每日使用葡萄糖酸洗必泰抗菌沐浴的意义

chlorohexidine gluconate bathing

impregnated cloths results in

significant reduction in

line-associated bloodstream

M.Dixon,RN,BSN,MHA,CCRN,CIC,and Robin L.Carver,RN,BSN,CIC

Raleigh,North Carolina

Background:Central line-associated bloodstream infections(CLABSI)contribute to increased morbidity,mortality,length of stay, and excessive cost of care.

Methods:This study was an observational cohort study using historical controls in the setting of a9-bed surgical intensive care unit in a Level I trauma center;all patients admitted or transferred into the unit were enrolled in the study.

Objectives:A quality improvement intervention protocol was instituted to reduce CLABSI incidence with a3-month effectiveness study using2%chlorhexidine gluconate-impregnated cloths for daily patient bathing;education of surgical intensive care unit staff on changes to CLABSI prevention protocol and all existing CLABSI prevention policies and bundles already in place;and com-pliance monitoring and documentation.

Results:The3-month effectiveness study showed a decrease in CLABSI rates from12.07CLABSIs per1000central line-days to3.17 CLABSIs per1000central line-days(73.7%rate reduction;P5.0358).

Conclusion:CLABSI incidence rates were reduced in a high-risk patient population using evidence-based prevention bundles and implementing daily bathing with2%chlorhexidine gluconate nonrinse cloths.

Key Words:CLABSI;bloodstream infection;chlorhexidine;CHG bathing.

Copyrightª2010by the Association for Professionals in Infection Control and Epidemiology,Inc.Published by Elsevier Inc.All rights reserved.(Am J Infect Control2010;38:817-21.)

The Centers for Disease Control and Prevention de-

fines a central line-associated bloodstream infection

(CLABSI)as a primary bloodstream infection occurring

in a patient with a central line in place within48hours

prior to onset of the infection.1In2008,the National

Healthcare Safety Network reported a pooled mean

incidence rate of CLABSIs in the trauma critical care

patient population of4.0CLABSIs per1000central

line-days.2

CLABSIs contribute to patient morbidity and mortality,

extended length of stay,and increased cost of care.3-8In-

fectious disease and infection prevention professionals

follow the guidance of national prevention programs to

prevent CLABSIs and other hospital-acquired infec-

tions.8,9One of the most frequently touted prevention

tools is the Institute for Healthcare Improvement(IHI)

Central Line Bundle,9which consists of5interventions:

(1)hand hygiene;(2)maximal barrier precautions during

insertion;(3)skin antisepsis with chlorhexidine gluco-

nate(CHG);(4)optimal catheter site selection with avoid-

ance of the femoral vein for central venous access in

adult patients;and(5)daily review of line necessity,

with prompt removal of unnecessary lines.

The surgical intensive care unit(SICU)in a Level I

trauma center successfully implemented the IHI Cen-

tral

Line Bundle in2005.By January2007,compliance

with the IHI Central Line Bundle was sustained at

greater than90%,but the unit’s CLABSI rate was trend-

ing above the National Healthcare Safety Network

benchmark rate.A review of the available literature

identified a study by Bleasdale et al(2007)10in which

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