针对血液透析中心的 COVID-19 预防措施与显著降低中心静脉导管相关感染相关。
Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections.
机构信息
Nephrology Unit, ASST Fatebenefratelli Sacco, Milano, Italy.
School of Nephrology, Università di Milano, Milano, Italy.
出版信息
J Nephrol. 2021 Apr;34(2):345-353. doi: 10.1007/s40620-020-00900-3. Epub 2020 Dec 28.
BACKGROUND
In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates.
METHODS
An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019.
RESULTS
In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81-1.68)/1000 days [2.07 (95% CI 1.12-3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51-1.24)/1000 days [1.04 (95% CI 0.41-2.15)/1000 days in the Feb-May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01-0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15-1.6)/1000 days.
CONCLUSIONS
The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002-0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004-1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections.
背景
在血液透析（HD）患者中，中心静脉导管（CVC）相关血流感染是发病率和死亡率的主要原因。卫生预防措施是预防感染的透析护理的关键方面，但不足以完全避免 CVC 相关感染的发生。在 COVID-19 大流行期间，预防病毒传播的卫生预防措施得到了明显加强。我们评估了它们对 CVC 相关感染率的影响。
方法
在同一机构的两个血液透析单位进行了一项观察性回顾性研究，共治疗 215 名慢性血液透析患者，其中 71 名患者（33%）目前正在使用 CVC。在 CVC 队列中，我们比较了 COVID-19 大流行在意大利的最大传播期间（2020 年 2 月至 5 月）与同年同期和 2019 年全年的数据之间的导管相关感染率。
结果
2019 年，我们记录了导管相关血流感染（CRBSI）率为 1.19（95%CI 0.81-1.68）/1000 天[2.07（95%CI 1.12-3.52）/1000 天在 2 月至 5 月 2019 期间]和隧道和出口部位感染率为 0.82（95%CI 0.51-1.24）/1000 天[1.04（95%CI 0.41-2.15）/1000 天在 2 月至 5 月 2019 期间]。在 COVID-19 大流行期间，感染率急剧下降，仅记录了一例导管相关血流感染。导管相关血流感染率显著降低至 0.20（95%CI 0.01-0.9）/1000 天（与 2019 年和 2 月至 5 月 2019 年相比，p<0.05 和 p<0.005），隧道和出口部位感染率降低不显著至 0.6（95%CI 0.15-1.6）/1000 天。
结论
与 2019 年同期相比，导管相关血流感染减少了 91%[IRR 0.09（95%CI 0.002-0.64）]，与 2019 年全年相比减少了 83%[IRR 0.17（95%CI 0.004-1.009）]，表明透析环境中更严格地实施卫生预防措施可显著改善 CVC 相关感染问题。
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