Title: Outbreak of Bloodstream Infection Temporally Associated with the Use of an Intravascular Needleless Valve
Author: Mark E. Rupp,1,4 Lee A. Sholtz,4 Dawn R. Jourdan,4 Nedra D. Marion,4 Laura K. Tyner,4 Paul D. Fey,2 Peter C. Iwen,2 and James R. Anderson3
Sourse: Clinical Infectious Diseases 2007;44:1408-1414
Background. Needleless intravascular catheter connector valves have been introduced into clinical practice to minimize the risk of needlestick injury. However, infection-control risks associated with these valves may be underappreciated. In March 2005, a dramatic increase in bloodstream infections was noted in multiple patient care units of a hospital in temporal association with the introduction of a needleless valve into use.
Methods. Surveillance for primary bloodstream infection was conducted using standard methods throughout the hospital. Blood culture contamination rates were monitored. Cultures were performed using samples obtained from intravascular catheter connector valves.
Results. The relative risk of bloodstream infection for the time period in which the suspect connector valve was in use, compared with baseline, was 2.79 (95% confidence interval, 2.27–3.43). In critical care units, the rate of primary bloodstream infection increased with the introduction of the valve from 3.87 infections per 1000 catheter-days to 10.64 infections per 1000 catheter-days (P < .001), and it decreased to 5.59 infections per 1000 catheter-days (P = .02) in the 6 months following removal of the device from use. Similarly, in inpatient nursing units, the rate of bloodstream infection increased from 3.47 infections per 1000 catheter-days to 7.3 infections per 1000 catheter-days (P = .02) following introduction of the device, and it decreased to 2.88 infections per 1000 catheter-days (P = .57) following removal of the device from use. Similar events occurred in the cooperative care units. The rate of blood culture contamination did not substantially change over the course of the study. Of 37 valves that were subjected to microbiological sample testing, 24.3% yielded microbes, predominantly coagulase-negative staphylococci.
Conclusion. A significant association between primary bloodstream infection and a needleless connector valve was observed. Evaluation of needleless connector valves should include a thorough assessment of infection risks in prospective randomized trials prior to their introduction to the market.
初译：
Title: Outbreak of Bloodstream Infection Temporally Associated with the Use of an Intravascular Needleless Valve
与血管内无针单向阀相关的短暂血流感染爆发
Author: Mark E. Rupp,1,4 Lee A. Sholtz,4 Dawn R. Jourdan,4 Nedra D. Marion,4 Laura K. Tyner,4 Paul D. Fey,2 Peter C. Iwen,2 and James R. Anderson3
Sourse: Clinical Infectious Diseases 2007;44:1408-1414
Background：Needleless intravascular catheter connector valves have been introduced into clinical practice to minimize the risk of needlestick injury. However, infection-control risks associated with these valves may be underappreciated. In March 2005, a dramatic increase in bloodstream infections was noted in multiple patient care units of a hospital in temporal association with the introduction of a needleless valve into use.
背景：无针血管内导管接管单向阀引入临床实践可将针刺损伤的风险性减至最少。尽管如此，与这些单向阀相关的感染控制风险可能还未被阐明。在2005年3月，有医院的多个病人监护室内曾注意到，引入无针导管接管单向阀使用相关的短暂血流感染显著增加。
Methods. Surveillance for primary bloodstream infection was conducted using standard methods throughout the hospital. Blood culture contamination rates were monitored. Cultures were performed using samples obtained from intravascular catheter connector valves.
方法：通过医院血培养污染率检测主要的血流感染作为标准检测方法。从血管内导管接管单向阀中获得培养检测的标本。
Results. The relative risk of bloodstream infection for the time period in which the suspect connector valve was in use, compared with baseline, was 2.79 (95% confidence interval, 2.27–3.43). In critical care units, the rate of primary bloodstream infection increased with the introduction of the valve from 3.87 infections per 1000 catheter-days to 10.64 infections per 1000 catheter-days (P < .001), and it decreased to 5.59 infections per 1000 catheter-days (P = .02) in the 6 months following removal of the device from use. Similarly, in inpatient nursing units, the rate of bloodstream infection increased from 3.47 infections per 1000 catheter-days to 7.3 infections per 1000 catheter-days (P = .02) following introduction of the device, and it decreased to 2.88 infections per 1000 catheter-days (P = .57) following removal of the device from use. Similar events occurred in the cooperative care units. The rate of blood culture contamination did not substantially change over the course of the study. Of 37 valves that were subjected to microbiological sample testing, 24.3% yielded microbes, predominantly coagulase-negative staphylococci.
结果：对比试验初始值而言，导管接管单向阀试验期间的血流感染相对危险度是2.79（95％可信区间是2.27－3.43）。在病危护理室中，引入单向阀使用可致主要血流感染率的增加：从每1000导管.天的3.87例感染到每1000导管.天的10.64例感染(P < .001)；在运用此装置后取出随访6个月，其感染率则增加到每1000导管.天的5.59例 (P = .02)。同理，在入院病人护理室中，运用此装置的血流感染率从每1000导管.天的3.47例增加到每1000导管.天的7.3例(P = .02)，而在运用此装置后取出血流感染率降至每1000导管.天的2.88例(P = .57)。上述情况在合作的监护病房中同样如此。血培养的感染率实际上在研究期间并未改变。在37例运用无针单向阀中进行样本的微生物学检测，24.3％病例产生微生物，主要是凝固酶阴性葡萄球菌。
Conclusion. A significant association between primary bloodstream infection and a needleless connector valve was observed. Evaluation of needleless connector valves should include a thorough assessment of infection risks in prospective randomized trials prior to their introduction to the market.
结论：可以观察到在主要血流感染和无针导管接管单向阀之间存在显著相关。无针导管接管单向阀的评估应包括技术实施前的前瞻性随机试验中总的感染风险评估。
编译投稿：（614字）
【据《临床感染性疾病》2007年44卷的一项研究报道】题为：与血管内无针单向阀相关的短暂血流感染爆发（作者Mark等）
此项研究的背景是既往报道无针血管内导管接管单向阀引入临床实践可将针刺损伤的风险性减至最少，但是与这些单向阀相关的感染控制风险可能还未被阐明。在2005年3月，有医院的多个病人监护室内曾注意到，引入无针导管接管单向阀使用相关的短暂血流感染显著增加。研究人员在研究中通过医院血培养污染率检测主要的血流感染作为标准检测方法。从血管内导管接管单向阀中获得培养检测的标本。结果显示，对比试验初始值而言，导管接管单向阀试验期间的血流感染相对危险度是2.79（95％可信区间是2.27－3.43）。在病危护理室中，引入单向阀使用可致主要血流感染率的增加：从每1000导管.天的3.87例感染到每1000导管.天的10.64例感染(P < .001)；在运用此装置后取出随访6个月，其感染率则增加到每1000导管.天的5.59例 (P = .02)。同理，在入院病人护理室中，运用此装置的血流感染率从每1000导管.天的3.47例增加到每1000导管.天的7.3例(P = .02)，而在运用此装置后取出血流感染率降至每1000导管.天的2.88例(P = .57)。上述情况在合作的监护病房中同样如此。血培养的感染率实际上在研究期间并未改变。在37例运用无针单向阀中进行样本的微生物学检测，24.3％病例产生微生物，主要是凝固酶阴性葡萄球菌。由此相关研究人员提出结论：在主要血流感染和无针导管接管单向阀之间存在显著相关。无针导管接管单向阀的评估应包括技术实施前的前瞻性随机试验中总的感染风险评估。
