2011

IA.IB.

IC. II..

Total 103 recommendations21 IA37 IB3 IC31 II 11

2002370200214040%

2002CVC0.5%

ICUICU/ICUCRBSICVC

0.5%2%CRBSI

catheter-related bloodstream infections (CRBSI)

CRBSI

CRBSI

(peripheral venous catheters)3 inches(peripheral arterial catheters)3 inchesMidline catheters38 inches(nontunneled central venous catheters)8cmCRBSI(pulmonary arterial catheters)Teflon30cmCVCsPICC20cm(tunneled central venous catheters)8cm(totally implantable)8cmCRBSI(umbilical catheters)6cm

AAAICUICUCRBSIB

ICU 9 hospitals, 5,200 beds 10Pre-test avg score: 78.3%Post-test avg score: 89.9%BSI10.8/1000 3.7/1000Coopersmith CM, et al. Critical Care Med, 2002

Coopersmith CM, et al. Critical Care Med, 2002

Effect of Education on CLAB

StudyType of unitPre-intervention rate (per 1000 catheter days)Post-intervention rate (per 1000 catheter days)Coopersmith, Crit Care Med, 2002Surg/burn/trauma ICU10.83.7Rosenthal, AJIC 2003ICU17.09.9Warren, Crit Care Med, 2003ICU (Comm. Hosp.)4.92.1Warren, Chest 2004MICU (Univ. Hosp.)9.45.5

/SICUBSIFridkin SK, et al. ICHE, 1996

midline catheterB

midline catheterA6PICC

midline catheterCRBSIB

midline catheter

PICCmidline catheter

CVCAAB

CVCCVC

CVCACVCA

CVCB

CVCCVCBA48B

CVCRCTParienti, et al. JAMA 2008 (N=750)VSCVCMerrer, et al. JAMA 2001 (N=289)VSCVC

CVCRCTRupp, et al. Ann Intern Med, 2005 (CHG/SS vs Control CVC)393CVC5%19%39%Raad, et al. Ann Intern Med, 1997 266CVCVS 0.39(p=0.02);VS0.28(p=0.002)

BB

CAC

CVCPICCBB

70%B0.5%70%A

++

AAB

BCVC2BCVC7B

CVC1CVCBB

>2CLABSIBB

chlorhexidine gluconate (CHG) gel dressing

CLA-BSI: 1.4/1000VS 0.4/100037Timsit, et al. JAMA, 2009

2%1CRBSI

CHGArch Intern Med 2007ICHE 2007ICUCHGBSI16.8/1000CVC6.4/1000.ICUCHGMRSA52%

/5CLABSI//CVC0.5%A

/

//

CRBSIB

///BB

CRBSI

Safdar & Maki, CID, 2006 P=0.03taurolidine

No. CRBSI/No. IVDsControlVHLSRR (95% CI)Schwartz et al8/293/24 0.45 (0.14-1.38)Rackoff et al10/3110/32 0.97 (0.47-1.98)Daghistani et al3/342/30 0.76 (0.16-3.56)Carratala et al17/6015/57 0.84 (0.47-1.5)Henrickson et al31/806/35 0.08 (0.04-0.18)Garland et al18/437/42 0.4 (0.19-0.82)Barriaga et al26/4418/390.78 (0.50-1.18)Overall113/32161/259 0.49 (0.26-0.95)

72~96BB

CVCPICCCVCPICCBCVCPICCB

CVCPICCBB

9671A

24B612A

7272

70%AC

CR-BSI

108ICUsCHGCVCMean BSI/1000 CVC d(P

Center for Medicare & Medicaid Service2008101CMSObject left in surgery,Air embolism,Blood incompatibility,Catheter-associated urinary tract infections,Pressure ulcers (decubitus ulcers), Vascular catheter-associated infections,Surgical site infections mediastinitis after coronary artery bypass graft Hospital-acquired injuries fractures, dislocations, intracranial injuries, crushing injuries, burns, and other unspecified effects of external causes

CR-BSI

CR-BSI

2/70CVCBMJ Qual Saf. 2011;20(2):174-80.

CVCCVC BMJ Qual Saf. 2011;20(2):174-80.

CVCBMJ Qual Saf. 2011;20(2):174-80.

BMJ Qual Saf. 2011;20(2):174-80.

CLA-BSI---

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