Risk Factors Of Central Venous Catheter-related Infection And The Effect Of Insertion Site Intervention In Burn Patients

Part A metaⅠ-analysis of risk factors for CVC-RI in burn patientsObjective To identify risk factors for central venous catheter-related infection in burn patients through Meta analysis.Methods Chinese and English databases MEDLINE,EMBASE,CENTRAL,Chinese biomedical literature database(CBM),CNKI,vipdatabase(VIP),Wan Fang database and references of the included literatures were searched.Two evaluators independently screened,extracted and evaluated the literatures according to the inclusion and exclusion criteria.Meta analysis was performed with Rev Man5.3.Results A total of 496 references were retrieved and 15 were included(sample size was 4317 catheters).Among them,6 are in Chinese,9 are in English.There were 31 risk factors involved,only the total burn area was > 50%(OR=2.01,95%CI: 1.26-1.86,P<0.001),inhalation injury(OR=3.30,95%CI: 1.12-9.70,P=0.03),femoral vein catheterization(OR=1.71,95%CI: 1.11-2.65,P=0.02),catheter placement near the wound(OR=2.46,95%CI: 1.76-3.45,P<0.001),and catheter indwelling > 7days(OR=1.75,95%CI: 1.25-2.45,P=0.001)and catheter indwelling days > 14 days(OR=2.46,95%CI: 1.55-3.89,P<0.001)was statistically significant and was a risk factor for CVC-RI in burn patients,while the use of antimicrobial catheter(OR=0.51,95%CI: 0.30-0.89,P=0.02)was a protective factor for CVC-RI in burn patients.Conclusions There is insufficient evidence on the risk factors of central venous catheter-related infection in burn patients,and the CRI diagnostic criteria involved in the study are inconsistent and not applicable to burn patients.Therefore,more original studies with rigorous design and unified CRI diagnostic criteria are needed in the future to provide a reliable basis for the prevention of central venous catheter-related infection in burn patients.Part Ⅱ The Efficacy and Comparison of Chlorhexidine Acetate and Povidone Iodine in the Maintenance of Central Venous Catheter Insertion Site in Burn Patients:A Randomized Controlled TrialObjective To verify and compare the maintenance effect of chlorhexidine acetate and povidone iodine solution on central venous catheter puncture site in burn patients.Methods A randomized controlled clinical trial was conducted to randomly divide 66 burn patients with central venous catheters placed in or around the wound in Fujian Burn Center into the conventional group,the povidone iodine wet compress group and the chlorhexidine acetate wet compress group,with 22 patients in each group.On the basis of the conventional group,the povidone iodine wet compress group used the iodine wet compress for 15 minutes.The clohexidine acetate group used the clohexidine acetate cotton ball for disinfection and the clohexidine acetate wet compress for 15 minutes.The other operations were the same.The incidence of CRI and CRBSI in central venous catheter was compared among the three groups,and the independent risk factors of CVC-RI in burn patients were further analyzed.Results(1)A total of 100 strains of pathogenic bacteria were detected in 59 patients with secondary CVC catheterization.Among them,20 were positive in blood culture,19 were positive in catheter tip culture,and 61 were positive in wound culture.A total of 62 strains of gram-negative bacteria were found,accounting for 62.00%.Among the pathogens detected in blood culture and wound culture,klebsiella pneumoniae was the most detected,accounting for 25.00%(5/20)and 22.95%(14/61),respectively.Among the pathogens in catheter tip culture,staphylococcus aureus ranked first,accounting for 31.58%(6/19).Among them,MRSA and CRAB are the main multi-drug resistant bacteria.(2)The incidence of CRI and CRBSI in the clohexidine acetate wet compress group was lower than that in the conventional group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of CRI and CRBSI between the iodine-acetate wet compress group and the conventional group,and the iodine-iodine wet compress group and the conventional group(P>0.05).(3)Multi-factor Cox proportional risk regression model showed that wet application of chlorhexidine acetate was superior to conventional maintenance.The risk of CVC-RI in burn patients using wet application of chlorhexidine acetate was only 3.1%(HR=0.031,95%CI 0.003-0.335,P <0.05).For each additional device,the risk of infection increased by 3.561 times(HR=3.561,95%CI 1.358-9.340,P<0.05).Conclusions(1)Among the CVC-RI pathogenic bacteria in burn patients,the proportion of gramnegative bacteria was slightly higher than that of gram-positive bacteria.The main pathogens were staphylococcus aureus,klebsiella pneumoniae and acinetobacter baumannii.MRSA and CRAB were the main multidrug-resistant bacteria.(2)Wet application of chlorhexidine acetate on CVC puncture site in burn patients can significantly reduce bacterial colonization on catheter tip,thus effectively reducing the incidence of CRI and CRBSI in central venous catheter.(3)Additional device is an independent risk factor of CVC-RI in burn patients.Clinically,the use of additional device should be reduced as much as possible,and detailed management of CVC should be done well during catheter indwelling.