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预防血管内导管相关感染指南 ( 2011 ). 浙江大学医学院附属第一医院急诊中心 浙江大学医学部急诊医学教学委员会 浙江大学医学一系急诊医学教研室 蔡洪流. 推荐级别. IA 类 . 极强烈推荐的措施,其循证支持来自于设计严谨良好的实验性、临床上或流行病学上的研究 IB 类 . 强烈推荐的措施,其循证支持来自于实验性、临床上或流行病学上的研究,以及较强理论依据或者可接受的实践(例如,无菌技术). 推荐级别. IC 类 . 政府相关规定、法令或标准的要求。 II 类 . 建议性措施,其依据来自于建议性的临床或流行病学上的研究或理论依据 - PowerPoint PPT Presentation
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2011
IA.IB.
IC. II..
Total 103 recommendations21 IA37 IB3 IC31 II 11
2002370200214040%
2002CVC0.5%
ICUICU/ICUCRBSICVC
0.5%2%CRBSI
catheter-related bloodstream infections (CRBSI)
CRBSI
CRBSI
(peripheral venous catheters)3 inches(peripheral arterial catheters)3 inchesMidline catheters38 inches(nontunneled central venous catheters)8cmCRBSI(pulmonary arterial catheters)Teflon30cmCVCsPICC20cm(tunneled central venous catheters)8cm(totally implantable)8cmCRBSI(umbilical catheters)6cm
AAAICUICUCRBSIB
ICU 9 hospitals, 5,200 beds 10Pre-test avg score: 78.3%Post-test avg score: 89.9%BSI10.8/1000 3.7/1000Coopersmith CM, et al. Critical Care Med, 2002
Coopersmith CM, et al. Critical Care Med, 2002
Effect of Education on CLAB
StudyType of unitPre-intervention rate (per 1000 catheter days)Post-intervention rate (per 1000 catheter days)Coopersmith, Crit Care Med, 2002Surg/burn/trauma ICU10.83.7Rosenthal, AJIC 2003ICU17.09.9Warren, Crit Care Med, 2003ICU (Comm. Hosp.)4.92.1Warren, Chest 2004MICU (Univ. Hosp.)9.45.5
/SICUBSIFridkin SK, et al. ICHE, 1996
midline catheterB
midline catheterA6PICC
midline catheterCRBSIB
midline catheter
PICCmidline catheter
CVCAAB
CVCCVC
CVCACVCA
CVCB
CVCCVCBA48B
CVCRCTParienti, et al. JAMA 2008 (N=750)VSCVCMerrer, et al. JAMA 2001 (N=289)VSCVC
CVCRCTRupp, et al. Ann Intern Med, 2005 (CHG/SS vs Control CVC)393CVC5%19%39%Raad, et al. Ann Intern Med, 1997 266CVCVS 0.39(p=0.02);VS0.28(p=0.002)
BB
CAC
CVCPICCBB
70%B0.5%70%A
AAB
BCVC2BCVC7B
CVC1CVCBB
>2CLABSIBB
chlorhexidine gluconate (CHG) gel dressing
CLA-BSI: 1.4/1000VS 0.4/100037Timsit, et al. JAMA, 2009
2%1CRBSI
CHGArch Intern Med 2007ICHE 2007ICUCHGBSI16.8/1000CVC6.4/1000.ICUCHGMRSA52%
/5CLABSI//CVC0.5%A
/
//
CRBSIB
///BB
CRBSI
Safdar & Maki, CID, 2006 P=0.03taurolidine
No. CRBSI/No. IVDsControlVHLSRR (95% CI)Schwartz et al8/293/24 0.45 (0.14-1.38)Rackoff et al10/3110/32 0.97 (0.47-1.98)Daghistani et al3/342/30 0.76 (0.16-3.56)Carratala et al17/6015/57 0.84 (0.47-1.5)Henrickson et al31/806/35 0.08 (0.04-0.18)Garland et al18/437/42 0.4 (0.19-0.82)Barriaga et al26/4418/390.78 (0.50-1.18)Overall113/32161/259 0.49 (0.26-0.95)
72~96BB
CVCPICCCVCPICCBCVCPICCB
CVCPICCBB
9671A
24B612A
7272
70%AC
CR-BSI
Center for Medicare & Medicaid Service2008101CMSObject left in surgery,Air embolism,Blood incompatibility,Catheter-associated urinary tract infections,Pressure ulcers (decubitus ulcers), Vascular catheter-associated infections,Surgical site infections mediastinitis after coronary artery bypass graft Hospital-acquired injuries fractures, dislocations, intracranial injuries, crushing injuries, burns, and other unspecified effects of external causes
CR-BSI
CR-BSI
2/70CVCBMJ Qual Saf. 2011;20(2):174-80.
CVCCVC BMJ Qual Saf. 2011;20(2):174-80.
CVCBMJ Qual Saf. 2011;20(2):174-80.
BMJ Qual Saf. 2011;20(2):174-80.
CLA-BSI---
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