导管相关感染

1、项目评分红斑无红斑0轻度红斑1重度红斑2脓性分泌物无0有1肿胀无0有1疼痛无0有1指标指标阳性导管数(%)CRBSIN = 35细菌定植的导管N = 333无感染无定植的导管N = 894疼痛(0, 1)25 (2)0.00.2 0.40.2 0.4红斑(0 2)25 (2)0.00.1 0.30.1 0.2肿胀(0, 1)126 (10)0.2 0.40.1 0.40.1 0.4脓液(0, 1)10 (0.8)00.0 0.10总分(0 5)126 (10.0)0.2 0.40.1 0.10.1 0.1敏感性%特异性%PPV%NPV%导管定植(n = 333)红4941773肿6924647

2、痛15913080脓1994073CRBSI (n = 35)红398497肿095094痛094097脓099097真正菌血症培养结果是(n = 34)否(n = 266)阳性2820阴性6246敏感性82.4%(69.7 95.1)特异性92.5%(89.4 95.6)阳性预期值58.3%(44.4 72.2)阴性预期值97.6%(95.7 99.5)对照组CVC怀疑CRBSI的CVC无CRBSIN = 50无CRBSIN = 25CRBSIN = 25明显细菌定植的导管腔数16410233103005导管外表面细菌定植的导管数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医生怀疑CRI, 计划拔除CVC研究组标准治疗组留取血培养 x 2拔除CVCCVC继续留置5天血培养阳性或血流动力学

4、不稳定拔除CVC感染好转感染持续保留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继续教育项目, 操作规程标准化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.干预措施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,