Increased Rate of Catheter-Related Bloodstream Infection Associated With Use of a Needleless Mechanical Valve Device at a Long-Term Acute Care Hospital
Increased Rate of Catheter-Related Bloodstream Infection Associated With Use of a Needleless Mechanical Valve Device at a Long-Term Acute Care Hospital
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长期急症护理医院使用无针机械瓣膜装置导致导管相关血流感染率增加
DOI：
10.1086/516800
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
J. Cantey
中科院分区：
文献类型：
--
作者：
C. Salgado;L. Chinnes;Tammy H. Paczesny;J. Cantey
Objective.确定在长期急性护理医院引入无针机械瓣膜器械（NMVD）是否与导管相关血流感染（BSI）频率增加相关。设计对于置入中心静脉导管的患者，比较了在引入NMVD前24个月期间（使用无针分裂式隔膜器械（NSSD）的期间（以下简称NSSD期间））的导管相关BSI发生率与引入NMVD后24个月期间（以下简称NMVD期间）的导管相关BSI发生率。还比较了每个时期导管相关BSI的微生物学特征。采用χ2分析比较和计算相对危险度（RR）及95%置信区间（CI）。结果研究期间发生了86例导管相关BSI（3.86例感染/1，000导管-天）。NMVD期间导管相关BSI的发生率显著高于NSSD期间（5.95 vs 1.79感染/1,000导管日; RR，3.32 [95%CI，2.88-3.83]; P < .001）。与NSSD期间记录的百分比相比，NMVD期间由革兰氏阴性菌引起的导管相关BSI的百分比显著更高（39.5% vs 8%; P = 0.007）。在由革兰氏阳性菌引起的导管相关BSI中，NMVD期间肠球菌引起的百分比显著高于NSSD期间（54.8% vs 13.6%; P = 0.004）。NMVD期间导管相关BSI发生率仍然较高，尽管开展了几次关于正确使用NMVD的教育会议。结论.导管相关BSI发生率增加与研究医院使用NMVD存在时间相关性，尽管有几次关于正确使用NMVD的教育会议。NMVD的当前设计在某些患者人群中使用可能不安全。
Objective. To determine whether introduction of a needleless mechanical valve device (NMVD) at a long-term acute care hospital was associated with an increased frequency of catheter-related bloodstream infection (BSI). Design. For patients with a central venous catheter in place, the catheter-related BSI rate during the 24-month period before introduction of the NMVD, a period in which a needleless split-septum device (NSSD) was being used (hereafter, the NSSD period), was compared with the catheter-related BSI rate during the 24-month period after introduction of the NMVD (hereafter, the NMVD period). The microbiological characteristics of catheter-related BSIs during each period were also compared. Comparisons and calculations of relative risks (RRs) with 95% confidence intervals (CIs) were performed using χ2 analysis. Results. Eighty-six catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during the study period. The rate of catheter-related BSI during the NMVD period was significantly higher than that during the NSSD period (5.95 vs 1.79 infections per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88–3.83]; P < .001). A significantly greater percentage of catheter-related BSIs during the NMVD period were caused by gram-negative organisms, compared with the percentage recorded during the NSSD period (39.5% vs 8%; P = .007). Among catheter-related BSIs due to gram-positive organisms, the percentage caused by enterococci was significantly greater during the NMVD period, compared with the NSSD period (54.8% vs 13.6%; P = .004). The catheter-related BSI rate remained high during the NMVD period despite several educational sessions regarding proper use of the NMVD. Conclusions. An increased catheter-related BSI rate was temporally associated with use of a NMVD at the study hospital, despite several educational sessions regarding proper NMVD use. The current design of the NMVD may be unsafe for use in certain patient populations.