Analysis Of Risk Factors Of Central Line-Associated Bloodstream Infections And Prevention And Control Strategies

ObjectivePatients with Intensive Care Unit(ICU)were often implanted with central line for treatment.Because ICU patients are in critical condition,multiple complications,various intrusive operations and long-term bed rest are easy to cause Central Line-Associated Bloodstream Infections(CLABSI).This will not only increase the cost of hospitalization,prolong length of stay,or even lead to death.To study the incidence of CLABSI in ICU patients and analyze the risk factors for CLABSI.Based on the analysis results,evaluate the effectiveness of prevention of CLABSI by training doctors and nurses on the prevention of CLABSI's bundle interventions.Based on the analysis results,evaluate the effectiveness of prevention of CLABSI by training doctors,nurses and nurse workers on the prevention of CLABSI's bundle interventions.To understand the distribution of pathogenic microorganisms lead to CLABSI in ICU patients.MethodsBaseline survey:The clinical data of 2010-2014 years hospitalized in ICU and central line were retrospectively collected.Inclusion criteria:The subject to be investigated and monitored must be all patients who have undergone central catheterization at the ICU and have been observed,treated,and treated at the ICU.The time for patients to enter ICU is more than 48 hours,and the CLABSI within 48 hours after ICU is transferred to other wards is still included.Exclusion criteria:The time of the patient at ICU was<48 hours.Patients were transferred from other hospitals to our hospital ICU,and central catheter was placed in the external hospital.Patients who were give up treatment for various reasons.Patients with a central catheter indwelling time<48 hours.The exclusion of CLABSI,when encountering patients with unclear diagnosis,the expert group was invited to discuss it and then make a diagnosis.Ultimately exclude patients who did not meet the diagnostic criteria.A total of 2270 patients were included in the study,and 98 cases of CLABSI occurred.The clinical data of patients with central catheterization include:hospitalization number,major diagnosis,gender,age,location of central catheter placement,use of antibiotics before catheter placement,whether surgery,indwelling urinary catheter,and mechanical ventilation.The general epidemiological characteristics of CLABSI patients were analyzed,compared with the clinical data of patients without CLABSI,and the risk factors associated with CLABSI were analyzed by Logistic regression.Education and training for doctors and nurses:According to the CLABSI guidelines for international prevention and control,in January 2015,education and training for doctors and nurses in ICU began to implement "bundle" interventions for prevention and control of CLABSI.The director of ICU department carries out education and training on the basis of on-the-spot instruction and live demonstration.It mainly includes the following measures:(1)Before and after the catheterization of the central line,the doctors and nurses were given instructions on hand hygiene and hand hygiene methods.(2)use the largest sterile barriers(caps,masks,sterile robes,sterile gloves,and complete sterile surgical towels).(3)The patient was given a 2%glucose chlorhexidine rubbing bath 1 day prior to catheterization.(4)Avoid femoral venous catheterization.(5)The necessity of indwelling catheter is evaluated daily,and unnecessary catheter is removed in time.(6)The results of the monitoring are timely feedback.The case-time infection rate and incidence rate of CLABSI infection before and after the intervention were statistically significant.Education and training for doctors,nurses and nurse workers:Since 2017,The director of ICU conducted education training with on-site teaching and on-site demonstration.ICU doctors and nurses have been trained to prevent CLABSI's bundle interventions.The education and training of CLABSI prevention interventions to care is the main methods of hand hygiene and hand hygiene training time.The timing of hand hygiene includes:1.before touching a patient.2.before performing aseptic and clean procedures.3.after being at risk of exposure to body fluids.4.after touching a patient.5.and after touching patient surroundings.Hand hygiene method:"six steps" washing technique.After education and training for all ICU employees.At the same time,we collected relevant clinical data of patients undergoing central line catheterization in ICU.Each day,patients undergoing central catheterization were brushed with glucose chlorhexidine.Data collection was collected as of December 31,2017,and all patients with central catheterization were counted,and relevant clinical data of CLABSI patients were statistically confirmed.The incidence of CLABSI was compared with that of CLABSI before intervention and the intervention of doctors and nurses,and analyze whether the bundle intervention measures were effective.Analyze the major pathogenic organisms that caused CLABSI in patients during 2010-2017.ResultsIn the baseline survey stage,there were 2270 cases of central line catheterization in ICU.There were 1436 male patients and 834 female patients.The minimum age was 11 years old,the largest age was 97 years old,and the average age was 59.85 + 11.76 years.CLABSI 98 cases were recorded.CLABSI case-time infection rate was 4.32%.The incidence rate of CLABSI is 7.60 per 1000 catheter day.Among the 2270 patients,239(11.00%,239/2172)were dead without CLABSI and 21(21.43%,21/98)patients with CLABSI were dead,and there was a statistically significant difference in mortality between the two groups.The median length of hospital stay for CLABSI patients was 39.50[IQR(22.00,34.75)]days,while the median length of hospital stay for patients without CLABSI was 21.00[IQR(12.00,34.00)]days.The difference between the two groups was statistically significant(Z=-7.094,P<0.001).Univariate analysis showed that the main risk factors of CLABSI in ICU patients,such as Age,mechanical ventilation,indwelling catheter,trauma,diabetes,malignancy,location of central catheterization,central catheter placement time>6 days.There was no statistically significant difference between the patient's gender,surgery,combined chronic lung disease,nephropathy,emergency centered catheter placement,and antibiotic administration before catheterization.Logistic regression analysis of CLABSI:the variables with statistically significant difference in univariate analysis were included in Logistic regression analysis.The results showed that the risk of CLABSI in patients over 65 years old is 1.76 times that of patients aged<65 years(p=0.018,OR=1.755,95%CI=1.100?2.801),The risk of CLABSI in malignant tumor is 2.76 times that of non malignant tumor patients(p=0.001,OR=2.758,95%CI=1.489-5.108),The risk of CLABSI in diabetics is 5.69 times that of non-diabetic patients(p<0.001,OR=5.693,95%CI=2.784?11.639),The risk of CLABSI occurred when the central catheter was intubated for more than 6 days was 33.32 times higher than that of patients with central line intubation time<6 days(p<0.001,OR=33.317,95%CI=2.052?5.362),The risk of CLABSI in trauma patients was 3.15 times that of non-traumatic patients(p<0.001,OR=3.149,95%CI=1.842?5.381).In the past 2015-2016 years,doctors and nurses began to implement bundle education interventions.In this period,877 cases of central line catheterization were treated by ICU,of which 40 cases had CLABSI,and the case-time infection rate was 4.51%.Compared with the baseline survey,the case-time infection rate increased,but the difference was not statistically significant(p=0.812).The incidence of CLABSI was 7.71 per thousand catheter days,which was not statistically different from baseline survey(p=0.640).In 2017 the implementation of bundle intervention measures on doctors,nurses and nurse workers education.In this year,594 patients with central catheter intubation were treated with 12 cases of CLABSI.The incidence of case-time infection rate was 2.02%,and the incidence of CLABSI was 3.28 per thousand catheter days,Compared with intervention nurses and doctors,the case-time infection rate and incidence of CLABSI decreased,the difference was statistically significant(p1=0.010,p2=0.013).In addition,the case-time infection rate and incidence of CLABSI in 2017 were also decreased compared with the results of the baseline survey,and the difference was statistically significant(p1 =0.010,p2=0.005).The distribution of pathogenic microorganisms was detected in CLABSI patients.160 cases of CLABSI occurred in 2010-2017,a total of 134 pathogenic microorganisms were detected.There were 68(50.75%)Gram-negative bacteria,55(41.04%)Gram-positive bacteria and 11(8.21%)fungi.Of all detected pathogenic microorganisms,coagulase-negative staphylococci were the most common,accounting for 34.33%,followed by Acinetobacter,Pseudomonas,Enterobacteriaceae,and Staphylococcus aureus.Conclusion1.Mortality and length of stay in CLABSI patients were significantly higher than those with non-CLABSI patients2.Major risk factors for CLABSI:patient factors,Age? 65 years old,diabetes mellitus,malignant tumor;External factors:trauma,catheterization time>6 days.3.Prevention and control of CLABSI have little effect only rely on ICU's doctors and nurses.4.The role of nurse workers in preventing and controlling CLABSI cannot be ignored.5.The most common pathogenic microorganisms of CLABSI was coagulase-negative staphylococci.