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素浴和与医疗保健相关的感染:一项随机临床试验
Michael J Noto1, Henry J Domenico2, Daniel W Byrne2
1Department of Medicine, Vanderbilt University, Nashville, Tennessee.
JAMA
|January 21, 2015
概括
在重症监护室每天用赫西丁洗并没有显著减少与医疗保健相关的感染. 这项研究表明,目前的做法可能无法有效地预防诸如CLABSI,CAUTI,VAP或C. difficile等感染.
科学领域:
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
- 抗微生物药物管理委员会
背景情况:
- 每天用赫西丁洗是重症监护病房 (ICU) 的常见做法,以预防与医疗相关的感染 (HAI).
- 支持其在重症患者群体中的有效性的证据仍在争论中.
- 这项研究旨在严格评估素浴对HAI率的影响.
研究的目的:
- 确定每天用2%的赫西丁洗是否可以降低重症患者的HAI发病率.
- 评估对特定感染的影响,包括中央线路相关的血液感染 (CLABSI),导管相关的尿路感染 (CAUTI),呼吸器相关的肺炎 (VAP) 和Clostridium difficile感染.
主要方法:
- 一个实用的集群随机交叉试验,涉及5个重症监护室的9340名患者.
- 单位在每天的赫西丁洗和控制 (非抗菌布) 之间交替进行10周的时间,每隔2周的洗间隔.
- 主要结局是CLABSI,CAUTI,VAP和C. difficile感染的组合.
主要成果:
- 主要综合结果的发生率在赫西丁 (2.86/1000患者日) 和对照 (2.90/1000患者日) 浴期 (P=.95) 之间是相似的.
- 没有观察到特定的HAI或二次结果的显著减少,包括多种耐药生物体感染.
- 在单个ICU内的子组分析也显示没有显著差异.
结论:
- 每天用赫西丁洗并没有有效地降低重症患者中与医疗保健相关的主要感染的发生率.
- 这些发现不支持在这个患者群体中为预防HAI而常规使用素浴.
- 可能需要进一步的研究来探索在ICU中预防HAI的替代或辅助策略.
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