背景:法国在血液透析环境中预防血管通路感染的指南于2005年发布。目前尚不清楚是否符合这些准则。我们的目的是评估法国血液透析单位血管通路感染预防指南的遵守情况。并描述报告的困难。
方法:于2019年3月至12月对法国随机选择的200个血液透析单位进行了横断面调查。数据通过问卷调查收集,通过与感染控制医生的电话采访完成。当>85%的单位宣布始终遵守准则时,该做法被视为合规。
结果:共有103个单位(51.5%)同意参加。大多数做法都符合指导方针,然而,其中一些(在连接中心静脉导管(CVC)线时成对工作,在断开管路之前进行手部卫生,在涂漆CVC出口部位或动静脉瘘(AVF)穿刺部位前冲洗防腐皂,让防腐油漆干燥,用防腐剂浸渍纱布处理CVC分支,用手套进行AVF压缩后的手部卫生,连接/断开CVC或穿刺AVF时佩戴防护眼镜,穿刺AVF时穿着礼服)未达到85%的依从性阈值。最经常报告的困难是人员不足,由于出口部位皮肤损伤而导致的皮肤准备困难,缺乏扣眼技术专长。
结论:尽管总体依从性良好,这项调查强调了在遵守感染预防指南方面的一些缺点,这可能与更高的血管通路感染风险或血液传播的病毒传播增加有关。
BACKGROUND: French
guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these
guidelines is currently unknown. The aim of this study was to assess compliance with the
guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported.
METHODS: A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the
guidelines.
RESULTS: In total, 103 units (51.5%) agreed to participate. Most practices complied with the
guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise.
CONCLUSIONS: Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.