Infection Control Division, South Miyagi Medical Center, Aza-Nishi 38-1, Ogawara, Shibata-gun, Miyagi 989-1253, Japan.
Infection Control Division, South Miyagi Medical Center, Aza-Nishi 38-1, Ogawara, Shibata-gun, Miyagi 989-1253, Japan; Department of Emergency and Critical Care Medicine, South Miyagi Medical Center, Aza-Nishi 38-1, Ogawara, Shibata-gun, Miyagi 989-1253, Japan.
J Infect Chemother. 2020 Feb;26(2):188-193. doi: 10.1016/j.jiac.2019.08.007. Epub 2019 Sep 5.
Bundled measures have been recommended to reduce the risk of central venous catheter (CVC)-related bloodstream infection. However, the importance of each procedure involved in CVC insertion/management for preventing catheter-related bloodstream infection (CRBSI) has not been thoroughly assessed. We aimed to analyze the effectiveness of maintenance antisepsis at the CVC insertion site in reducing the CRBSI risk through comparing the use of 0.05% chlorhexidine to 1% chlorhexidine.
In the South Miyagi Medical Center, Japan, 372 patients with a CVC who had undergone antisepsis maintenance using 0.05% chlorhexidine swabs 12 months prior to implementing 1% chlorhexidine swabs, and 344 patients at 12 months post-implementation of 1% chlorhexidine swabs, were followed prospectively for the development of CRBSI and signs of infection, and their data compared.
Post-implementation of the 1% chlorhexidine swabs, the CRBSI rate decreased from 3.64/1000 catheter-days to 1.77/1000 catheter-days. The risk of CRBSI decreased to 0.465 (95% confidence interval [CI]: 0.216-1.001). Furthermore, the risk of CRBSI ≥20 days after CVC insertion decreased to 0.200 (95% CI: 0.049-0.867); however, we found no difference between 0.05% and 1% chlorhexidine use within 19 days of CVC insertion. The increased number of patients with insertion site tenderness after implementing 1% chlorhexidine indicated a possible adverse effect of chlorhexidine.
Maintenance antisepsis with 1% chlorhexidine decreased the risk of developing CRBSI ≥20 days after CVC insertion, indicating the effectiveness of antisepsis with 1% chlorhexidine. Our data highlight the importance of maintenance antisepsis in reducing the rate of late-phase CRBSI.
已推荐采用捆绑措施来降低中心静脉导管（CVC）相关血流感染的风险。然而，在预防导管相关性血流感染（CRBSI）方面，CVC 插入/管理过程中每个程序的重要性尚未得到彻底评估。我们旨在通过比较使用 0.05%洗必泰与 1%洗必泰来分析 CVC 插入部位维持消毒对降低 CRBSI 风险的效果。
在日本南宫城医疗中心，对 372 例接受 CVC 并在实施 1%洗必泰棉签 12 个月前使用 0.05%洗必泰棉签进行了维持消毒的患者和 344 例在实施 1%洗必泰棉签 12 个月后接受治疗的患者进行前瞻性研究，以了解他们是否发生了 CRBSI 和感染迹象，并对其数据进行了比较。
实施 1%洗必泰棉签后，CRBSI 发生率从 3.64/1000导管日降至 1.77/1000导管日。CRBSI 的风险降低至 0.465（95%置信区间[CI]：0.216-1.001）。此外，CVC 插入后 20 天以上发生 CRBSI 的风险降低至 0.200（95%CI：0.049-0.867）；但是，我们发现 CVC 插入后 19 天内使用 0.05%洗必泰和 1%洗必泰之间没有差异。实施 1%洗必泰后，更多患者出现插入部位压痛，表明洗必泰可能存在不良反应。
采用 1%洗必泰进行维持消毒可降低 CVC 插入后 20 天以上发生 CRBSI 的风险，表明 1%洗必泰消毒有效。我们的数据突出了维持消毒在降低晚期 CRBSI 发生率方面的重要性。
