Secil DENİZ, İrem AKIN ŞEN, Kevser OZDEMİR, Nurefşan AYDENİZ, Ayşe KIVRAK, Simay SERİN, Hülya SUNGURTEKİN, Hüseyin TURGUT

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

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

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

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.

Keywords:

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

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1. Bell T, O’Grady NP. Mary Alexander, et al. Prevention of central line–associated bloodstream infections. Infect Dis Clin 2017;31:551-559. https://doi.org/10.1016/j.idc.2017.05.007
2. Moriyama K, Ando T, Kotani M, et al. Risk factors associated with increased incidences of catheter-related bloodstream infection. Medicine 2022;101:e31160. https://doi.org/10.1097/MD.0000000000031160
3. Kolikof J, Peterson K, Baker AM. Central Venous Catheter. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, Available from: https://www.ncbi.nlm.nih.gov/books/NBK557798/. Accessed 23 May, 2021
4. Hina HR, McDowell JR. Minimising central line‐associated bloodstream infection rate in inserting central venous catheters in the adult intensive care units. J Clin Nurs 2017;26:3962-3973. https://doi.org/10.1111/jocn.13824
5. O’Grady NP, Alexander M, Burns LA, et al. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. CID 2011;52:1087-1099. https://doi.org/10.1093/cid/cir138
6. Margatho AS, Ciol MA, Hoffman JM, et al. Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: a pilot randomised controlled trial. Australian Critical Care 2019;32:471-478. https://doi.org/10.1016/j.aucc.2018.11.001
7. Nkwata A, Soe M, Li Q, Godfrey Johnson D, Edwards J, Dudeck M. Incidence trends of central-line–associated bloodstream infections in acute-care hospitals, NHSN, 2009–2018. Infection Control & Hospital Epidemiology 2020;41:294-295. https://doi.org/10.1017/ice.2020.873
8. Rosenthal VD, Duszynska W, Ider BE, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2013-2018, Adult and Pediatric Units, Device-associated Module. American Journal of Infection Control 2021;49:1267-1274. https://doi.org/10.1016/j.ajic.2021.04.077
9. Reyes DCV, Bloomer M, Morphet J. Prevention of central venous line associated bloodstream infections in adult intensive care units: a systematic review. Intensive and Critical Care Nursing 2017;43:12-22. https://doi.org/10.1016/j.iccn.2017.05.006
10. Lee KH, Cho NH, Jeong SJ, Kim MN, Han SH, SongYG. Effect of central line bundle compliance on central line-associated bloodstream infections. Yonsei Med J 2018;59:376-382. https://doi.org/10.3349/ymj.2018.59.3.376
11. Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acutecare hospitals: 2022 Update. ICHE 2022;43:553-569. https://doi.org/10.1017/ice.2022.87
12. Atilla A, Doğanay Z, Kefeli Çelik H, Tomak L, Günal Ö, Sırrı Kılıç S. Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean Journal of Anesthesiology 2016;69:599-603. https://doi.org/10.4097/kjae.2016.69.6.599
13. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-332. https://doi.org/10.1016/j.ajic.2008.03.002
14. Ling ML, Apisarnthanarak A, Jaggi N, et al. APSIC guide for prevention of central line associated bloodstream infections (CLABSI). Antimicrobial Resistance and Infection Control 2016;5:1-9. https://doi.org/10.1186/ s13756-016-0116-5
15. Mishra SB, Misra R, Azim A, et al. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Health Care 2017;29:63-67. https://doi.org/10.1093/intqhc/mzw144
16. Polat F, Sahinoglu AH, Dilek A, et al. The effect of care bundles based on guidelines over the central venous catheter infections in an intensive care unit. Turkish Journal of Intensive Care 2014;12:86-93. https://doi.org/10.4274/tybdd.19483
17. Jeong IS, Park SM, Lee JM, Song JY, Lee SJ. Effect of central line bundle on central line-associated bloodstream infections in intensive care units. American Journal of Infection Control 2013;41:710-716. https:// doi.org/10.1016/j.ajic.2012.10.010
18. Furuya EY, Dick AW, Herzig CT, Pogorzelska Maziarz M, Larson EL, Stone PW. Central line-associated bloodstream ınfection reduction and bundle compliance in ıntensive care units: a national study. Infect Control Hosp Epidemiol 2016;37:805-810. https://doi.org/10.1017/ice.2016.67
19. Walz JM, Ellison, Richard T, Mack Deborah A, et al. The Bundle “Plus”: The effect of a multidisciplinary team approach to eradicate central line-associated bloodstream ınfections. Anesthesia & Analgesia 2015;120:868-876. https://doi.org/10.1213/ANE.0b013e3182a8b01b
20. Baier C, Linke L, Eder M, Schwab F, et al. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One 2020;15:e0227772. https://doi.org/10.1371/journal.pone.0227772
21. Karapanou A, Vieru AM, Sampanis MA, et al. Failure of central venous catheter insertion and care bundles in a high central line–associated bloodstream infection rate, high bed occupancy hospital. American Journal of Infection Control 2020;48:770-776. https://doi. org/10.1016/j.ajic.2019.11.018