Estrategias de prevención en las infecciones asociadas a catéter en recién nacidos: revisión sistemática de la literatura
ABSTRACT Las infecciones asociadas a catéter son la primera causa de infección nosocomial descrita en las unidades de cuidado crítico y un control de estas conlleva a disminuir la morbilidad y mortalidad en estos pacientes, tiempos de estancia hospitalaria y aliviar el costo de una hospitalización prolongada para su familia y la sociedad. Objetivo : evaluar la evidencia en las estrategias de prevención de las infecciones asociadas a catéter en recién nacidos. Materiales y métodos : se realizó una búsqueda sistemática en: Cochrane, Pubmed, desde 1995 hasta Abril de 2009. Se seleccionaron revisiones sistmáticas, ensayos clínicos y estudios observacionales. Se utilizó le metodología SIGN para la calificación de los estudios y evaluar el grado de recomendación basada en la evidencia. Resultados : se evaluaron 13 estudios que cumplían con los criterios de inclusión y que respondían a 6 preguntas sobre las diferentes estrategias para la prevención de infecciones asociadas a catéter en recién nacidos. La heterogenicidad de las investigaciones no permitió la realización de metananálisis. Conclusiones : la implementación de un sistema de control y vigilancia en el seguimiento de todos los procesos con mayor atención en todas las medidas de colocación, cuidado y manejo de los catéteres centrales son de forma integral la mejor estrategia en la prevención de infecciones asociadas a catéter en recién nacidos. Vascular catheters are consider fundamental in Neonatal Intensive Care Units and it's insertion is the most common procedure. 1 Blood related catheter infections (BRCI) are the first nosocomial infection related diseases all purposes to diminished them reduces mobility and mortality, hospitalization and relieves costs for long hospital stays for families and society. 2 There has been many control measures but there are not consensus based on evidence to give general recommendations on this age group. Objective Evaluate evidence on prevention measures for BRCI in newborns. Materials and Methods A systematic search was made at: Cochrane, Pubmed, from 1995 to April 2009. Systematic reviews, randomized controlled trials, case control and cohort studies were analyzed by SIGN evidence methodology. Results Thirteen studies met inclusion criteria and answered to 6 questions about different prevention strategies for blood catheter related infections in newborns. Studies heterogeneity didn't allow to make methanalysis. Conclusions Implementation of a surveillance protocol in all process with handling catheters seems to be the best strategy on preventing BRCI in newborns.
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ABSTRACT: To determine the cost-effectiveness of the newer antiseptic and antibiotic-impregnated central venous catheters (CVCs) relative to uncoated CVCs and to each other. Decision model analysis of the cost and efficacy of CVCs coated with either chlorhexidine silver sulfadiazine (CSS) or rifampin-minocycline (RM) at preventing catheter-related bloodstream infections (CRBSIs). The primary outcome is the incremental cost (or savings) to prevent one additional CRBSI. Model estimates are derived from prospective trials of the CSS and RM CVCs and from other studies describing the costs of CRBSIs. Setting and patients: Hypothetical cohort of 1,000 patients requiring placement of a CVC. In the model, patients were managed with either an uncoated CVC, CSS CVC, or RM CVC. Measurements and main results: The incremental cost-effectiveness of the treated CVCs was calculated as the savings resulting from CRBSIs averted less the additional costs of the newer devices. Sensitivity analysis of the effect of the major clinical inputs was performed. For the base case analysis, we assumed the incidence of CRBSIs was 3.3% with traditional catheters and that the CSS and RM CVC conferred a relative risk reduction for the development of CRBSIs of 60% and 85%, respectively. Despite their significantly higher cost than older catheters, both novel CVCs yield significant savings. Employing either of the treated CVCs saves approximately $10,000 per CRBSI prevented (relative to standard catheters). Comparing the RM CVC to the CSS CVC revealed the RM product to be economically superior, saving nearly $9,600 per CRBSI averted and $81 per patient in the cohort. For sensitivity analysis, we adjusted all model variables by 50% individually and then simultaneously. This demonstrated the model to be most sensitive to the cost of a CRBSI; however, with all inputs skewed by 50% against both the CSS CVC and the RM CVC, these devices remained economically attractive. Under this scenario, use of either treated device was less costly. Utilization of antiseptic and antibiotic-impregnated CVCs represent an attractive alternative for the prevention of CRBSIs and may lead to significant savings. Of the two newer, coated devices, the RM CVC performs better financially. These observations hold over a range of estimates for our model inputs.Chest 08/2003; 124(1):275-84. · 5.85 Impact Factor
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ABSTRACT: Nosocomial sepsis is a frequent complication of caring for very low birth weight infants and incidence varies substantially among centres. Many cases are preventable. An organized approach to understanding the epidemiology of nosocomial sepsis within a unit, and implementing evidence-based practices can successfully reduce the incidence. Diagnostic accuracy is important to limit excess empiric antibiotic therapy. Instituting a hand hygiene program of education, monitoring, and consideration of waterless hand disinfectants to avoid hand transmission of organisms is essential. An emphasis on early achievement of enteral nutrition, preferably with human milk is important to reduce unnecessary exposure to central catheters and parenteral nutrition. Use of maximum sterile barrier precautions by personnel trained and skilled in central catheter insertion, followed by meticulous care in preventing catheter hub contamination will reduce the incidence of catheter related sepsis. Ultimately, the culture of the NICU needs to shift from a focus on early detection of infection to one of prevention.Seminars in Neonatology 09/2002; 7(4):325-33.
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ABSTRACT: The purpose of this study was to compare the efficacy of chlorhexidine and povidone iodine for cleansing the operative field for vaginal surgery. This was a randomized controlled trial that compared 10% povidone iodine and 4% chlorhexidine gluconate as surgical scrubs. Our primary end point was the proportion of contaminated specimens (defined as total bacterial colony counts of >/=5000 colony-forming units) per group found throughout the surgical procedures. All patients received standard infection prophylaxis that included preoperative intravenous antibiotics. Immediately before antibiotic administration and baseline aerobic and anaerobic cultures of the vaginal flora were obtained, which were followed by cultures at 30 minutes after the surgical scrub and hourly thereafter throughout each patient's surgery. A total of 50 patients were enrolled between October 2002 and September 2003. There were no differences between the povidone iodine (n = 27) and chlorhexidine (n = 23) groups with respect to age, race, exogenous hormone use, body mass index, gravity, parity, preoperative mean colony counts, or operative time. Among the first set of intraoperative specimens (which were obtained 30 minutes after the surgical scrub), 63% of the cultures (17/27) from the povidone iodine group and 22% of the cultures (5/23) from the chlorhexidine group were classified as contaminated ( P = .003; relative risk, 6.12; 95% CI, 1.7, 21.6). Subsequent cultures failed to demonstrate significant differences. Chlorhexidine gluconate was more effective than povidone iodine in decreasing the bacterial colony counts that were found in the operative field for vaginal hysterectomy.American Journal of Obstetrics and Gynecology 02/2005; 192(2):422-5. · 3.88 Impact Factor