Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Yoğun Bakım Ünitesinde Santral Kateter İlişkili Kan Dolaşımı Enfeksiyonu Kontrol Demeti Uygulamasının Sonuçları: Prospektif Kohort Çalışma
Results of Implementation of Bundle to Prevent Central Line Associated-Bloodstream Infection in an Intensive Care Unit: A Prospective Cohort Study
Adem ŞAHİNa, Süleyman YILDIRIMb, Murat GÜNEŞa, Gürsel ERSANc, Işıl KÖSE GÜLDOĞANa, Nimet ŞENOĞLUa
aSağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi, Anestezi Yoğun Bakım Ünitesi, İzmir, TÜRKİYE
bSağlık Bilimleri Üniversitesi Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Yoğun Bakım Ünitesi, İzmir, TÜRKİYE
cSağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, İzmir, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2021;19(2):59-65
doi: 10.5336/anesthe.2021-83236
Article Language: TR
ÖZET
Amaç: Santral venöz kateterler (SVK), yoğun bakımlarda tedavi ve monitörizasyon amaçlı olarak kullanılan gereçlerdir. Tüm faydalarının yanında SVK'ler, mekanik ve enfektif komplikasyonlara neden olabilir. Santral kateter ilişkili kan dolaşımı enfeksiyonu (SKİ-KDE), sık karşılaşılan komplikasyonlardan biridir. SKİ-KDE gelişimi, yoğun bakımda kalma süresini ve mortaliteyi artırmaktadır. SKİ-KDE, önlenebilir bir durumdur. SKİKDE gelişimini önleme demeti, kateter takılması esnasında ve takip sırasında uyulması gereken çeşitli tedbirleri içerir. Bu çalışmanın amacı, SKİ-KDE önleme demeti uygulamasının, yoğun bakımımızda etkinliğinin değerlendirilmesidir. Gereç ve Yöntemler: Bu çalışma, prospektif öncesisonrası çalışmasıdır. Çalışma, Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi, Anestezi Yoğun Bakım Ünitesinde yapılmıştır. Demet uygulamasına 1 Nisan 2019 tarihinde başlanmış ve bu tarihten önceki 6 ay ve sonraki 6 ay içerisinde SVK'si bulunan hastalar, SKİ-KDE gelişimi ve kateter kalma süreleri açısından karşılaştırılmıştır. Bulgular: Demet uygulaması öncesi dönemde 111, demet uygulama sonrası dönemde 118 SVK'si bulunan hasta çalışmaya dâhil edilmiştir. Demet öncesi grupta 16 hastada SKİ-KDE gelişirken, demet sonrası grupta 11 hastada SKİ-KDE gelişmiştir (p=0,23). SVK kalma süresi, demet uygulaması sonrası ortalama 16,3±15,4 günden 12,5±8,5 güne inmiştir (p=0,023). SVK için femoral ven kullanımı, demet uygulaması sonrası dönemde (18 hasta), demet uygulaması öncesi döneme (35 hasta) göre azaltılmıştır (p=0,01). Diabetes mellitus, total parenteral nütrisyon ve propofol infüzyonu ile SKİ-KDE gelişimi ilişkili bulunmuştur. Sonuç: Demet uygulaması, istatistiksel olarak anlamlı olmasa da SKİ-KDE sayısını azaltmıştır. Demet uygulaması ile kateter kalma süresi ve femoral ven kullanımı azalmıştır.

Anahtar Kelimeler: Santral venöz kateter; kateter kaynaklı enfeksiyonlar; enfeksiyon kontrolü; yoğun bakım üniteleri
ABSTRACT
Objective: Central venous catheters (CVCs) are devices that used for treatment and monitoring in intensive care units. Despite beneficial effects CVC can lead to mechanical and infectious complications. Central line associated-bloodstream infection (CLABSI) is one of the most common complications of CVC. CLABSI increases length of stay and mortality in intensive care unit. CLABSI is a preventable condition. The bundle for prevention of CLABSI include a variety precautions during catheter insertion and follow up period to prevent development of CLABSI. The aim of this study is to evaluate the effectiveness of CLABSI prevention bundle implementation in our intensive care unit. Material and Methods: This is a prospective before-after study. The study was conducted in University of Health Science Tepecik Training and Research Hospital, Intensive Care Unit of Anesthesiology. Bundle implementation was started on April 1, 2019, patients with CVC within 6 months before and after this date were compared in terms of development CLABSI and catheter duration. Results: Before bundle implementation 111 patients with CVC and after bundle implementation 118 patients with CVC were included. During pre-bundle period 16 patients had CLABSI and 11 patients had in after bundle period (p=0.23). Catheter duration decreased from 16.3±15.4 days to 12.5±8.5 days after bundle implementation (p=0.023). Femoral vein preference for CVC decreased from 35 to 18 after bundle implementation (p=0.01). Diabetes mellitus, total parenteral nutrition and infusion of propofol were found associated with CLABSI. Conclusion: Bundle implementation decreased number of CLABSI, but it was not statistically significant. After bundle implementation catheter duration and preference of femoral vein reduced.

Keywords: Central venous catheter; catheter-related infections; infection control; intensive care units
REFERENCES:
  1. Jamshidi R. Central venous catheters: Indications, techniques, and complications. Semin Pediatr Surg. 2019;28(1):26-32. [Crossref] [PubMed] 
  2. Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007; 204(4):681-96. [Crossref] [PubMed] 
  3. Centers for Disease Control and Prevention. National and State Healthcare Associated Infections Progress Report 2016. Centers for Disease Control and Prevention; 2016. Accessed 9 March 2016. Available at: [Link] 
  4. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al; French Catheter Study Group in Intensive Care. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286(6):700-7. [Crossref] [PubMed] 
  5. Marra AR, Opilla M, Edmond MB, Kirby DF. Epidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition. J Clin Gastroenterol. 2007;41(1):19-28. [Crossref] [PubMed] 
  6. Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000;355(9218): 1864-8. [Crossref] [PubMed] 
  7. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related blood stream infections in the ICU. N Engl J Med. 2006;355(26):2725-32. Erratum in: N Engl J Med. 2007;356(25):2660. [Crossref] [PubMed] 
  8. Shapey IM, Foster MA, Whitehouse T, Jumaa P, Bion JF. Central venous catheter-related bloodstream infections: improving post-insertion catheter care. J Hosp Infect. 2009; 71(2):117-22. [Crossref] [PubMed] 
  9. Kim JS, Holtom P, Vigen C. Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: epidemiologic and economic consequences. Am J Infect Control. 2011; 39(8):640-6. [Crossref] [PubMed] 
  10. Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004;32(10):2014-20. [Crossref] [PubMed] 
  11. Warren DK, Cosgrove SE, Diekema DJ, Zuccotti G, Climo MW, Bolon MK, et al; Prevention Epicenter Program. A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol. 2006;27(7):662-9. [Crossref] [PubMed] 
  12. Salama MF, Jamal W, Al Mousa H, Rotimi V. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections. J Infect Public Health. 2016;9(1): 34-41. [Crossref] [PubMed] 
  13. Callister D, Limchaiyawat P, Eells SJ, Miller LG. Risk factors for central line-associated bloodstream infections in the era of prevention bundles. Infect Control Hosp Epidemiol. 2015;36(2):214-6. [Crossref] [PubMed] 
  14. Mishra SB, Misra R, Azim A, Baronia AK, Prasad KN, Dhole TN, 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(1):63-7. [PubMed] 
  15. Guerin K, Wagner J, Rains K, Bessesen M. Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. Am J Infect Control. 2010;38(6):430-3. [Crossref] [PubMed] 
  16. Lin KY, Cheng A, Chang YC, Hung MC, Wang JT, Sheng WH, et al. Central line-associated bloodstream infections among critically-ill patients in the era of bundle care. J Microbiol Immunol Infect. 2017;50(3):339-48. [Crossref] [PubMed] 
  17. Hajjej Z, Nasri M, Sellami W, Gharsallah H, Labben I, Ferjani M. Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit. J Infect Chemother. 2014;20(3):163-8. [Crossref] [PubMed] 
  18. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, et al; 3SITES Study Group. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 2015;373(13):1220-9. [Crossref] [PubMed] 
  19. Arvaniti K, Lathyris D, Blot S, Apostolidou-Kiouti F, Koulenti D, Haidich AB. Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients: a pairwise and network meta-analysis. Crit Care Med. 2017;45(4): e437-48. [Crossref] [PubMed] 
  20. Wallace MC, Macy DL. Reduction of central line-associated bloodstream infection rates in patients in the adult intensive care unit. J Infus Nurs. 2016;39(1):47-55. [Crossref] [PubMed] 
  21. Stoeckle M, Kaech C, Trampuz A, Zimmerli W. The role of diabetes mellitus in patients with bloodstream infections. Swiss Med Wkly. 2008;138(35-36):512-9. [PubMed] 
  22. Longmate AG, Ellis KS, Boyle L, Maher S, Cairns CJ, Lloyd SM, et al. Elimination of central-venous-catheter-related bloodstream infections from the intensive care unit. BMJ Qual Saf. 2011;20(2):174-80. [Crossref] [PubMed] 
  23. Sacks GD, Diggs BS, Hadjizacharia P, Green D, Salim A, Malinoski DJ. Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle. Am J Surg. 2014;207(6):817-23. [Crossref] [PubMed] 

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