Comparison of catheter related infection rates in pediatric cardiovascular surgery patients with use of transparent cover and transparent cover saturated with chlorhexidin gluconate in central catheter care

Yıl 2013, Cilt: 15 Sayı: 2, 57 - 67, 01.08.2013

Yadigar Arpa Hande Aygün Yusuf Yalçınbaş Demet San Ayşe Ulukol

Öz

Objective: The study was conducted to compare catheter related blood circulation infection and catheter colonization rates in pediatric cardiovascular surgery patients with use of transparent cover in central catheter dressing and transparent cover saturated with chlorhexidin gluconate in central catheter dressing. Method: Transparent cover was used in the central catheter dressing of 60 of 245 pediatric patients who underwent cardiac surgery at Acıbadem Bakırköy Hospital between April 2011-Aralık 2011, whereas transparent cover saturated with chlorhexidin gluconate was used in 63 patients. The clinical study was held on consent of the patients. Patients whose catheters were affixed under emergency conditions or into femoral area, as well as those whose consents were not obtained were not included in the study. In analysis of the data, descriptive statistics, Mann Whitney U, Pearson’s Chi-square, Fisher’s Exact, and Yates Continuity Correction tests, were used. Results: No statistically significant difference was found between mean ages, gender distributions, days of catheter use, days of stay in the intensive care unit and the hospital of the patients p>0.05 . The period of stay in the intensive care unit of the patients with use of transparent cover saturated with chlorhexidin was 2.0 days 1-4 median, 25%-75% percentile , days of stay in the hospital 14.0 days 8-22 median, 25%-75% percentile , and days of catheter use 7.0 days 6-10 median, 25%-75% percentile . The period of stay in the intensive care of the patients with use of transparent cover was 2.0 days 1-4 median, 25%-75% percentile , days of stay in the hospital 14.0 days 8-22 median, 25%-75% percentile , and days of catheter use 7.5 6-9.75 median, 25%-75% percentile . While no statistically significant difference was found between the rates of infection in blood circulation related to central catheter and infection at the site of catheter entry, the rate of colonization in the group using transparent cover saturated with chlorhexidin was found significantly lower compared to the other group p

Anahtar Kelimeler

Catheter infection, catheter dressing, colonization, chlorhexidin, pediatric cardiovascular surgery

Santral Kateter Bakımında Şeffaf Örtü ve Klorheksidin Glukonat Emdirilmiş Şeffaf Örtü Kullanılan Pediyatrik Kardiyovasküler Cerrahi Hastalarının Kateter İlişkili Enfeksiyon Oranlarının Karşılaştırılması

Öz

Amaç: Bu çalışma, pediyatrik kardiyovasküler cerrahi hastalarında, santral kateter pansumanında klorheksidin glukonat emdirilmiş şeffaf örtü kullanılan hastalar ile santral kateter pansumanında şeffaf örtü kullanılan hastaların kateter ile ilişkili kan dolaşımı enfeksiyonu ve kateter kolonizasyon oranlarını karşılaştırmak amacıyla yapılmıştır. Yöntem: Nisan 2011-Aralık 2011 tarihleri arasında Acıbadem Bakırköy Hastanesi’nde kalp cerrahisi uygulanan 245 pediatrik hastadan 60’ının santral kateter pansumanında şeffaf örtü kullanılırken, 63’ünde klorheksidin glukonat emdirilmiş şeffaf örtü kullanıldı. Klinik çalışma hastalardan onam alınarak yapıldı. Kateteri acil şartlarda veya femoral bölgeye takılan ve onam alınamayan hastalar çalışmaya alınmadı. Verilerin analizinde tanımlayıcı istatistikler, Mann Whitney U, Pearson’un Ki-kare, Fisher’in Kesin ve Yates Süreklilik Düzeltmesi testleri kullanıldı. Bulgular: Hastaların yaş ortalamaları, cinsiyet dağılımları, kateter kullanım günleri, yoğun bakımda ve hastanede kalış süreleri arasında istatistiksel olarak anlamlı farklılık saptanmadı p>0.05 . Klorheksidin emdirilmiş şeffaf örtü kullanılan hastaların yoğun bakımda kalış günü 2.0 1-4 medyan, %25-%75 persentil , hastanede kalış günü 14.0 8-22 medyan, %25-%75 persentil , kateter kullanım günü 7.0 6-10 medyan, %25-%75 persentil ’dir. Şeffaf örtü kullanılan hastaların yoğun bakımda kalış günü 2.0 1-4 medyan, %25-%75 persentil , hastanede kalış günü 14.0 9-17 medyan, %25-%75 persentil , kateter kullanım günü 7.5 6-9.75 medyan, %25-%75 persentil ’tir. Santral kateter ile ilişkili kan dolaşımında enfeksiyon görülme oranları ve kateter giriş yeri enfeksiyonu arasında istatistiksel olarak anlamlı farklılık saptanmazken, klorheksidin emdirilmiş şeffaf örtü kullanılan grupta kolonizasyon görülme oranları diğer gruba göre anlamlı düzeyde düşük bulundu p

Anahtar Kelimeler

Kateter enfeksiyonu, kateter pansumanı, kolonizasyon, klorheksidin, pediyatrik kardiyovasküler cerrahi

Kaynakça

• Gülmen Ş, Kiriş İ, Peker O, Koçyiğit A, Okutan H. Açık kalp cerrahisinde santral venöz kateterizasyon: İnternal juguler ven ya da supraklaviküler subklaviyen ven yaklaşım. Turk Gogus Kalp Dama 2010;18(1): 011- 016.
• Aygün G. Kateter İlişkili Bakteremi Yönetimi. Yoğun Bakım Dergisi 2006;6(Ek 1):11-17.
• Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002;8(5):295- 309.
• Crawford AG, Fuhr JP, RAO B. Cost–Benefit Analysis of Chlorhexidine Gluconate Dressing in the Prevention of CatheterRelated Bloodstream Infections. Infect Control Hosp Epidemiol 2004;25(8): 668-674.
• Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15(4):231- 238.
• Hu KK, Lipsky BA, Veenstra DL, Saint S. Using maximal sterile barriers to prevent central venous catheter-related infection: a systematic evidencebased review. Am J Infect Control 2004;32(3):142-146.
• Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991; 338(8763):339- 343.
• Eggimann P, Harbarth S, Constantin MN, Touveneau S, Didier JC, Pittet Dl. Impact of a prevention strategy targeted at vascular- Access care on incidence of infections acquired in intensive care. Lancet 2000; 355(9518):1864- 1868.
• Polderman KH, Girbes AR. Central venous catheter use. Part 2: infectious complications. Intensive Care Med 2002; 28(1):18-28.
• Maki DG, Stolz SS, Wheeler S, Mermel LA. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med 1994; 22 (11):1729–1737.
• Rasero L, Degl’Innocenti M, Mocali M, Mocali M, Alberani F, Boschi S, Giraudi A, Arnaud MT, Zucchinali R, Paris MG, Dallara R, Thaler S, Perobelli G, Parfazi S. Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized, multicenter study. The Italian Nurse Bone Marrow Transplant Group (GITMO). Haematologica 2000; (85): 275-279.
• Hoffmann KK, Weber DJ, Samsa GP, Rutala WA. Transparent polyurethane film as an intravenous catheter dressing. A meta- analysis of the infection risks. JAMA 1992; 267(15):2072– 2076.
• Ho KM, Litton E. Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother 2006; 588(2): 281–287.
• Timsit JF, Schwebel C, Bouadma L, Geffroy A. Clorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults. JAMA 2009; 301(12):1231-1241.
• Levy I, Katz J, Solter E, Samra Z, Vidne B, Birk, E, Ashkenazi S, Dagan O. Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatric Infect Disease Journal 2005; 24(8): 676–679.
• Ulusoy S, Akan H, Arat M, Baksan S, Bavbek S, Çakar N, Şardan YÇ, Somer A, Yavuz SŞ, Damar İçi Kateter Enfeksiyonlarının Önlenmesi Kılavuzu. Hastane İnfeksiyonları Dergisi 2005; 9(1):5-9.
• Dudeck MD, Horan TC, Peterson KD, Bridson KB, Morrell G, Pollock DA, Edwards JR. National Healthcare Safety Network (NHSN) Report, Data Summary for 2010, Device-associated Module. Am J Infect Control 2011;39(10):798-816.
• Karadağ A. Damar içi kateter uygulamalarında kullanılan pansuman materyalleri. C. Ü. Hemşirelik Yüksekokulu Dergisi 1999;3(2):35-39
• Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Mary C. Harris MC, Naples M, Pellegrini J, Buck RK, Timothy L. McAuliffe TL, Goldmann DA, Maki DG. A randomised trial comparing povidone-iodine to a chlorhexidine gluconate- impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107(6):1431- 1436.