Dramatic increase of central venous catheter-related infections associated with a high turnover of the nursing team

详细信息    查看全文

• 作者：Elé ; a Mirabel-Chambaud^a ; ¹ ; ^{e.mirabelchambaud@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Michael N'Guyen^a ; ¹ ; ^{michael.nguyenhuu@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Marie-Laure Valdeyron^b ; ^{marie.laure.@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Thierry Quessada^a ; ^{thierry.quessada@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Joelle Goudable^a ; ^d ; ^e ; ^{joelle.goudable@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Irene Loras-Duclaux^c ; ^{irene.loras-duclaux@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Stephanie Marotte^c ; ^{stephanie.marotte@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Sophie Heissat^c ; ^{sophie.heissat@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Lioara Restier^c ; ^{lioara.restier@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Alain Lachaux^c ; ^d ; ^{alain.lachaux@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author} ; Noel Peretti^c ; ^d ; ^e ; ^{noel.peretti@chu-lyon.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Parenteral nutrition ; Children ; Septicemia ; Nosocomial infection ; CRBSI
• 刊名：Clinical Nutrition
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：35
• 期：2
• 页码：446-452
• 全文大小：586 K

文摘

This retrospective study evaluated the impact of new organization during the moving to a new university pediatric hospital on the incidence of central catheter-related blood stream infections (CRBSIs) among children on long-term parenteral nutrition.

Methods

The study ran from April 2007 to March 2014, starting a year prior to reorganisation of the department of pediatric Hepato-Gastroenterology and Nutrition associated to moving the children to a new hospital in April 2008, and continuing for 6 years following the move. During this time, data from all children hospitalized in this department who received parenteral nutrition (PN) for more than 15 days were analysed.

Results

During this 7-years study, 183 children aged 4.6 ± 0.5 years received prolonged PN. Intestinal diseases were the main aetiologies (89%), primarily short bowel syndrome (18.4%), Hirschsprung disease and CIPO (13.5%) and inflammatory bowel disease (13.8%). The mean durations of hospitalization and of PN during hospitalization were, respectively, 70 ± 2.1 and 55.7 ± 3.6 days. During the study period, 151 CRBSIs occurred in 77 children (42% of all patients), i.e. 14.8 septic episodes/1000 PN days and 12.0 septic episodes/1000 CVC days. No patient died of a central venous catheter-related infection.

However, following the move from the older hospital to the newer one, the rate of CRBSIs significantly doubled, from 3.9/1000 to 8.8/1000 CVC days (p = 0.02). During the following 4 years, the incidence of CRBSIs tended to increase between the 2nd and the 5th year after the move: 11.3 (p = NS); 21.4 (p = 0.01); 17.3 (p = NS), 20.3/1000 (p = NS) CVC days. We also observed that after evaluations by the Department of Infection Control, nurse training and stabilization of the nursing team, the incidence decreased significantly from 20.3 to 11.1/1000 CVC days during the 6th year after the move (p = 0.01).

Conclusion

Our results reveal the deleterious impact of the reorganization during the hospital moving on the CRBSI incidence rate, and the possible implication of inexperienced team of nurses.