1Department of Infection Control, Hung Vuong Hospital, 128 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam.
2Hung Vuong Hospital, 128 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam.
Antimicrob Resist Infect Control. 2020 Jan 7;9(1):9. doi: 10.1186/s13756-019-0669-1. eCollection 2020.
Catheter-related bloodstream infections (CR-BSI) cause high neonatal mortality and are related to inadequate aseptic technique during the care and maintenance of a catheter. The incidence of CR-BSI among neonates in Hung Vuong Hospital was higher than that of other neonatal care centres in Vietnam.
An 18-month pre- and post-intervention study was conducted over three 6-month periods to evaluate the effectiveness of the intervention for CR-BSI and to identify risk factors associated with CR-BSI. During the intervention period, we trained all nurses in the Department of Neonatology on BSI preventive practices, provided auditing and feedback about aseptic technique during catheter care and maintenance, and reorganised preparation of total parenteral nutrition. All neonates with intravenous catheter insertion ≥48 h in the pre- and post-intervention period were enrolled. A standardised questionnaire was used to collect data. Blood samples were collected for cultures. We used Poisson regression to calculate rate ratio (RR) and 95% confidence interval (CI) for CR-BSI incidence rates and logistic regression to identify risk factors associated with CR-BSI.
Of 2225 neonates enrolled, 1027 were enrolled in the pre-intervention period, of which 53 CR-BSI cases occurred in 8399 catheter-days, and 1198 were enrolled in the post-intervention period, of which 32 CR-BSI cases occurred in 8324 catheter-days. Incidence rates of CR-BSI significantly decreased after the intervention (RR = 0.61, 95% CI 0.39-0.94). Days of hospitalisation, episodes of non-catheter-related hospital-acquired infections, and the proportion of deaths significantly decreased after the intervention ( < 0.01). The CR-BSI was associated with days of intravenous catheter (odds ratio [OR] = 1.05, 95% CI 1.03-1.08), use of endotracheal intubation (OR = 2.27, 95% CI 1.27-4.06), and intravenous injection (OR = 8.50, 95% CI 1.14-63.4).
The interventions significantly decreased the incidence rate of CR-BSI. Regular refresher training and auditing and feedback about aseptic technique during care and maintenance of catheters are critical to reducing CR-BSI.
导管相关血流感染（CR-BSI）会导致新生儿死亡率升高，这与导管护理和维护过程中无菌技术不足有关。在 Hung Vuong 医院，新生儿的 CR-BSI 发生率高于越南其他新生儿护理中心。
在三个 6 个月的时间内进行了 18 个月的干预前和干预后研究，以评估干预措施对 CR-BSI 的有效性，并确定与 CR-BSI 相关的危险因素。在干预期间，我们对新生儿科的所有护士进行了 BSI 预防措施培训，对导管护理和维护过程中的无菌技术进行了审核和反馈，并对全胃肠外营养的准备进行了重新组织。所有在干预前和干预后期间静脉导管插入≥48 小时的新生儿均被纳入研究。使用标准化问卷收集数据。采集血样进行培养。我们使用泊松回归计算 CR-BSI 发生率的率比（RR）和 95%置信区间（CI），使用逻辑回归确定与 CR-BSI 相关的危险因素。
共纳入 2225 名新生儿，其中 1027 名在干预前纳入，8399 导管日中有 53 例 CR-BSI 发生；1198 名在干预后纳入，8324 导管日中有 32 例 CR-BSI 发生。干预后 CR-BSI 的发生率显著下降（RR=0.61，95%CI 0.39-0.94）。住院天数、非导管相关性医院获得性感染发作和死亡率在干预后显著下降（ < 0.01）。CR-BSI 与静脉导管使用天数（比值比[OR] = 1.05，95%CI 1.03-1.08）、气管插管使用（OR = 2.27，95%CI 1.27-4.06）和静脉注射（OR = 8.50，95%CI 1.14-63.4）有关。
干预措施显著降低了 CR-BSI 的发生率。定期进行无菌技术再培训和审核反馈，对减少 CR-BSI 至关重要。
