導管相關感染

1、項目評分紅斑無紅斑0輕度紅斑1重度紅斑2膿性分泌物無0有1腫脹無0有1疼痛無0有1指標指標陽性導管數(%)CRBSIN = 35細菌定植的導管N = 333無感染無定植的導管N = 894疼痛(0, 1)25 (2)0.00.2 0.40.2 0.4紅斑(0 2)25 (2)0.00.1 0.30.1 0.2腫脹(0, 1)126 (10)0.2 0.40.1 0.40.1 0.4膿液(0, 1)10 (0.8)00.0 0.10總分(0 5)126 (10.0)0.2 0.40.1 0.10.1 0.1敏感性%特異性%PPV%NPV%導管定植(n = 333)紅4941773腫6924647

2、痛15913080膿1994073CRBSI (n = 35)紅398497腫095094痛094097膿099097真正菌血癥培養(yǎng)結果是(n = 34)否(n = 266)陽性2820陰性6246敏感性82.4%(69.7 95.1)特異性92.5%(89.4 95.6)陽性預期值58.3%(44.4 72.2)陰性預期值97.6%(95.7 99.5)對照組CVC懷疑CRBSI的CVC無CRBSIN = 50無CRBSIN = 25CRBSIN = 25明顯細菌定植的導管腔數16410233103005導管外表面細菌定植的導管數281420Rijnders BJ, Peetermans W

3、E, Verwaest C, Wilmer A, Van Wijngaerden E. Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med (2004) 30:10731080. DOI 10.1007/s00134-004-2212-x醫(yī)生懷疑CRI, 計劃拔除CVC研究組標準治療組留取血培養(yǎng) x 2拔除CVCCVC繼續(xù)留置5天血培養(yǎng)陽性或血流動力學

4、不穩(wěn)定拔除CVC感染好轉感染持續(xù)保留CVCRijnders BJ, Peetermans WE, Verwaest C, Wilmer A, Van Wijngaerden E. Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med (2004) 30:10731080. DOI 10.1007/s00134-004-2212-xLobo RD, Lev

5、in AS, Gomes LMP, Cursino R, Park M, Figueiredo VB, Taniguchi L, Polido CG, Costa SF. Impact of an educational program and policy changes on decreasing catheter associated bloodstream infections in a medical intensive care unit in Brazil. Am J Infect Control 2005; 33: 83-7繼續(xù)教育項目, 操作規(guī)程標準化MMWR. 2002;5

6、1:RR-10Larsen. Clin Infect Dis 1999;29:1287-94Lancet 2000;356:1307-1312Am J Med 1991;91(3B):197S-205SInfect Control Hosp Epidemiol 1994;15:231-8Ann Intern Med. 2002;136:792-801JAMA 2001, 286: 700-7Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E,

7、 Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004 Oct;32(10):2014-20.Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Per

8、l TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004 Oct;32(10):2014-20.Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related b

9、loodstream infections in the intensive care unit. Crit Care Med. 2004 Oct;32(10):2014-20.Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensi

10、ve care unit. Crit Care Med. 2004 Oct;32(10):2014-20.Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004 Oc

11、t;32(10):2014-20.干預措施NNIS均值Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004 Oct;32(10):2014-20.Berenholt

12、z SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004 Oct;32(10):2014-20.Berenholtz SM, Pronovost PJ, Lipsett PA, et a

13、l. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004; 32(10): 2014-2020.Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355: 2725-2732Pronovost P, Needham D, Berenholtz S,