Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'water-free' patient care
Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'water-free' patient care
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DOI：
10.1186/s13756-017-0213-0
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发表时间：
2017-06-10
影响因子：
5.5
通讯作者：
vd Hoeven, Hans
中科院分区：
文献类型：
--
作者：
Hopman, Joost;Tostmann, Alma;vd Hoeven, Hans
背景：病房内的水槽与医院获得性感染有关。本研究的目的是评估移走重症监护病房(ICU)病房水槽和引入无水护理对革兰氏阴性杆菌定殖率的影响。方法：我们进行了为期两年的准实验研究，对干预前后的每月革兰氏阴性杆菌定殖率进行了比较，采用分段回归分析中断的时间序列数据。纳入了三级护理医疗中心的五个ICU。研究对象均为在ICU住院至少48小时且在干预前12个月或干预后12个月内接受选择性消化道净化的18岁及以上患者。评估了清除水槽和引入无水病人护理对革兰氏阴性杆菌定殖率的影响。这项研究的主要结果是每月革兰氏阴性杆菌的定殖率(GNB)。酵母菌定殖率作为“阴性对照”。此外，对ICU入院后>；=3、>；=5、>；=7、>；=10和>；=14天的首次阳性培养结果计算定植率，并进行卡方检验。结果：干预前1496例(9153天)，干预后1444例(9044天)。分段回归分析表明，在干预之后，在没有干预前或干预后GNB定殖化趋势的情况下，GNB定殖率立即在统计上显着减少。总的GNB定植率从26.3降至21.6GNB/1000 ICU(定殖率比0.82；95%CI 0.67~0.99；P=0.02)。在ICU住院时间(LOS)较长的患者中，GNB定殖率的下降更加明显：从1.22倍(=2天)减少到1.6倍(=5天；P=0.002)，2.5倍(=10天；P<；0.001)到3.6倍(&>=14天；P<；；0.001)减少。结论：从病房移走水槽和引入无水的病人护理方法与显著减少患者在GNB中的定植有关，特别是在ICU住院时间较长的患者。
Background: Sinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of 'water-free' patient care on gram-negative bacilli colonization rates.Methods: We conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre-and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18 years and older admitted to our ICUs for at least 48 h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of 'water-free' patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a 'negative control'. In addition, colonization rates were calculated for first positive culture results from cultures taken >= 3, >= 5, >= 7, >= 10 and >= 14 days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests.Results: In the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67-0.99; P = 0.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (= 2 days), to a 1.6-fold (>= 5 days; P = 0.002), 2.5-fold (for >= 10 days; P < 0.001) to a 3.6-fold ( >= 14 days; P < 0.001) reduction.Conclusions: Removal of sinks from patient rooms and introduction of a method of 'water-free' patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.