Peruzzi W T, Noskin G A, Moen S G, Yungbluth M, Lichtenthal P, Shapiro B A
Department of Anesthesia, Northwestern University Medical School, Chicago, IL 60611, USA.
Crit Care Med. 1996 Jul;24(7):1157-62. doi: 10.1097/00003246-199607000-00015.
To compare microbial contamination of two different blood conservation devices; to determine if there was an association between contamination of the blood conservation devices and clinical infections; to determine if there was a significant user preference for either of the two devices.
Prospective, randomized trial.
Medical, neurosurgical, and spinal cord intensive care units of an urban, university hospital.
Forty patients who required clinically indicated intrafierial catheters placed at new sites.
The two most widely available blood conservation devices at the time of the study (Venous Arterial blood Management Protection system [VAMP], Baxter Edwards Critical-Care, Irvine, CA; and Safe Draw, Ohmeda, Madison, WI) were chosen for comparison. After the normal 48 to 72 hrs of device use, the blood conservation systems were removed and semi-quantitative and quantitative cultures were taken from comparable sites of the two devices. Positive cultures from the patients were recorded and correlated with cultures obtained from the devices. In order to assess preference for either device, a survey tool was administered to the nursing staff who participated in the study.
Quantitative cultures from all sites cultured in both groups demonstrated mean colony counts of < 10(3) colony-forming units (cfu)/mL. There were no statistically significant differences in the colony counts at any of the sites compared between the two groups. There were no statistically significant relationships between positive cultures and patient age, gender, duration of device utilization, frequency of device entry, or the intensive care unit in which the study was conducted. In no circumstance did positive cultures from any of the blood conservation devices correlate with positive culture results from any sites of clinical infection. The clinical survey demonstrated a statistically significant preference for the VAMP system, which persisted despite increased experience with the Safe Draw system.
The levels of microbial contamination noted in these devices were not consistent with clinical infection (defined as 10(3) cfu/mL on quantitative cultures). There was no significant difference in degree or pattern of contamination between the two devices. When utilized and changed according to the Centers for Disease Control guidelines, blood conservation devices are not harbors of infection in the critical care setting. Blood conservation devices can be used as part of a comprehensive blood conservation program in the critical care setting without undue concern for exacerbating infectious processes.
比较两种不同血液保存装置的微生物污染情况；确定血液保存装置的污染与临床感染之间是否存在关联；确定两种装置中是否有一种存在显著的用户偏好。
前瞻性随机试验。
一家城市大学医院的内科、神经外科和脊髓重症监护病房。
40例需要在新部位放置临床指示的动脉内导管的患者。
选择研究时两种最常用的血液保存装置（静脉 - 动脉血液管理保护系统 [VAMP]，百特爱德华兹重症护理公司，加利福尼亚州欧文市；以及安全采血器，欧姆达公司，威斯康星州麦迪逊市）进行比较。在正常使用装置48至72小时后，移除血液保存系统，并从两种装置的可比部位进行半定量和定量培养。记录患者的阳性培养结果，并与从装置中获得的培养结果进行关联。为了评估对任一装置的偏好，向参与研究的护理人员发放了一份调查工具。
两组所有培养部位的定量培养均显示平均菌落计数<10³菌落形成单位（cfu）/mL。两组之间在任何比较部位的菌落计数均无统计学显著差异。阳性培养结果与患者年龄、性别、装置使用时长、装置穿刺频率或进行研究的重症监护病房之间均无统计学显著关系。在任何情况下，任何血液保存装置的阳性培养结果均与临床感染任何部位的阳性培养结果无关。临床调查显示对VAMP系统存在统计学显著偏好，尽管使用安全采血器系统的经验增加，这种偏好仍然存在。
这些装置中记录的微生物污染水平与临床感染（定量培养定义为10³ cfu/mL）不一致。两种装置在污染程度或模式上无显著差异。按照疾病控制中心指南使用和更换时，血液保存装置在重症监护环境中并非感染源。血液保存装置可作为重症监护环境中综合血液保存计划的一部分使用，无需过度担心会加剧感染过程。
