65 DOI: 10.6526/ICJ.2016.203 (APSIC) (CLABSI)-2015 ( ) 1,2 李聰明 Moi Lin Ling 4 等編譯 1 天主教雲林虎尾若瑟醫院院長室 2 馬偕紀念醫院感染管制中心 4 亞太感染管制學會 (APSIC) (APSIC) 2013 Moi Lin Ling, : Moi Lin Ling ( APSIC ),Namita Jaggi ( ),Glenys Harrington ( APSIC ),Keita Morikane ( / ),Le Thi Anh Thu ( HICS ),Patricia Ching ( APSIC ),Victoria Villanueva ( PHICS ), ( ),Jae Sim Jeong ( ) 2015 (ICST) 105 4
66 (HKICNA) (HISI) [ICA(S)] (PHICS) APSIC GUIDE FOR PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI)2015 (APSIC), 2011 (Central Line Associated Blood Stream Infection, CLABSI) ( ) (CVC) CVC ( CLABSI) CVC CLABSI 1. (PA) PA / (PICC) ( PICC) 2.CLABSI CRBSI
67 (CLABSI) (CRBSI) (Intra-Venous Device,IVD) CRBSI CLABSI CLABSI (CDC) (National Healthcare Safety Network, NHSN) BSI NHSN CLABSI http://www.cdc.gov/nhsn/psc_ da.htmlclabsi 48 CLABSI CLABSI CVC CRBSI CRBSI CVC BSI CRBSI CRBSI CLABSI CVC / CRBSI a. CVC (/) 15 [CFU]/ 103 CFU/ b. CVC 5:1 c. CVC 2 ( ) CVC 1 1. CVC 10 CVC 2. IV IV CVC 10 CVC Hickman Broviac PICC CVC 105 4
68 (IVD) HCW CrnichCJ MakiDG.Thepromiseofnoveltechnologyforthepreventionofintravasculardevi ce-relatedbloodstreaminfection.i.pathogenesisandshort-termdevices.clininfectdis.2002m ay1;34(9):1232-1242.usedwithpermission., IV CLABSI (coagulasenegative staphylococci) (Staphylococcus aureu) 31% 20%(Enterococcus) (Candida species) 9% (Escherichia coli) 6% (Klebsiella species) CLABSI CLABSI 50% 64.8% 66% (Klebsiella pneumoniae)
69 (Pseudomonas aeruginosa) CLABSI ICU (MRSA) ICU 50% (Ceftazidime) (Imipenem) ( ) CLABSI 2008 CLABSI $3700 $36441 CDC CLABSI $16550 2001 2009 (ICU) 1000 CR-BSI 3.64 1.65 2009 18000 2004 2009 36 422 ICU BSI 1000 6.8 CLABSI 15 2002 (INICC) CLABSI 54% 58% 86 ICU CLABSI CLABSI CLABSI CLABSI ( ) A. CLABSI NHSN 2012 ICU ICU / CLABSI 1000 1.4 1.1 / ICU ICU / 1.2 0.8 CLABSI 105 4
70 CLABSI B. CLABSI C. CLABSI CLABSI 2012 NHSN CLABSI 1000 3.4 2.4 ICU ICU CLABSI (<1500 g) CLABSI 750g 751-1000g 1001-1500g CLABSI 1000 2.3 1.6 1.1 1501-2500g 2500 g 0.6 0.8 D. CLABSI ( ) A. CLABSI B. CVC CLABSI CLABSI (RCT) CLABSI RCT (metaanalyses) Parienti JJ et al CLABSI Marik PE et al CLABSI CLABSI C. CLABSI D. 10 CLABSI CLABSI E. CLABSI CLABSI
71 F. CLABSI G. CLABSI ( ) A. CLABSI B. CLABSI / CLABSI CLABSI - CLABSI A CVC CVC CVC ( ) a. - (CVP) b. c. d. e. f. g. (KCL) h. i. j. CVC CVC CVC 105 4
72 CVC ( )CVC a. b. c. d. e. f. CLABSI ( ) a. b. c. 2% (Alcohol-based 2% chlorhexidine gluconate) - 2%CHG d. (Maximum barrier precautions) 1. CRBSI 1.79 5.12 (IB) (IA) IV (PICC) (IB) a.
73 (IA) b. (I) c. (II) d. CVC e. (IA) f. (IB) 2. 48 (ABHR) (IB) (IB) (IA) (II) (IC) 3.2% (Alcohol-based 2% chlorhexidine gluconate, 2%CHG) 2%CHG (povidone iodine) 2%CHG CRBSI 2%CHG 0.5% CHG 10% (CVC) CRBSI 2% CHG 10% 70% 10% 70% CRBSI 105 4
74 4143 (meta-analysis) CHG 49% 95% CI 28 88 CVC CHG CRBSI 1.6% 0.23% $113CHG 10% 5% 70% CVC 0.5% CHG 2% CHG CHG (tincture of iodine) 70% (IA) 2 CHG UI 2 CHG 2 CHG (IB) (IIB) 2% CHG 70% (IIB) 4. (Maximum sterile barrier MSB) CVC CVC MSB MSB RR = 0.32 95% CI 10 0.96 P =.04) CR-BSI RR = 0.16 95% CI 0.02 1.30 P = 0.06 MSB MSB MSB MSB CRBSI MSB [OR 3.40 95%CI 1.32 3.67] (IB) (IB) ( )
75 1. 2. / (Pennsylvania) (2010) NHSN 72% CLABSI 5 CVC CLABSI SHEA CDC APIC JCI (APSIC) A 3. CLABSI 1 2 3 4 5 4. 1 CLABSI CLABSI 105 4
76 2 A. B. (CVC) 48 2% CHG C. a. b. (CVC) c. D. a. b. c. d. e. / 4 (IA) (IA) (IA) (ICU) ICU /CRBSI (IB) 48 (IB) (CVC) PICC (IB) (CVC) PICC (II) (IB)
77 (IB) 5. 1 (WHO) 2 3 4 5 (II) (ABHR) (IB) (IB) (IA) (II) (IC) (IB) 6. / (CVC) CLABSI (CVC) (needleless connectors,nc) CLABSI 105 4
78 70% CHG 70% CHG 0.5% 15-30 (CVC) (IB) (IV) (IC) 72 (II) (II) CHG 70% (IA) (II) 7. (CVC) a), (CVC) b) >0.5% CHG CHG 70% c) d) e) (CVC) f) (CVC) g) CHG 2 h) (BSI)
79, (IA) (II) (IB) (IB) (IB) (CVC) (II) (CVC) (IB) (CVC) (II) (IB) CLABSI CHG (IB) (II) 8. 1 96 7 2 24 3 96 4 72 96 7 (IA) 105 4
80 3:1 24 (IB) 6-12 (Propofol) (IA) 9. (PICC) Broviac Hickman Groshong, 10. 1 2 3 CHG 70% / 2 4 11. 1 2 3 Groshong 12. 1 2 3
81 13. 1 2 24 12 4 / 3 70% CHG/ 14. 1 2 / 3 4 5 / 105 4