Fridkin S K, Pear S M, Williamson T H, Galgiani J N, Jarvis W R
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Infect Control Hosp Epidemiol. 1996 Mar;17(3):150-8. doi: 10.1086/647262.
To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.
Case-control and cohort studies of surgical intensive care unit (SICU) patients.
A university-affiliated Veterans Affairs medical center.
Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).
CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.
When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence interval, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the outbreak period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.
Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.
确定在一次持续性暴发期间中心静脉导管相关血流感染（CVC-BSI）的危险因素。
对外科重症监护病房（SICU）患者进行病例对照研究和队列研究。
一所大学附属的退伍军人事务医疗中心。
病例对照研究：在暴发期间（1992年1月至1993年9月）发生CVC-BSI的所有患者以及随机选择的对照。队列研究：研究期间（1991年1月至1993年9月）所有SICU患者。
CVC-BSI或部位感染率、SICU患者临床数据以及SICU患者与护士的月平均比例。
按医院位置和部位分析时，与上一年（1991年1月至1991年12月：暴发前时期）相比，仅SICU的CVC-BSI在暴发期间显著增加。在SICU患者中，CVC-BSI与接受全胃肠外营养（TPN）相关；比值比为16；95%置信区间为4至73）。当我们对TPN使用情况进行控制后，CVC-BSI与疾病严重程度增加和辅助通气天数相关。暴发期间的SICU患者在SICU和医院的住院时间较短，年龄较小，死亡率相似，但与暴发前时期的患者相比接受了更多的TPN。此外，与暴发前时期相比，暴发期间患者与护士的比例显著增加。当我们对TPN使用、辅助通气和住院时间进行控制后，患者与护士的比例是SICU患者CVC-BSI的独立危险因素。
在TPN使用增加的时期，护理人员减少到临界水平以下，可能因难以进行充分的导管护理而导致SICU中CVC-BSI增加。在医疗改革和医院规模缩小时，需要严格评估人员减少对患者结局（即医院感染）的影响。
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