Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line-Associated Bloodstream Infections
Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line-Associated Bloodstream Infections
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DOI：
10.1086/674862
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发表时间：
2014-02-01
影响因子：
4.5
通讯作者：
Perreault, Therese
中科院分区：
文献类型：
--
作者：
Quach, Caroline;Milstone, Aaron M.;Perreault, Therese
背景：尽管实施了推荐的最佳做法，我们的中心线相关血流感染(CLABSI)的发生率仍然很高。我们的目的是描述洗必泰(CHG)沐浴对新生儿CLABSI发生率的影响。方法：研究对象为2009年4月至2013年3月在新生儿重症监护病房使用中心静脉导管(CVC)的婴儿。出生体重在1,000克或以下，出生28天以下，以及出生体重超过1,000克的新生儿在2012年3月31日之前用温和的肥皂洗澡(基线)，从2012年4月1日开始用2%的CHG浸渍布洗澡(干预)。出生体重在1000克或以下，出生28天或更长时间的婴儿，在整个过程中都要用温和的肥皂洗澡。新生儿重症监护病房护士报告了不良事件。使用泊松回归计算调整后的发病率比率(AIRR)，以比较基线和干预期内CLABSI/1,000 CVC天数。结果：总共有790名患有CVCS的新生儿纳入研究。在干预期间，CHG沐浴新生儿的CLABSI发生率下降(6.00vs1.92/1,000 CVC-day；aIRR，0.33[95%可信区间(CI)，0.15-0.73])，但不符合CHG沐浴条件的出生婴儿(8.57vs8.62/1000 CVC-day；aIRR，0.86[95%CI，0.17--4.44])保持不变。总体而言，195名出生体重超过1000克的婴儿和24名出生体重在1000克或以下、出生28天或更长时间的婴儿接受了CHG沐浴。没有报告不良事件。结论：在没有观察到不良事件的情况下，我们观察到CHG沐浴的新生儿CLABSI发生率降低。尽管实施了其他建议的措施，但如果CLABSI率仍然很高，则应考虑进行CHG沐浴。
Background.Despite implementation of recommended best practices, our central line--associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.Methods.Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.Results.Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15--0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17--4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.Conclusions.We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.