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

改进的管理系统可减少 TPN 治疗患者的 CR-BSI

基本信息

批准号：
13672471
负责人：
DOI Matsuko
金额：
$ 2.05万
依托单位：
University of Shizuoka
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2001
资助国家：
日本
起止时间：
2001 至 2002
项目状态：
已结题

项目摘要

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.

本研究旨在通过阐明感染途径来降低血管内器械相关感染（CR-BSI）的发生率。并构建了减少静脉输液管和输液微生物污染的预防策略。我们发现植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%）作为潜在的皮肤定植微生物。封闭型IV细胞系未检出微生物，而开放型IV细胞系检出微生物（16.6%）。这些结果表明，经常通过轮毂操作导管可能是线污染的主要因素之一。经药师在无菌条件下固定的TPN注射液未发现污染。另一方面，那些由护士固定在病房的输液中，5.9%的输液被细菌污染。卫生维护不充分，例如，洗手，医务人员在换线和现场护理时使用手套，往往会导致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管理对于减少导管中心和输注微生物的污染至关重要。基于这些结果，我们改进了传统的TPN管理方法，并通过进行第二次观察研究来评估其疗效。我们发现，在第二次观察研究期间，医务人员洗手、使用手套和消毒技术的比例比以前增加了很多。