Çocuk yoğun bakım ünitelerinde sağlık hizmeti ilişkili enfeksiyonları önlemede düşük konsantrasyonlu sodyum hipokloritli banyo uygulamalarının etkinliği

Öz

Amaç: Sağlık hizmeti ile ilişkili enfeksiyonlar (SHİE) son on yılda çocuk yoğun bakım ünitelerinde (YBÜ) artış göstermiştir. El hijyeni sağlamak, girişimsel uygulamalarda asepsi şartlarına uymak, temas önlemleri ve klorheksidin glukonat banyoları, SHİE’leri önlemenin en temel yollarıdır. Ancak, tüm önlemlere rağmen, SHİE insidansının global olarak pediatrik yoğun bakımlarda artış gösterdiği görülmektedir. Bu çalışmanın amacı çocuk YBÜ’de %0,005 sodyum hipokloritli (NaOCl) banyo uygulamalarının dirençli bakteriler ile ortaya çıkan SHİE önleyip önlemeyeceğini değerlendirmektir.

Yöntemler: Bu vaka kontrol çalışması, 17 yataklı çocuk BYÜ’de prospektif olarak yapıldı. Çalışmanın ilk altı ayında hastalar sadece su ve sabun ile yıkanırken ikinci altı aylık dönemde NaOCl ile yıkandılar. SHİE tanıları hastalık kontrol ve önleme merkezinin rehberine göre konuldu.

Bulgular: Çalışma kriterlerini karşılayan 230 hasta (118 kontrol grubu, 112 NaOCl grubu) çalışmaya dahil edildi. Kontrol grubundan 26 hasta ve NaOCl grubundan 20 hastada sağlık hizmeti ile ilişkili enfeksiyon saptandı. NaOCl grubunda kontrol grubuna göre P. aeruginosa ve S. aureus enfeksiyonlarında sırasıysa %100 ve %66 oranında azalma tespit edildi. SHİE sayısı açısından gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Her iki grupta da en sık görülen SHİE ventilator ile ilişkili pnömoni ve kan dolaşım yolu enfeksiyonlarıydı. Çoklu ilaç dirençli gram negatif bakteri oranı kontrol grubunda %77,8 (17/18) iken, NaOCl grubunda %66,7 (5/15) olarak saptandı. Yaygın ilaç dirençli bakteri oranı kontrol grubunda %38,9 (7/18), NaOCl grubunda %26,7 (4/15) idi. Gruplar arasında anlamlı fark yoktu (P=0,458). NaOCl uygulanan hastalarda herhangi bir lokal veya sistemik yan etki gözlenmedi.

Sonuç: Haftalık %0,005’lik NaOCl banyo uygulamalarının P. aeruginosa ve S. aureus enfeksiyonlarında azalma sağladığı, ancak hastane kalma süresi, total SHİE sayısı ve gram negatif bakterilerin antibiyotik duyarlılıklarında ise bir değişikliğe sebep olmadığı gösterilmiştir.

Anahtar Kelimeler

• Antibiyotik direnci,Klorheksidin glukonat,Gram negatif bakteriler,Sağlık hizmeti ilişkili enfeksiyonlar,Sodyum hipoklorit

The efficacy of very low-density sodium hypochloride washes in preventing healthcare-associated infections in pediatric intensive care units

Abstract

Aim: Healthcare-associated infections (HAIs) have increased in pediatric intensive care units (ICUs) within the last decade. Maintaining hand hygiene, performing invasive interventions in accordance with aseptic techniques, contact precautions and chlorhexidine gluconate showers are the usual prevention methods against HAIs. However, despite all prevention methods, HAI incidence has globally increased in pediatric ICUs. The purpose of this study is to investigate the preventive effects of 0.005% sodium hypochlorite (NaOCl) showers against HAIs in pediatric ICUs. 

Methods: This case control study was conducted in a 17-bed pediatric intensive care unit. Patients were washed with water and soap during the first six months and water and 0.005% sodium hypochlorite during the following six months, after which the incidence of HAIs was compared. The diagnosis of HAIs was made according to Centers for Disease Control and Prevention National Healthcare Safety Network guidelines.

Results: Two hundred thirty patients (118 patients in control group, 112 patients in NaOCl group) who met the inclusion criteria were included in the study. 26 patients among the control group and 20 patients among the NaOCl group were diagnosed with HAIs. In the NaOCl group, we detected 100% and 66% reductions in P. aeruginosa and S. aureus infections, respectively. There was no statistically significant difference between the groups in terms of overall HAI incidences (P=0.510). Most frequently encountered HAIs in both groups were ventilator-associated pneumonia and bloodstream infections. The rates of multidrug resistant gram-negative bacterial isolation were 77.8% (14/18) in the control group and 66.7% (5/15) in the sodium hypochlorite group. The rates of extensive drug resistant gram-negative bacterial isolation were 38.9% (7/18) in the control group and 26.7% (4/15) in the NaOCl group. There was no statistically significant difference between the two groups (P=0.458). We did not encounter any local or systemic side effects in any of our patients.

Conclusion: We found that weekly 0.005% NaOCl showers reduced P. aeruginosa and S. aureus infections, although it did not change length of hospital stay, incidence of total HAIs and the sensitivity of gram-negative bacteria to antibiotics.

Keywords

• Antibiotic resistance,Chlorhexidine gluconate,Gram negative bacteria,Healthcare-associated infections,Sodium hypochlorite

Kaynakça

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