Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain.
3Universitat de les Illes Balears, Palma, Spain.
Antimicrob Resist Infect Control. 2019 Jul 22;8:124. doi: 10.1186/s13756-019-0581-8. eCollection 2019.
Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices among inpatients. Catheter-related bloodstream infections (CRBSI) are serious yet preventable events for patients. Although the contribution of PIVCs towards these infections is gradually being recognised, its role in the Spanish setting is yet to be determined. We aimed to estimate the rate and incidence of PIVC failure at Manacor hospital (Spain) as baseline within a wider quality improvement initiative.
Tips from all PIVC removed during December 2017 and January 2018 in hospital wards were cultured semiquantitatively. The study population included all PIVCs inserted in adult patients admitted to any of three medical and one surgical wards, emergency department, critical care unit and operating rooms. Clinical, microbiological and ward information was collected by clinical researchers for each PIVC from insertion to removal on the study sites. CRBSI was defined per international guidelines (i.e., Centers for Disease Control and Prevention, USA). Data was analysed descriptively.
Seven hundred and eleven tips were cultured, with 41.8% (297/711) reported as PIVC failure. The PIVC failure rate density-adjusted incidence for hospital length of stay (HLOS) was 226.2 PIVC failure/1000 HLOS. 5.8% (41/711) tips yielded positive isolates, with most frequent microorganisms ( 29/41, 70.7%, 2/41, 4.9%, 2/41, 4.9%), and (1/41, 2.4%). One isolate was methicillin-resistant. 53.6% (22/41) positive cultures were obtained from patients with local signs and symptoms compatible with catheter-related infection (CRI), 2.4% (1/41) were compatible with CRBSI type 2 and that clinical signs improve within 48 h of catheter removal (density-adjusted incidence for hospital stays of 16.7 PIVC-CRI/1000 hospital-stays and 0.76 PVC-BSI/1000 hospital-stays respectively) and no patients were diagnosed CRBSI type 3 with a bacterial growth concordant in tip and blood cultures. Most cases responded favourably to catheter removal and management.
Our findings show that almost 42% PIVCs resulted in unplanned removal, amplifying the importance in terms of morbidity, mortality and patient safety. A high number of positive tip cultures without clinical signs and symptoms was observed. We underpin the importance to remove unnecessary PIVCs for the prevention of CRBSI.
外周静脉导管（PIVC）是住院患者中使用最广泛的侵入性器械。导管相关血流感染（CRBSI）是患者可预防的严重事件。尽管 PIVC 对这些感染的贡献逐渐得到认可，但在西班牙的情况尚待确定。我们旨在估计马纳科尔医院（西班牙）的 PIVC 失败率和发病率，作为更广泛质量改进计划的基线。
对 2017 年 12 月和 2018 年 1 月期间从医院病房中取出的所有 PIVC 的尖端进行半定量培养。研究人群包括在三个内科病房、一个外科病房、急诊室、重症监护病房和手术室中接受任何成人患者插入的所有 PIVC。临床研究人员在研究现场收集每个 PIVC 从插入到移除的临床、微生物学和病房信息。根据国际指南（即美国疾病控制与预防中心）定义 CRBSI。数据以描述性方式进行分析。
培养了 711 个尖端，其中 41.8%（297/711）报告为 PIVC 失败。调整医院住院时间（HLOS）的 PIVC 失败率密度调整发病率为 226.2 PIVC 失败/1000 HLOS。5.8%（41/711）的尖端培养出阳性分离株，最常见的微生物是 （29/41，70.7%，2/41，4.9%，2/41，4.9%）和 （1/41，2.4%）。1 株分离物为耐甲氧西林。53.6%（22/41）的阳性培养物来自局部有感染相关导管的体征和症状的患者（CRI），2.4%（1/41）与 CRBSI 2 型相符，临床症状在导管移除后 48 小时内改善（密度调整发病率为 16.7 PIVC-CRI/1000 住院/1000 住院和 0.76 PVC-BSI/1000 住院/1000 住院），没有患者被诊断为 CRBSI 3 型，尖端和血液培养的细菌生长一致。大多数病例对导管移除和管理反应良好。
我们的发现表明，近 42%的 PIVC 导致计划外移除，这增加了发病率、死亡率和患者安全方面的重要性。观察到大量有临床症状但无阳性尖端培养物。我们强调为预防 CRBSI 而去除不必要的 PIVC 的重要性。
