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重症监护中静脉治疗并发症的细菌污染(作者译)

[Bacterial contamination as a complication of intravenous therapy in intensive care (author's transl)].

作者信息

Kilian J, Hösch A, Ahnefeld F W, Schmitz J E, Vanek E

出版信息

Anaesthesist. 1980 Oct;29(10):559-66.

PMID:7004262
Abstract

Intravenous infusion therapy has become an indispensible part of intensive care. Problems of bacterial contamination during this therapy are well known. To check on the possible routes of contamination we examined the infusion system in its several parts (infusion solution, infusion system, connection between infusion system and catheter and content of syringes). The highest rate of contamination was found at the connection between the infusion system and the catheter after use for 24 h (26.7%, 39 out of 146 probes); just at the beginning of the infusion we found bacterial growth in 7.1% (10 out of 141 probes). After injection of drugs into the system the infusion solution was contaminated in 1.9% (6 of 320 probes). The system for measuring the central venous pressure was contaminated in 2.7% (4 of 148 probes). At the end of infusion the infusion solutions were contaminated in 3.1% (9 of 287 probes). Different drugs in syringes in no case were contaminated. In most cases (59 probes) we found gram-positive bacteria (87.3%), in only seven cases (9.7%) gram-negative bacterias and in two cases Candida tropicalis. Our results show that the extrinsic or in use contamination plays the most important part in bacterial contamination of the infusion system. Infection control of intravenous therapy necessitates care in the hygienic standard adopted during the infusion and injection procedures.

摘要

静脉输液治疗已成为重症监护中不可或缺的一部分。这种治疗过程中的细菌污染问题是众所周知的。为了检查可能的污染途径,我们对输液系统的几个部分(输液溶液、输液系统、输液系统与导管的连接处以及注射器内的内容物)进行了检查。在使用24小时后,发现输液系统与导管的连接处污染率最高(26.7%,146个样本中有39个);就在输液开始时,我们发现7.1%(141个样本中有10个)出现细菌生长。向系统中注入药物后,输液溶液的污染率为1.9%(320个样本中有6个)。测量中心静脉压的系统污染率为2.7%(148个样本中有4个)。输液结束时,输液溶液的污染率为3.1%(287个样本中有9个)。注射器中的不同药物在任何情况下均未被污染。在大多数情况下(59个样本),我们发现的是革兰氏阳性菌(87.3%),只有7例(9.7%)是革兰氏阴性菌,2例是热带念珠菌。我们的结果表明,外在污染或使用过程中的污染在输液系统的细菌污染中起最重要的作用。静脉治疗的感染控制需要在输液和注射过程中采用严格的卫生标准。

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