干预措施降低急性护理中外周血培养污染的效果：系统评价方案。
The effectiveness of interventions to reduce peripheral blood culture contamination in acute care: a systematic review protocol.
机构信息
School of Nursing, Queensland University of Technology, Brisbane, Australia.
Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Ground Floor, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia.
出版信息
Syst Rev. 2018 Nov 30;7(1):216. doi: 10.1186/s13643-018-0877-4.
BACKGROUND
Blood cultures are an integral part of the diagnosis of bacteremia in unwell patients. The treatment of bacteremia involves the rapid and accurate identification of the causative agent grown from the blood cultures collected. Contamination of blood cultures with non-pathogenic microbes such as skin commensals causes false positive results and subsequent unnecessary and potentially harmful interventions. While guidelines for blood culture quality recommend no more than 2-3% contamination rate, rates up to 12% are reported in the literature. There have been a number of methods proposed to reduce the contamination of blood cultures, including educational interventions, changing of skin cleansing preparations and introduction of blood culture collection packs in acute care settings. This protocol outlines methods to identify and evaluate interventions to reduce blood culture contamination in the acute care setting.
METHODS
The reviewers will conduct a systematic search of literature in CINHAL, PubMed, EMBASE and the Cochrane Central register of controlled trials. Unpublished works will be identified in ProQuest Dissertations and Theses. Articles will be assessed for relevance based on their title and abstract. Remaining relevant citations will have their full text retrieved and assessed against eligibility criteria. All studies that meet the eligibility criteria will have their methodological quality appraised. Assessments for relevance and methodological quality will be conducted independently by two reviewers. If appropriate, data will be analysed using the Mantel-Haenszel method under a random effects model. Heterogeneity of the studies will be assessed using the I and chi-squared statistic. Meta-analysis will be attempted if the data is suitable.
DISCUSSION
This review will identify and summarise the interventions previously described in the literature aimed at reducing peripherally collected blood culture contamination rates in acute care. These findings have the potential to lead to multifaceted interventions based on previous evidence to reduce blood culture contamination in the acute setting. Reductions in the proportion of contaminated blood cultures have the potential to save money, unrequired treatment (particularly antimicrobials) and hospital bed days.
SYSTEMATIC REVIEW REGISTRATION
In accordance with guidelines outlined in the PRISMA-P methodology, this protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on December 8, 2017, and last updated on January 4, 2018 (registration number CRD42017081650).
背景
血液培养是诊断不适患者菌血症的重要组成部分。菌血症的治疗涉及从采集的血液培养物中快速准确地鉴定出病原体。血液培养物受到非致病性微生物（如皮肤共生菌）的污染会导致假阳性结果，并导致随后进行不必要且潜在有害的干预。尽管血液培养质量指南建议污染率不超过 2-3%，但文献中报告的污染率高达 12%。已经提出了许多方法来减少血液培养物的污染，包括教育干预、改变皮肤清洁制剂以及在急性护理环境中引入血液培养采集包。本方案概述了在急性护理环境中识别和评估减少血液培养物污染的干预措施的方法。
方法
审查员将在 CINHAL、PubMed、EMBASE 和 Cochrane 对照试验中心注册库中进行系统的文献搜索。未发表的作品将在 ProQuest Dissertations and Theses 中确定。根据标题和摘要评估文章的相关性。其余相关引文将检索其全文，并根据入选标准进行评估。所有符合入选标准的研究都将进行方法学质量评估。相关性和方法学质量的评估将由两名审查员独立进行。如果合适，将使用随机效应模型下的 Mantel-Haenszel 方法对数据进行分析。使用 I 和卡方统计量评估研究的异质性。如果数据合适，将尝试进行荟萃分析。
讨论
本综述将确定并总结文献中以前描述的旨在降低急性护理中外周采集血液培养物污染率的干预措施。这些发现有可能基于以前的证据，针对急性环境中的血液培养污染提出多方面的干预措施。降低污染血液培养物的比例有可能节省资金、不必要的治疗（特别是抗生素）和住院天数。
系统评价注册
根据 PRISMA-P 方法学概述的指南，本方案于 2017 年 12 月 8 日在国际前瞻性系统评价注册库（PROSPERO）中注册，并于 2018 年 1 月 4 日最后更新（注册号 CRD42017081650）。
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