PDF(Pubmed)
Abstract：
Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.
摘要：
医院耐甲氧西林金黄色葡萄球菌（MRSA）菌血症导致住院患者的发病率和死亡率显着增加。我们的目的是分析在危重病人的医院（MRSA）菌血症中除氯己定（CHG）沐浴外，每天两次对两个鼻孔应用10％聚维酮碘（PI）的影响。在设计前和设计后完成了质量改进研究。研究期为2018年1月至2020年2月，2021年2月和2021年6月。控制期（从2018年1月到2019年5月）包括仅CHG沐浴，在干预期，我们在危重患者的鼻孔中增加了10%的PI.我们的主要结果是医院MRSA菌血症的发生率，我们的次要结局是中线相关血流感染(CLABSI)和潜在的成本节约.危重患者MRSA菌血症发生率无显著差异。在医疗/手术区域（MSA）的干预期间，医院MRSA菌血症显着降低。危重患者的CLABSI在干预期间显着降低。在干预期间，重症监护区（CCA）没有金黄色葡萄球菌CLABSI。干预措施显示出潜在的显着成本节省。除CHG沐浴外，每天两次使用10％聚维酮碘可导致危重患者的CLABSI显着减少，而非干预地区的医院MRSA减少。需要进一步的试验来挑选出将从干预中受益的个体患者。
