隔日使用洗必泰沐浴对预防外科重症监护病房医院获得性感染的效果：一项单中心随机对照试验
Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial.
作者信息
Swan Joshua T, Ashton Carol M, Bui Lan N, Pham Vy P, Shirkey Beverly A, Blackshear Jolene E, Bersamin Jimmy B, Pomer Rubie May L, Johnson Michael L, Magtoto Audrey D, Butler Michelle O, Tran Shirley K, Sanchez Leah R, Patel Jessica G, Ochoa Robert A, Hai Shaikh A, Denison Karen I, Graviss Edward A, Wray Nelda P
机构信息
1Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX.2Allied Health Sciences, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX.3Department of Pharmacy, Houston Methodist Hospital, Houston, TX.4Center for Outcomes Research, Department of Surgery, Houston Methodist Research Institute, Houston, TX.5Department of Surgery, Houston Methodist Hospital, Houston, TX.6Department of Surgery, Weill Cornell Medical College, New York, NY.7Department of Pharmacy, Memorial Hermann Greater Heights Hospital, Houston, TX.8Surgical Intensive Care Unit, Houston Methodist Hospital, Houston, TX.9Ambulatory Treatment Center, MD Anderson Cancer Center, Houston, TX.10Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX.11Rapides Regional Physician Group, Rapides Regional Medical Center, Alexandria, LA.12Novartis Pharmaceuticals Corporation, East Hanover, NJ.13Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Houston Methodist Hospital, Houston, TX.14Infection Prevention and Control, Houston Methodist Hospital, Houston, TX.15Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX.
出版信息
Crit Care Med. 2016 Oct;44(10):1822-32. doi: 10.1097/CCM.0000000000001820.
OBJECTIVE
To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients.
DESIGN
This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded.
SETTING
Twenty-four-bed surgical ICU at a quaternary academic medical center.
PATIENTS
Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included.
INTERVENTIONS
Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm).
MEASUREMENTS AND MAIN RESULTS
The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309-0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5-16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95).
CONCLUSIONS
Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.
目的
检验以下假设：与每日使用肥皂和水沐浴相比，每两天使用2%葡萄糖酸氯己定沐浴长达28天可降低外科重症监护病房（SICU）患者发生医院获得性导尿管相关尿路感染、呼吸机相关性肺炎、手术切口部位感染和原发性血流感染的风险。
设计
这是一项单中心、实用、随机试验。患者和临床医生知晓治疗组分配情况；确定结果的研究人员对分组情况不知情。
地点
一家拥有24张床位的四级学术医疗中心的外科重症监护病房。
患者
纳入2012年7月至2013年5月入住外科重症监护病房、预计在外科重症监护病房停留48小时或更长时间的成年人。
干预措施
患者被随机分为两组，一组每两天交替使用2%葡萄糖酸氯己定和肥皂与水沐浴（治疗组），另一组每天使用肥皂和水沐浴（对照组）。
测量指标及主要结果
主要终点是导尿管相关尿路感染、呼吸机相关性肺炎、手术切口部位感染和原发性血流感染的综合结果。在350名随机分组的患者中，24名因之前已参与本试验被排除，1名撤回同意书。因此，对325名患者进行了分析（164名使用肥皂和水，161名使用氯己定）。患者共发生53例感染。与使用肥皂和水沐浴相比，每两天使用氯己定沐浴降低了感染风险（风险比=0.555；95%置信区间，0.309 - 0.997；p = 0.049）。对于使用肥皂和水沐浴与使用氯己定沐浴的患者，导尿管相关尿路感染的医院获得性感染发生率分别为14例和7例，呼吸机相关性肺炎分别为13例和8例，手术切口部位感染分别为6例和3例，原发性血流感染分别为2例和0例；在所有感染类型中效果一致。发生医院获得性感染的绝对风险降低了9.0%（95%置信区间，1.5 - 16.4%；p = 0.019）。皮肤不良反应的发生率相似（肥皂和水组为18.9%，氯己定组为18.6%；p = 0.95）。
结论
与使用肥皂和水相比，每两天使用氯己定沐浴可使外科重症监护病房患者发生感染的风险降低44.5%。
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