The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients.
The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients.
复制标题
%20使用%20的%203.15%%20氯己定%20葡萄糖酸盐/70%%20酒精%20hub%20消毒%20到%20预防%20中央%20线相关%20血流%20感染%20在%20透析%20患者中。
DOI：
10.2309/j.java.2019.004.001
复制
发表时间：
2019
影响因子：
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通讯作者：
Wanda Shade
中科院分区：
文献类型：
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作者：
R. Marty Cooney;N. Manickam;P. Becherer;Laura S. Harmon;Liza Gregg;Zena Farkas;Louanne M. Shea;Priyanka Parekh;Jacqueline Murphy;Wanda Shade
目的
预防透析住院患者中的 CLABSI 事件是一项重大挑战。与导管或移植物相关的菌血症是常见的健康相关感染，会导致不良的患者预后。由于健康频率需求、更频繁的住院治疗、多种合并症问题、瘘管功能以及多次尝试导管通路导致额外的并发症、费用、发病率和死亡率，透析患者的感染风险要高得多。
方法
进行了一项观察性研究，包括中心导管装置天数、CLABSI 事件以及入院透析患者中可能存在的混杂变量。所有 CLABSI 数据均根据疾病控制和预防中心的国家医疗安全网络对 CLABSI 的定义进行识别。干预措施包括去除70%酒精棉签和酒精枢纽消毒帽，然后更换为含有3.15%葡萄糖酸氯己定/70%酒精的棉签，用于中心线枢纽消毒和血管移植通路皮肤消毒。
结果
5 年预干预期（2008-2012）涉及 7568 个中心线日、11 次 CLABSI 事件以及每 1000 台设备日率 1.45 次。 6 个月的试验期涉及 1559 个中心线日，没有发生 CLABSI 事件。实施后 5 年期间（2013-2017 年）涉及 9787 个中心线天数、5 次 CLABSI 事件以及每 1000 台设备 0.51 天的比率。与实施前相比，实施后时期的 CLABSI 事件减少了 65%，具有统计显着性（P 值 = 0.0493）。
局限性
一个限制是中心静脉导管毂接入期间擦洗时间和干燥时间的变化。当我们比较两种产品时，使用这两种产品的行为实践可能是影响因素，并且代表了可能的混杂变量。
结论
这项研究发现，在进入中心导管枢纽和血管移植物之前使用酒精和葡萄糖酸氯己定可以减少 CLABSI 事件，并在住院透析人群中维持统计学上显着较低的 CLABSI 率。亮点 在进入中央导管枢纽之前，将酒精与葡萄糖酸氯己定 (CHG) 一起使用，有助于减少中心导管相关血流感染 (CLABSI) 事件 在进入血管移植物之前，将酒精与 CHG 一起使用，有助于减少 CLABSI 事件 使用后，CLABSI 事件发生率在统计上显着减少 (65%)。使用酒精和 CHG 可以持续显着降低 CLABSI 率。
PURPOSE
Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality.
METHODS
An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection.
RESULTS
The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period.
LIMITATIONS
A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable.
CONCLUSIONS
This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.