
尽管进行了监测，但魁北克医疗相关感染监测项目发现血液透析（HD）中血管通路相关血流感染并无改善。我们旨在确定魁北克血液透析单位推荐并实施的感染控制措施、当地规程与感染控制实践指南的依从性，以及动静脉内瘘低普及率背后的原因。
根据美国疾病控制与预防中心（CDC）和美国国立肾脏基金会肾脏病预后质量倡议指南制定了一项在线调查。该问卷经过了验证（结构、内容、表面效度和信度），并发送给魁北克所有的血液透析单位（n = 40）。使用描述性统计、线性回归和泊松回归对结果进行分析。
40个血液透析单位中有37个（93%）参与了调查。在32个插入中心静脉导管的中心中，有30个（94%）制定了书面插入规程。除了导管插入过程中的全身铺巾（79%）和插入部位使用软膏（3%）外，对实践指南的依从性良好。导管维护的预防措施符合指南要求，但至少使用0.5%氯己定和70%酒精进行皮肤消毒（依从率67%）以及在插入部位定期使用抗菌软膏（3%）除外。在进行内瘘穿刺前，皮肤准备并不理想；仅61%的病例进行了前臂清洁。有几个因素可以解释内瘘使用率低的原因，包括患者偏好（69%）和缺乏手术资源（39%；P = 0.01）。
有必要根据实践指南提高护理的标准化水平。通过增加手术资源的可及性和患者教育，可以提高内瘘使用率。目前正在制定策略来应对这些发现。
