Independent Researcher, United States of America.
College of Medical, Veterinary and Life Sciences, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
J Clin Nurs. 2017 Dec;26(23-24):3962-3973. doi: 10.1111/jocn.13824. Epub 2017 Jul 5.
To investigate the procedural aspects in inserting central venous catheters that minimise central line-associated bloodstream infection rates in adult intensive care units through a structured literature review.
In adult intensive care units, central line-associated bloodstream infections are a major cause of high mortality rates and increased in costs due to the consequences of complications.
Eligible articles were identified by combining indexed keywords using Boolean operator of "AND" under databases of Ovid and CINAHL. Titles and abstract of retrieved papers were screened and duplicates removed. Inclusion and exclusion criteria were applied to derive the final papers, which contained seminal studies. The quality of papers was assessed using a special data extraction form.
The number of papers retrieved from all databases was 337, reduced to 302 after removing duplicates. Papers were scanned for titles and abstract to locate those relevant to the review question. After this, 250 papers were excluded for different reasons and a total of 52 papers were fully accessed to assess for eligibility. The final number of papers included was 10 articles.
Many interventions can be implemented in the adult intensive care unit during the insertion of a central venous catheter to minimise central line-associated bloodstream infections rates. These include choosing the subclavian site to insert the catheters as the least infectious and decolonising patients' skin with alcoholic chlorhexidine gluconate preparation due to its broad antimicrobial effect and durability.
Choosing optimal sites for central venous catheter insertion is a complex process that relies on many factors. Furthermore, the introduction of chlorhexidine gluconate preparations should be accompanied with multifaceted interventions including quality improvement initiatives to improve healthcare workers' compliance. As a quality marker in adult intensive care units, healthcare sectors should work on establishing benchmarks with other sectors around the world.
通过系统文献回顾，探讨在成人重症监护病房中插入中心静脉导管的程序方面，以降低中心静脉相关血流感染率。
在成人重症监护病房中，中心静脉相关血流感染是导致高死亡率和增加成本的主要原因，因为并发症会带来严重后果。
通过在 Ovid 和 CINAHL 数据库中使用布尔运算符“AND”组合索引关键字，确定符合条件的文章。筛选检索到的论文的标题和摘要，去除重复项。应用纳入和排除标准得出最终论文，其中包含重要研究。使用专门的数据提取表评估论文的质量。
从所有数据库中检索到的论文数量为 337 篇，去除重复项后减少到 302 篇。扫描论文的标题和摘要以确定与审查问题相关的论文。在此之后，有 250 篇论文因各种原因被排除在外，总共对 52 篇论文进行了全面评估以确定其是否符合纳入标准。最终纳入的论文数量为 10 篇。
在成人重症监护病房中插入中心静脉导管时，可以实施许多干预措施来降低中心静脉相关血流感染率。这些干预措施包括选择锁骨下部位插入导管，因为该部位感染风险最低；使用含酒精的葡萄糖酸氯己定制剂对患者皮肤进行去定植，因为其具有广谱抗菌作用和耐久性。
选择中心静脉导管插入的最佳部位是一个复杂的过程，需要考虑许多因素。此外，应在引入葡萄糖酸氯己定制剂的同时采取多方面的干预措施，包括质量改进措施，以提高医护人员的依从性。作为成人重症监护病房的质量指标，医疗保健部门应致力于与世界各地的其他部门一起建立基准。
