Evaluation of risk factors for central venous line-associated bloodstrem infections (CLABSIs) and the benefits of central line bundle application in reducing CLABSIs

Öz

Purpose: We aimed to identify the risk factors for central line-associated bloodstrem infections (CLABSIs) and the efficacy of chlorhexidine and bundle application to prevent CLABSIs. Materials and methods: This study was performed in the anesthesia-intensive care unit (AICU) of a tertiary hospital. A structured survey form including patients’ characteristics and a central line bundle checklist was used for following of patients. Adult patients a.who had undergone recent central venous catheter (CVC) insertion at the AICU, and bthose who had been transferred to ICU with the previous catheter insertion in other departments and c.who had received a diagnosis of CLABSI fourty-eight hours after remaining in the ICU were included in the study. The data obtained were evaluated with respect to the risk factors for CLABSIs. Result: The current study included 156 patients with the mean age 67.97±17.20 years (median 71.00 years) 66 women (42,3%). Fourty-seven patients developed CLABSIs. Evaluating the results of univariate analysis, the rate of infection was lowest when catheters were inserted with the aim hemodialysis (p<0.01). The subclavian vein (p<0.01) and three-lumen catheters (p<0.01), receiving CVCs under emergency condition (p=0.04), having been intubated (p=0.01), undergoing surgery (p=0,04) and receiving antibiotics before catheterisation (p<0.01), receiving blood product through CVCs (p=0.01), repeat catheter insertions (p<0.01) were found that associated with development of CLABSI. Conclusion: In summary, multivariate analyses showed that repeat catheter insertions (p<0.01) and prolonged ICU stay (p<0.01) could raise the risk of CLABSIs. However, patients with bundle application had a lover rate of infection (p<0.01) was seen.

Anahtar Kelimeler

• Bundle
• central line
• blood stream infection
• intensive care

Santral venöz kateter ilişkili kan dolaşımı enfeksiyonları için risk faktörlerinin ve santral kateter paket uygulamasının yararlarının değerlendirilmesi

Öz

Amaç: Bu çalışmada santral venöz kateter-ilişkili kan dolaşımı enfeksiyonlarının (SKİ-KDE) risk faktörlerini ve SKİ-KDE’larını önlemek için klorheksidin ve paket uygulamasının etkinliğini belirlemeyi amaçladık. Gereç ve yöntem: Bu çalışma üçüncü basamak bir hastanenin anestezi yoğun bakım ünitesinde (AYBÜ) yapıldı. Hastaların takibi için hasta özelliklerini içeren yapılandırılmış anket formu ve santral kateter paketi kontrol listesi kullanıldı. a. Yakın zamanda AYBÜ'de santral venöz kateter (SVK) takılmış olan, b diğer bölümlerde daha önce kateter takılarak YBÜ'ne nakledilmiş olan ve c.YBÜ'de 48 saat kaldıktan sonra SKİ-KDE tanısı alan erişkin hastalar çalışmaya dahil edildi. Elde edilen veriler SKİ-KDE için risk faktörleri açısından değerlendirildi. Bulgular: Bu çalışmaya yaş ortalaması 67,97±17,20 (medyan 71,00 yıl) olan 156 hasta alındı, 66'sı kadındı (%42,3). Kırk yedi hastada SKİ-KDE gelişti. Tek değişkenli analizlerin sonuçları değerlendirildiğinde, hemodiyaliz amacıyla kateter takıldığında enfeksiyon oranı en düşüktü (p<0.01). Subklavian ven (p<0.01) ve üç lümenli kateterler (p<0.01), acil durumda SVK takılması (p=0.04), entübe olmuş olmak (p=0,01), kateterizasyon öncesi operasyon geçirilmesi (p=0,04) ve antibiyotik kullanımı (p<0,01), tekrarlayan kateter takılmaları (p<0.01) SKİ-KDE gelişimi ile ilişkili bulunmuştur. Sonuç: Özetle, çok değişkenli analizler, tekrarlayan kateter takılmalarının (p<0.01) ve uzun süreli YBÜ kalışının (p<0.01) SKİ-KDE riskini artırabileceğini göstermiştir. Ancak, paket uygulaması olan hastalarda enfeksiyon riskinin daha az olduğu (p<0,01) görüldü.

Anahtar Kelimeler

• bundle
• santral kateter
• kan dolaşım enfeksiyonu
• yoğun bakım

Kaynakça

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