A modified Management system to reduce CR-BSI in Patient with TPN Therapy

这项研究旨在通过阐明感染途径来减少血管内装置相关感染(CR-BSI)的发生率。通过减少静脉输液和输液微生物的污染，制定了预防感染的策略。我们发现插入部位的皮肤经常被定植(20%)。在阳性病例中分离到表皮葡萄球菌(60%)，作为皮肤定植的潜在微生物。闭合型IV型菌株中未检出微生物，而开放式IV型菌株中检出微生物(16.6%)。这些结果表明，通过集线器频繁操作导管可能是引起导管污染的主要因素之一。药剂师在无菌条件下固定的TPN输液中未发现污染。而护士固定在病房的输液，有5.9%的输液被细菌污染。不适当的卫生维护，例如洗手、医务人员在换线时使用的手套和现场护理，往往会导致医源性微生物传播到患者身体的其他部位以及其他患者。我们的研究结果表明，制备TPN溶液的无菌条件和适当的TPN管理对于减少导管枢纽和输液中微生物的污染是必不可少的。在此基础上，我们对传统的TPN管理方法进行了改进，并通过第二次观察性研究对其效果进行了评价。我们发现，在第二次观察性研究期间，医务人员洗手、使用手套和净化技术的比率比以前更高。

This study was designed to reduce the incidence of intravascular device-related infections (CR-BSI) by elucidating the infection route. And we constructed the prevention strategy of the infection by reducing the contamination of intravenous (IV) line and infusion with microorganisms. We found that the skin at the insertion site was frequently colonized (20%). Among the positive cases, S. epidermidis strain was isolated (60%) as the potential microorganism of skin colonization. No microorganism was detected in closed-type IV lines, but was detected in open-type IV lines (16.6%). These results suggested that frequent manipulation of the catheter via hub could be one of the major contributing factors of line contamination. No contamination was found in TPN infusions that were fixed by pharmacists in aseptic condition. On the other hand, those that were fixed at wards by nurses, 5.9% of infusions were contaminated with bacteria. Inadequate maintenance of hygiene for instance, hand washing, gloves use by medical personnel at the time of line change and site care often cause iatrogenic transmiddion of microorganisms to other parts of the patient's body, as well as to other patients. Our findings suggest that an aseptic condition for the preparation of TPN solutions and an appropriate TPN management are essential to reduce the contamination of catheter hub and infusion with microorganism. Based on these results, we modified the conventional method of TPN management, and evaluated its efficacy by performing the second observational study. We found that rate of hand washing, gloves use, and decontamination techniques were increased more than than before by medical personnel during this second observational study period.