Shen Yang, Tai Zijian, Bai Xue, Song Xuan, Chen Man, Guo Qianqian, Huan Cheng, Chen Li, Zhang Jicheng
Department of Critical Care Medicine, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China. Corresponding author: Zhang Jicheng, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Dec;36(12):1315-1320. doi: 10.3760/cma.j.cn121430-20240430-00397.
To provide evidence for further reducing the incidence of central line-associated bloodstream infection (CLABSI) according to investigation of the prevention and control of CLABSI in intensive care unit (ICU) in Shandong Province.
The questionnaire was developed by experts from Shandong Critical Care Medical Quality Control Center, combining domestic and foreign guidelines, consensus and research. A convenient sampling method was used to recruit survey subjects online from October 11 to 31, 2023 in the province to investigate the management status of central venous catheter (CVC) in ICU units of secondary and above hospitals.
A total of 201 valid data were collected, involving 186 hospitals in the province, with a total of 201 ICU units, mainly comprehensive ICU (91%). The beds in ICU units were mainly single rooms (89%) and triple rooms (79%), and the ratio of doctors to total beds was 0.54 : 1. The training on the knowledge and operation of intravascular catheter-associated bloodstream infection in each ICU unit was mainly irregular (49%), and 96% of the catheter operators were authorized by the hospital. In terms of CVC selection, 89% of ICU units used dual-chamber CVC, and 86% of ICU units used catheters without antibiotic coating. When selecting the placement site, for conventional CVC catheterization, 65% preferred subclavian vein. Femoral vein was preferred in 87% of ICU units undergoing continuous renal replacement therapy. 95% of ICU units had established standardized operation procedure (SOP) for CVC placement. 86% of ICU units were capable of ultrasound positioning or guided puncture at the time of catheterization. During catheterization, 88% of ICU units met the sterile dress code. Before and after catheterzation, 81% and 77% of ICU units standardized hand hygiene. Only 31% of ICU units were covered from head to toe by aseptic wipes. For the choice of skin disinfectant, the majority of ICU units (72%) only used iodophor. After tube placement, 54% of ICU units chose sterile transparent dressing and 25% chose sterile gauze dressing. 98% of ICU units were sutured to secure the catheter. Regarding catheter replacement and removal, 45% of ICU units could not be removed or replaced within 2 days in emergency situations where the principle of sterility was not guaranteed. When CLABSI was suspected, 55% of ICU units were able to obtain the catheter tip, transcatheter blood culture, and contralateral peripheral vein blood culture at the same time. For CVC replacement frequency, most ICU units (75%) would not be replaced regularly, and some ICU units would be replaced regularly, but the frequency of replacement was different. For CLABSI prevention and control, 82% of ICU units developed a verification form or supervision form. When analyzing the sources of CLABSI data, most of them were filled in by themselves (60%). As for the frequency of data analysis, 57% were once a month.
All ICU units in Shandong Province are standardized in terms of the authorization of operators, the formulation of SOP, the formulation and implementation of verification form and supervision form, ultrasound-guided puncture, and hand hygiene before and after catheterization. However, there are still deficiencies in the training on knowledge and operation of intravascular catheter-associated bloodstream infections, maximum aseptic coverage, catheter replacement and removal, and the reporting sources of CLABSI data, which need to be strengthened in the follow-up work. At present, the selection of CVC, the selection of catheterization site, the selection of skin disinfectant and the selection of dressings after catheterization still need further research.
通过对山东省重症监护病房（ICU）中心静脉导管相关血流感染（CLABSI）的防控调查，为进一步降低CLABSI发病率提供依据。
由山东省重症医学质量控制中心专家结合国内外指南、共识及研究制定调查问卷。采用方便抽样法，于2023年10月11日至31日在全省范围内通过网络招募调查对象，以调查二级及以上医院ICU病房中心静脉导管（CVC）的管理状况。
共收集到201份有效数据，涉及全省186家医院，共201个ICU病房，其中以综合ICU为主（91%）。ICU病房床位以单人房间为主（89%），三人房间占79%，医生与床位总数之比为0.54∶1。各ICU病房关于血管内导管相关血流感染知识及操作的培训主要不规范（49%），96%的导管操作人员获得医院授权。在CVC选择方面，89%的ICU病房使用双腔CVC，86%的ICU病房使用无抗生素涂层的导管。在选择置管部位时，对于常规CVC置管，65%的人首选锁骨下静脉。87%接受持续肾脏替代治疗的ICU病房首选股静脉。95%的ICU病房制定了CVC置管的标准化操作程序（SOP）。86%的ICU病房在置管时能够进行超声定位或引导穿刺。置管过程中，88%的ICU病房符合无菌着装规范。置管前后，81%和77%的ICU病房规范了手卫生。只有31%的ICU病房全身覆盖无菌巾。对于皮肤消毒剂的选择，大多数ICU病房（72%）仅使用碘伏。置管后，54%的ICU病房选择无菌透明敷料，25%选择无菌纱布敷料。98%的ICU病房对导管进行了缝合固定。关于导管更换与拔除，45%的ICU病房在不能保证无菌原则的紧急情况下，无法在2天内拔除或更换导管。怀疑发生CLABSI时，55%的ICU病房能够同时获取导管尖端、经导管血培养及对侧外周静脉血培养。对于CVC更换频率，大多数ICU病房（75%）不会定期更换，部分ICU病房会定期更换，但更换频率不同。对于CLABSI防控，82%的ICU病房制定了核查表或监督表。在分析CLABSI数据来源时，大部分由自身填写（60%）。至于数据分析频率，57%为每月1次。
山东省各ICU病房在操作人员授权、SOP制定、核查表及监督表制定与执行、超声引导穿刺、置管前后手卫生等方面均较为规范。然而，在血管内导管相关血流感染知识及操作培训、最大无菌覆盖、导管更换与拔除、CLABSI数据上报来源等方面仍存在不足，后续工作需加强。目前，CVC选择、置管部位选择、皮肤消毒剂选择及置管后敷料选择等仍需进一步研究。
