Recurrent central-line-associated bloodstream infection in a single high-risk patient.
Recurrent central-line-associated bloodstream infection in a single high-risk patient.
复制标题
单个高危患者中复发性中心导管相关血流感染。
DOI：
10.1017/ice.2022.190
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发表时间：
2023
影响因子：
4.5
通讯作者：
Baghdadi,JonathanD
中科院分区：
文献类型：
--
作者：
Pek,Zachary;Canepa,Hannah;Gregg,KarenL;Cabunoc,MarieK;Leekha,Surbhi;Baghdadi,JonathanD
在医疗相关感染中，CLABSI对患者结局的潜在负面影响最大，包括死亡风险增加和住院时间延长。1-3 CLABSI费率还与通过医疗保险医院获得的条件减少计划和马里兰州的质量为基础的报销医院报销。由于这些原因，CLABSI已被宣布为“永不发生的事件”，并已作出重大努力防止其发生。4美国大多数州都要求公众通过国家医疗安全网络（NHSN）报告与健康相关的感染。5根据NHSN的定义，任何在中心静脉导管内发生的血流感染，如果不能归因于其他来源，则被视为CLABSI。如果血液培养对合格病原体呈阳性，则不需要感染的体征或症状。替代感染源的确定取决于文件的质量，并且可能是主观的，根据谁进行图表审查而引入可变性。6- 8平均而言，美国的CLABSI发生率为每1,000个中心线日1.7起事件。9基于2,000天内的17次CLABSI，该患者的个体CLABSI发生率为每1,000个中心线日8.5起事件。这些CLABSI占其收治医院发生的所有CLABSI的27%。在此期间，NHSN定义的CLABSI率反映了单个患者在很大程度上不可改变的情况，而不是该医院大多数患者接受的护理质量。CLABSI的预防是困难的，需要整个医疗团队的参与。当公开报告的感染率有偏见地表明预防感染的做法没有产生影响时，维持这种接触的努力可能会受到破坏。当工作人员的积极性较低时，对经常性CLABSI的预期可能会
DiscussionAmong healthcare-associated infections, CLABSI has the greatest potential negative impact on patient outcomes, including increased mortality risk and prolonged length of hospital stay. 1–3 CLABSI rates are also linked to hospital reimbursement through the Medicare hospital-acquired conditions reduction program and the State of Maryland’s Quality-Based Reimbursement. For these reasons, CLABSI has been declared a “never event,” and significant efforts have been undertaken to prevent its occurrence. 4 Most US states legally require public reporting of healthcareassociated infections via the National Healthcare Safety Network (NHSN). 5 According to NHSN definitions, any bloodstream infection that develops in the context of a central line and cannot be attributed to an alternative source is counted as a CLABSI. If the blood culture is positive for a qualifying pathogen, signs or symptoms of infection are not required. Determination of an alternative source of infection depends on the quality of documentation and can be subjective, introducing variability based on who does the chart review. 6–8On average, the rate of CLABSI in the United States is 1.7 events per 1,000 central-line days. 9 Based on 17 CLABSIs over a single 2,000-day period, this patient’s individual CLABSI rate was 8.5 events per 1,000 central-line days. These CLABSIs accounted for 27% of all CLABSIs occurring at his admitting hospital. During this period, the NHSN-defined CLABSI rate reflected the largely unmodifiable circumstances of a single patient instead of the quality of care received by most patients at this hospital. CLABSI prevention is difficult and requires engagement by the entire healthcare team. Efforts to maintain that engagement can be undermined when publicly reported rates are biased to suggest that infection prevention practices do not make a difference. When staff are less motivated, the expectation of recurrent CLABSI can