中心静脉导管相关血流感染预防策略PPT精选课件.pptVIP

Dr.HU Bijie Weinstein估计与CRBSI有关的病原体，40-60%来自患者自身的皮肤菌群，20-40%源自医护人员手部交叉感染，20-25%来自菌群中抗生素导致的变化，20%代表来自其它外源性来源的暂居微生物。 Since the skin is the most common source of infecting microorganisms in CRBSI, it makes sense to focus initial efforts in prevention at this site.由于皮肤是CRBSI中传染微生物最常见来源，因此在该部位作出初步努力来预防是有意义的。 Reference: 参考文献： Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Int Care Med. 2004;30:62-67. The 2 most important sources of bacteria and fungi for catheter colonization and resultant CRBSI are the catheter insertion site and hub.导管定植和CRBSI的细菌与真菌2个最重要的来源是导管置入部位和接头。 For short-term catheters (of duration less than 10 days), the catheter insertion site is the most important source of contamination. Bacteria present on the patient’s skin are thought to migrate along the external surface of the catheter, from insertion site to catheter tip. Bacterial colonization of the catheter surface results in formation of a biofilm: microbes embedded in a protective matrix of extracellular bacterial polymers.对于短期导管（留置时间少于10天），导管置入部位是污染最重要的来源。人们认为患者皮肤上的细菌会随着导管的外表面从置入部位向导管尖迁移。导管表面导管定植形成生物膜：嵌入细胞外细菌聚合物的保护矩阵中的微生物。 For long-term catheters (of duration greater than 10 days), the catheter hub is the most important source of contamination. In this case, organisms are thought to be introduced during catheter manipulation, when the contaminated hands of medical personnel contact the catheter hub. Organisms then migrate from hub TOWARD the catheter tip, along the intra-luminal surface of the catheter. As with external colonization, a biofilm is formed; organisms may remain embedded in the biofilm, or detach to free-float in the catheter lumen.对于长期导管（留置时间超过10天），导管接头是污染最重要的来源。在这种情况下，人们认为医护人员受污染的手接触导管接头时，在导管操作期间引入了生物。生物然后沿着导管管腔内表面从接头迁移到导管尖。如外部定植一样，形成生物膜。生物会嵌入在生物膜中或分离开在导管腔内自由浮动。 Whether extraluminal or intraluminal, colonization can progress to CRBSI; however, progression is not inevitable. After insertion, a