Interventions to Prevent Catheter-Associated Bloodstream Infections: A Multicenter Study in Korea
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Background: The purpose of this study was to determine the efficacy of infectioncontrol interventions to decrease the incidence of catheter-associated bloodstream infections (CA-BSI) and to examine the sustainability of its effect during and after the intervention in Korea. Materials and Methods: We conducted a prospective multi-strategy intervention in intensive care units (ICUs) at 3 university hospitals in Korea. The intervention consisted of education and on-site training for medical personnel involved in catheter care, active surveillance, and reinforcement of current intervention in each unit. After the intervention of 3 months, we identified CA-BSI cases of each hospital using the electronic database for 6 months. Results: During the intervention, the number of CA-BSI decreased significantly compared to pre-interventional period (8.7 vs. 2.3 per 1,000 catheter days; rate ratio 0.28; 95% CI, 0.13-0.61). After the intervention, CA-BSI rate increased slightly,but was still significantly lower than that of pre-interventional period (4.3 per 1,000catheter days; rate ratio, 0.49; 95% CI, 0.31-0.78). Reduction of gram-negative bacterial infections was noted during and after the intervention. Conclusions: A multi-strategy approach to reduce CA-BSI could be implemented in diverse settings of medical and surgical units in Korea and decreased CA-BSI rates during the intervention.
Abstract
Background: The purpose of this study was to determine the efficacy of infectioncontrol interventions to decrease the incidence of catheter-associated bloodstream infections (CA-BSI) and to examine the sustainability of its effect during and after the intervention in Korea. Materials and Methods: We conducted a prospective multi-strategy intervention in intensive care units (ICUs) at 3 university hospitals in Korea. The intervention consisted of education and on-site training for medical personnel involved in catheter care, active surveillance, and reinforcement of current intervention in each unit. After the intervention of 3 months, we identified CA-BSI cases of each hospital using the electronic database for 6 months. Results: During the intervention, the number of CA-BSI decreased significantly compared to pre-interventional period (8.7 vs. 2.3 per 1,000 catheter days; rate ratio 0.28; 95% CI, 0.13-0.61). After the intervention, CA-BSI rate increased slightly,but was still significantly lower than that of pre-interventional period (4.3 per 1,000catheter days; rate ratio, 0.49; 95% CI, 0.31-0.78). Reduction of gram-negative bacterial infections was noted during and after the intervention. Conclusions: A multi-strategy approach to reduce CA-BSI could be implemented in diverse settings of medical and surgical units in Korea and decreased CA-BSI rates during the intervention.
참고문헌 (27)
- Edwards JR, "NHSN Facilities. National healthcare safety network (NHSN) report, data summary for 2006, issued June 2007", Am J Infect Control, 35, pp.290~301 (2007)
- Pittet D, "Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality", JAMA, 271, pp.1598~1601 (1994)
- Digiovine B, "The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit", Am J Respir Crit Care Med, 160, pp.976~981 (1999)
- Smith RL, "Excess mortality in critically ill patients with nosocomial bloodstream infections", Chest, 100, pp.164~167 (1991)
- Blot S, "Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study", Intensive Care Med, 29, pp.471~475 (2003)
- Rello J, "Evaluation of outcome of intravenous catheterrelated infections in critically ill patients", Am J Respir Crit Care Med, 162, pp.1027~1030 (2000)
- Lee SO, "Korean Nosocomial Infections Surveillance System (KONIS). Korean nosocomial infections surveillance system (KONIS) report: Data summary from July through September 2006", Korean J Nosocomial Infect Control, 11, pp.113~128 (2006)
- Eggimann P, "Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care", Lancet, 355, pp.1864~1868 (2000)
- Lobo RD, "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, 33, pp.83~87 (2005)
- Maas A, "Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme", J Hosp Infect, 40, pp.211~224 (1998)
- Rosenthal VD, "Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina", Am J Infect Control, 31, pp.405~409 (2003)
- Sherertz RJ, "Education of physicians-in-training can decrease the risk for vascular catheter infection", Ann Intern Med, 132, pp.641~648 (2000)
- Warren DK, "The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU", Chest, 126, pp.1612~1618 (2004)
- Yoo S, "Effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea", Infect Control Hosp Epidemiol, 22, pp.433~436 (2001)
- Warren DK, "A multicenter intervention to prevent catheter-associated bloodstream infections", Infect Control Hosp Epidemiol, 27, pp.662~669 (2006)
- Pronovost P, "An intervention to decrease catheter-related bloodstream infections in the ICU", N Engl J Med, 355, pp.2725~2732 (2006)
- Rosenthal VD, "International Nosocomial Infection Control Consortium. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries", Ann Intern Med, 145, pp.582~591 (2006)
- Yoo JY, "Impact of maximal sterile barrier during the insertion of central venous catheters in adults intensive care units", Korean J Nosocomial Infect Control, 12, pp.36~41 (2007)
- 정영주, "내과계 중환자실 환자에서 Chlorhexidine-silver Sulfadiazine Coated Catheter의 중심정맥관 감염에 대연구", Tuberculosis and Respiratory Diseases, 59(4), pp.389~396 (2005), 대한결핵및호흡기학회
- O'Grady NP, "Guidelines for the prevention of intravascular catheter-related infections", Pediatrics, 110, pp.e51~ (2002), The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S
- Horan TC, "CDC", NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting, 2008, pp.36, 309~332
- Barrett SP, "Infection control in Britain", J Hosp Infect, 50, pp.106~109 (2002)
- Pronovost P, "Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project", Am J Infect Control, 36, pp.S171~ (2008)
- Mehta A, "Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium (INICC)", J Hosp Infect, 67, pp.168~174 (2007)
- Chen YY, "Incidence rate and variable cost of nosocomial infections in different types of intensive care units", Infect Control Hosp Epidemiol, 30, pp.39~46 (2009)
- Sitges-Serra A, "Prevention of catheter sepsis: the hub", Nutrition, 13(Suppl 4), pp.30S~35S (1997)
- Leon C, "Antiseptic chambercontaining hub reduces central venous catheter-related infection: a prospective, randomized study", Critical Care Medicine, 31, pp.1318~1324 (2003)