Langley J M, LaRoche L, Hanakowski M
Can J Infect Control. 1995 Autumn;10(3):80-2.
The most common complication of central venous access device (CVAD) use is infection, which occurs in 3 to 48% of hospitalized patients. It is recommended that regular surveillance of adverse events with CVADs be conducted, expressed as a proportion of 1000 device days and reviewed and acted upon by the institution's infection control committee. In the process of developing a CVAD program the authors attempted to determine the standard of practice at other Canadian pediatric hospitals. A telephone survey of infection control practitioners (ICPS) or CVAD nurses in 15 university-affiliated Canadian pediatric hospitals was conducted using a standard questionnaire. Fourteen hospitals (93%) conduct surveillance for infections associated with CVADS. One program, a pilot project, follows mechanical complications of CVAD use. Eleven centres conduct comprehensive surveillance; in three, selected patients are followed. Only three programs have sufficient staff to follow out-patients. Definitions for CVAD infections varied widely. A positive blood culture from the catheter is sufficient for diagnosis in eight of the 14 centres (57%); the rest use Centers for Disease Control and Prevention (CDC) or modified CDC criteria. In the four centres where CVAD line days are collected on most or all patients, multiple personnel other than the ICP assist in data collection. Four hospitals report number of infections per 100 discharges, four report absolute number of infections and two use more than one denominator. Surveillance methods rely largely on paper-based chart and microbiology record review; no hospital had access to computerized patient data for direct data retrieval. Eight centres have CVAD committees for policy development, and all 15 have or are developing hospital-wide protocols for CVAD use. Canadian pediatric hospitals recognize the importance of CVAD infections, but it appears that insufficient resources are available to meet recommended data collection methods. Interhospital comparison of rates is not possible at present because of variation in definitions and denominators and in types of patients surveyed.
使用中心静脉通路装置（CVAD）最常见的并发症是感染，3%至48%的住院患者会出现这种情况。建议对CVAD相关不良事件进行定期监测，以每1000个装置日的比例表示，并由机构的感染控制委员会进行审查和采取行动。在制定CVAD计划的过程中，作者试图确定加拿大其他儿科医院的实践标准。使用标准问卷对加拿大15家大学附属医院的感染控制从业人员（ICPs）或CVAD护士进行了电话调查。14家医院（93%）对与CVAD相关的感染进行监测。一个项目作为试点项目，跟踪CVAD使用的机械并发症。11个中心进行全面监测；在3个中心，对选定的患者进行跟踪。只有3个项目有足够的工作人员跟踪门诊患者。CVAD感染的定义差异很大。在14个中心中的8个（57%），导管血培养阳性足以诊断；其余的使用疾病控制和预防中心（CDC）或修改后的CDC标准。在大多数或所有患者都收集CVAD置管天数的4个中心，除ICP外，还有多名人员协助数据收集。4家医院报告每100次出院的感染数，4家报告感染的绝对数，2家使用不止一种分母。监测方法主要依赖于纸质图表和微生物学记录审查；没有一家医院能够获取计算机化的患者数据以直接检索数据。8个中心设有CVAD委员会以制定政策，所有15家医院都有或正在制定全院范围的CVAD使用方案。加拿大儿科医院认识到CVAD感染的重要性，但似乎没有足够的资源来满足推荐的数据收集方法。由于定义、分母和调查患者类型的差异，目前无法进行医院间的感染率比较。
