BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutriti...BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.展开更多
The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the pre...The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.展开更多
目的针对肿瘤患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染(central line associated bloodstream infection,PICC-CLABSI)风险预测问题,利用Logistic回归和极限学习机(extreme learning ...目的针对肿瘤患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染(central line associated bloodstream infection,PICC-CLABSI)风险预测问题,利用Logistic回归和极限学习机(extreme learning machine,ELM)分别建立预测模型并验证其预测效果。方法回顾性收集2019年1月至2023年3月在山西省某三级甲等综合医院肿瘤科接受PICC置管的1146例患者的临床病历资料,将2019年1月至2021年12月收集的786例PICC置管患者的临床病历资料作为建模组,将2022年1月2023年3月收集的360例患者的临床资料作为验证组。采用χ^(2)检验对建模组数据进行分析,将有统计学意义的变量进行Logistic回归分析,构建风险预测模型,并绘制列线图,采用Hosmer-Lemeshow检验和受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评价该预测模型的拟合度及预测效果;将Logistic回归分析具有统计学意义的危险因素作为ELM预测模型的输入参数,肿瘤患者PICC-CLABSI发生风险作为输出参数,构建ELM预测模型;利用验证组数据对预测性能进行比较。结果(有)糖尿病史、化疗次数(≥3次)、维护周期(>7day)、维护地点(院外)、白细胞计数(<3.5×10^(9)/L)、白蛋白(<40g/L)是肿瘤患者发生经外周静脉置入中心静脉导管相关血流感染的风险因素(均P<0.05)。Logistic风险预测模型的Hosmer-Lemeshow检验结果显示:χ^(2)=5.201,P=0.736,AUC为0.860(95%CI:0.799~0.922),灵敏度是0.893,特异度是0.704,正确率为72.8%,表明模型具有良好的预测能力。ELM预测模型的决定系数为0.823,均方误差为0.051,模型的拟合度良好,正确率为74.5%,表明模型具有良好的预测能力。结论在Logistic回归分析筛选指标基础上建立的Logistic风险预测模型与ELM模型均具有较高的预测精度,可为临床医护人员筛查肿瘤PICC相关血流感染高危患者提供参考。展开更多
目的探讨基于行为转变理论的培训对新生儿护士经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染防控行为的影响。方法采取随机抽样法,选取绵阳市某医院42名新生儿护士为研究对象,对其实施基于行为转...目的探讨基于行为转变理论的培训对新生儿护士经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染防控行为的影响。方法采取随机抽样法,选取绵阳市某医院42名新生儿护士为研究对象,对其实施基于行为转变理论的PICC相关血流感染防控培训,培训前、培训后分别采用PICC相关血流感染防控行为阶段调查表与PICC相关血流感染防控实践现状调查表对新生儿护士的PICC相关血流感染防控行为、感染防控认知与操作水平、导管相关性血流感染发生率进行评价。结果培训后,新生儿护士导管相关血流感染防控行为阶段优于培训前,差异有统计学意义(P<0.001),培训后导管相关血流感染防控认知与操作技能评分均高于培训前,差异有统计学意义(P<0.001),培训后导管相关性血流感染发生率1.06‰(2/1887)较培训前6.42‰(14/2180)明显下降,差异有统计学意义(P<0.001)。结论基于行为转变理论的培训有助于提升新生儿护士实施PICC相关血流感染防控措施的依从性,促进其防控行为发生正向转变,有助于PICC相关血流感染防控措施的落实,从而降低PICC相关血流感染发生率。展开更多
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.展开更多
目的探讨“四体系一平台”护理管理模式预防重症监护病房(intensive care unit,ICU)中心导管相关血流感染(central line associated blood stream infection,CLABSI)的效果,降低CLABSI发生率。方法采用不同病例前-后对照研究,选取2019年...目的探讨“四体系一平台”护理管理模式预防重症监护病房(intensive care unit,ICU)中心导管相关血流感染(central line associated blood stream infection,CLABSI)的效果,降低CLABSI发生率。方法采用不同病例前-后对照研究,选取2019年9月至2021年8月本院4个外科ICU病区收治的5968例患者作为研究对象,其中2019年9月至2020年8月收治的2852例患者设为实施前组,2020年9月至2021年8月收治的3116例患者设为实施后组。实施前组应用常规护理管理方法,实施后组应用“四体系一平台”护理管理模式。比较两组患者CLABSI发生率,实施前后护士输液附加装置更换合格率、手卫生依从性;两组患者置管最大无菌屏障合格率、皮肤消毒合格率。结果应用“四体系一平台”护理管理模式后,患者CLABSI率由1.96‰(29/14765)降至0.97‰(17/17458),两组比较,差异具有统计学意义(χ^(2)=5.504,P=0.019);护士输液附加装置更换合格率(92.86%v 99.73%,χ^(2)=264.498,P<0.001)、手卫生方法正确率(99.02%v 99.73%,χ^(2)=32.342,P<0.001)、手卫生依从性(99.18%v 99.49%,χ^(2)=5.664,P=0.019)、最大无菌屏障合格率(95.93%v 99.69%,χ^(2)=10.399,P=0.002)、皮肤消毒合格率(93.61%v 98.80%,χ^(2)=67.630,P<0.001)均较实施前组提高,两组比较,差异有统计学意义。结论“四体系一平台”护理管理模式有利于促进ICU护士在导管维护时的规范性、有效性和依从性,降低ICU患者CLABSI率。展开更多
文摘BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.
文摘The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.
文摘目的针对肿瘤患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染(central line associated bloodstream infection,PICC-CLABSI)风险预测问题,利用Logistic回归和极限学习机(extreme learning machine,ELM)分别建立预测模型并验证其预测效果。方法回顾性收集2019年1月至2023年3月在山西省某三级甲等综合医院肿瘤科接受PICC置管的1146例患者的临床病历资料,将2019年1月至2021年12月收集的786例PICC置管患者的临床病历资料作为建模组,将2022年1月2023年3月收集的360例患者的临床资料作为验证组。采用χ^(2)检验对建模组数据进行分析,将有统计学意义的变量进行Logistic回归分析,构建风险预测模型,并绘制列线图,采用Hosmer-Lemeshow检验和受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评价该预测模型的拟合度及预测效果;将Logistic回归分析具有统计学意义的危险因素作为ELM预测模型的输入参数,肿瘤患者PICC-CLABSI发生风险作为输出参数,构建ELM预测模型;利用验证组数据对预测性能进行比较。结果(有)糖尿病史、化疗次数(≥3次)、维护周期(>7day)、维护地点(院外)、白细胞计数(<3.5×10^(9)/L)、白蛋白(<40g/L)是肿瘤患者发生经外周静脉置入中心静脉导管相关血流感染的风险因素(均P<0.05)。Logistic风险预测模型的Hosmer-Lemeshow检验结果显示:χ^(2)=5.201,P=0.736,AUC为0.860(95%CI:0.799~0.922),灵敏度是0.893,特异度是0.704,正确率为72.8%,表明模型具有良好的预测能力。ELM预测模型的决定系数为0.823,均方误差为0.051,模型的拟合度良好,正确率为74.5%,表明模型具有良好的预测能力。结论在Logistic回归分析筛选指标基础上建立的Logistic风险预测模型与ELM模型均具有较高的预测精度,可为临床医护人员筛查肿瘤PICC相关血流感染高危患者提供参考。
文摘目的探讨基于行为转变理论的培训对新生儿护士经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染防控行为的影响。方法采取随机抽样法,选取绵阳市某医院42名新生儿护士为研究对象,对其实施基于行为转变理论的PICC相关血流感染防控培训,培训前、培训后分别采用PICC相关血流感染防控行为阶段调查表与PICC相关血流感染防控实践现状调查表对新生儿护士的PICC相关血流感染防控行为、感染防控认知与操作水平、导管相关性血流感染发生率进行评价。结果培训后,新生儿护士导管相关血流感染防控行为阶段优于培训前,差异有统计学意义(P<0.001),培训后导管相关血流感染防控认知与操作技能评分均高于培训前,差异有统计学意义(P<0.001),培训后导管相关性血流感染发生率1.06‰(2/1887)较培训前6.42‰(14/2180)明显下降,差异有统计学意义(P<0.001)。结论基于行为转变理论的培训有助于提升新生儿护士实施PICC相关血流感染防控措施的依从性,促进其防控行为发生正向转变,有助于PICC相关血流感染防控措施的落实,从而降低PICC相关血流感染发生率。
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
