Toor Harjyot, Farr Saman, Savla Paras, Kashyap Samir, Wang Sharon, Miulli Dan E
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Infectious Disease, Arrowhead Regional Medical Center, Colton, USA.
Cureus. 2022 Mar 3;14(3):e22809. doi: 10.7759/cureus.22809. eCollection 2022 Mar.
Central line-associated bloodstream infections (CLABSIs) remain an important preventable healthcare-associated infection with a 2020 rate of 0.87 (per 1,000 central line days) in the United States intensive care units (ICU).
This was a retrospective cohort study of all adult patients in our institution. The total number of central venous catheter (CVC) insertions and line days were determined using daily unit logs maintained by unit managers. Central line insertion practice (CLIP) compliance was calculated as the total number of CLIP forms submitted divided by the total number of newly-inserted CVCs with and without associated CLIP forms as determined by unit logs.
A total of 1,125 CVCs were reviewed (448 - ICU and 677 - medical-surgical units). Of the 13 CLABSI, one patient had internal jugular (IJ), one patient had subclavian (SC), four patients had femoral, three patients had peripherally inserted central catheter (PICC) and four patients had hemodialysis catheters. Patients with CLABSI had CVC inserted for a range of five to 92 days with the average number of line days being 29 days.
Based on the analysis of our CLABSI patient population, we recommend our institution implement the following criteria to decrease the prevalence of CLABSI: All patients receiving a CVC must adhere to CLIP documentation in all units, any femoral or HD CVC placed without a CLIP form should have the line changed within 48 hours, those patients with a femoral CVC or hemodialysis catheter in place for four days or greater with an abnormal WBC (<4.0 or >11 mg/dL) or abnormal temperature (<97.0F or >100.4F) should be considered for catheter exchange, and those patients with an IJ, SC, or PICC CVC in place for seven days or greater with an abnormal WBC or abnormal temperature should have the catheter changed.
中心静脉导管相关血流感染（CLABSI）仍然是一种重要的可预防的医疗相关感染，2020年美国重症监护病房（ICU）的发生率为每1000个中心静脉导管日0.87例。
这是一项对本机构所有成年患者的回顾性队列研究。中心静脉导管（CVC）插入总数和置管天数通过各科室护士长维护的每日科室日志确定。中心静脉导管插入操作（CLIP）依从性计算方式为：提交的CLIP表格总数除以科室日志确定的新插入CVC总数（无论有无相关CLIP表格）。
共审查了1125根CVC（448根在ICU，677根在内外科病房）。在13例CLABSI患者中，1例患者的感染源为颈内静脉（IJ），1例为锁骨下静脉（SC），4例为股静脉，3例为经外周静脉穿刺中心静脉导管（PICC），4例为血液透析导管。发生CLABSI的患者CVC置管时间为5至92天，平均置管天数为29天。
基于对我们的CLABSI患者群体的分析，我们建议本机构实施以下标准以降低CLABSI的发生率：所有接受CVC的患者在所有科室都必须遵守CLIP记录，任何未填写CLIP表格而置入的股静脉或血液透析CVC应在48小时内更换导管，对于股静脉CVC或血液透析导管留置4天及以上且白细胞异常（<4.0或>11mg/dL）或体温异常（<97.0°F或>100.4°F）的患者应考虑更换导管，对于IJ、SC或PICC CVC留置7天及以上且白细胞或体温异常的患者应更换导管。
