Expert consensus on hospital infection prevention and control in continuous renal replacement therapy_West China Medical Journal

Authors：

 Nephrology Brunch of Sichuan International Medical Exchange & Promotion Association

Corresponding?author：

Nephrology Brunch of Sichuan International Medical Exchange & Promotion Association, Email: fupinghx@163.com

Keywords：

Continuous renal replacement therapy; hospital infection prevention and control; expert consensus

DOI：

10.7507/1002-0179.202306195

Video：

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Abstract Full text Figures/Tables Video References Cited by

Currently, there is a lack of guidelines and consensuses on hospital infection prevention and control for continuous renal replacement therapy (CRRT) at home and aboard. Given that in-hospital infection control for CRRT differs from that for intermittent hemodialysis, the Nephrology Brunch of Sichuan International Medical Exchange & Promotion Association, in collaboration with West China Hospital of Sichuan University, has established an expert consensus group for CRRT hospital infection prevention and control. The group conducted systematic retrieval, data analysis, and expert consultation on the thematic content, and developed five topics: occupational protection for CRRT healthcare personnel, CRRT catheter-related infections, collection of CRRT blood/waste specimens, disinfection of CRRT machines, and utilization and disposal of CRRT consumables and waste. The aim is to standardize clinical practices, prevent nosocomial infections, and enhance awareness among healthcare personnel regarding infection prevention and control in CRRT settings.

Citation： Nephrology Brunch of Sichuan International Medical Exchange & Promotion Association. Expert consensus on hospital infection prevention and control in continuous renal replacement therapy. West China Medical Journal, 2023, 38(7): 961-968. doi: 10.7507/1002-0179.202306195 Copy

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2.	王小芳, 徐文芳, 祝春紅, 等. ICU 連續性腎臟替代療法治療患者預防醫院感染的管理措施. 中華醫院感染學雜志, 2013, 23(16): 3889-3890, 3893.
3.	Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest, 2006, 129(1): 174-181.
4.	中華人民共和國衛生部. 醫院隔離技術規范: WS/T 311－2009. 北京: 中國標準出版社, 2009: 1-21.
5.	國家衛生健康委辦公廳. 新型冠狀病毒感染的肺炎防控中常見醫用防護用品使用范圍指引（試行）. 中國護理管理, 2020, 20(2): 164.
6.	中華醫學會《中華全科醫師雜志》編輯委員會, 《基層血液凈化中心（室）新型冠狀病毒感染防控建議》制訂專家組. 基層血液凈化中心（室）新型冠狀病毒感染防控建議. 中華全科醫師雜志, 2020, 19(3): 193-197.
7.	中華醫學會腎臟病學分會專家組. 中華醫學會腎臟病學分會關于血液凈化中心（室）新型冠狀病毒感染的防控建議. 中華腎臟病雜志, 2020, 36(2): 82-84.
8.	國家衛生健康委. 新型冠狀病毒感染的肺炎病例轉運工作方案（試行）. 醫師在線, 2020, 10(5): 38.
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12.	Warren DK, Cosgrove SE, Diekema DJ, et al. A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol, 2006, 27(7): 662-669.
13.	Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol, 2002, 23(12 Suppl): S3-S40.
14.	Bischoff WE, Reynolds TM, Sessler CN, et al. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med, 2000, 160(7): 1017-1021.
15.	Mimoz O, Lucet JC, Kerforne T, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet, 2015, 386(10008): 2069-2077.
16.	Mimoz O, Pieroni L, Lawrence C, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med, 1996, 24(11): 1818-1823.
17.	Maki DG, Stolz SS, Wheeler S, et al. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med, 1994, 22(11): 1729-1737.
18.	Froehlich CD, Rigby MR, Rosenberg ES, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med, 2009, 37(3): 1090-1096.
19.	Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.
20.	Rasero L, Degl’Innocenti M, Mocali M, et al. Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized, multicenter study. The Italian Nurse Bone Marrow Transplant Group (GITMO). Haematologica, 2000, 85(3): 275-259.
21.	Zakrzewska-Bode A, Muytjens HL, Liem KD, et al. Mupirocin resistance in coagulase-negative staphylococci, after topical prophylaxis for the reduction of colonization of central venous catheters. J Hosp Infect, 1995, 31(3): 189-193.
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23.	O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis, 2011, 52(9): e162-e193.
24.	趙宇亮, 楊濟橋, 張凌, 等. 枸櫞酸和肝素封管液預防血液透析長期留置導管相關感染的 Meta 分析. 中華腎臟病雜志, 2013, 29(8): 574-582.
25.	孫紅, 陳利芬, 郭彩霞, 等. 臨床靜脈導管維護操作專家共識. 中華護理雜志, 2019, 54(9): 1334-1342.
26.	Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis, 2009, 49(1): 1-45.
27.	Coupez E, Timsit JF, Ruckly S, et al. Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?. Crit Care, 2016, 20(1): 230.
28.	Flowers RH 3rd, Schwenzer KJ, Kopel RF, et al. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. A randomized, controlled trial. JAMA, 1989, 261(6): 878-883.
29.	Robbins J, Cromwell P, Korones DN. Swimming and central venous catheter-related infections in the child with cancer. J Pediatr Oncol Nurs, 1999, 16(1): 51-56.
30.	Seguin J, Fletcher MA, Landers S, et al. Umbilical venous catheterizations: audit by the Study Group for Complications of Perinatal Care. Am J Perinatol, 1994, 11(1): 67-70.
31.	Loisel DB, Smith MM, MacDonald MG, et al. Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. J Perinatol, 1996, 16(6): 461-466.
32.	Boo NY, Wong NC, Zulkifli SS, et al. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health, 1999, 35(5): 460-465.
33.	Wang F, Dai M, Zhao Y, et al. Reliability of monitoring acid-base and electrolyte parameters through circuit lines during regional citrate anticoagulation-continuous renal replacement therapy. Nurs Crit Care, 2022, 27(5): 646-651.
34.	中華人民共和國衛生部. 醫療機構消毒技術規范: WS/T 367－2012. 北京: 中國標準出版社, 2012: 1-36.
35.	潘夏蓁, 林碎釵, 屈敏吉, 等. 連續性血液凈化治療中管路采血對檢驗結果的影響. 中華護理雜志, 2013, 48(11): 1007-1008.
36.	張曉梅, 秦毅, 陳瑜, 等. 經中心靜脈通路裝置采血的最佳證據總結. 中華護理雜志, 2022, 57(9): 1134-1140.
37.	中華人民共和國國家質量監督檢驗檢疫總局, 中國國家標準化管理委員會. 醫院消毒衛生標準: GB 15982－2012, 2012: 1-12.
38.	Kellum J, Bellomo R, Ronco C. Continuous renal replacement therapy. New York: Oxford University Press, Inc: 2010: 247-251.
39.	Ali S, Moore G, Wilson AP. Effect of surface coating and finish upon the cleanability of bed rails and the spread of Staphylococcus aureus. J Hosp Infect, 2012, 80(3): 192-198.
40.	Trajtman AN, Manickam K, Alfa MJ. Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths. Am J Infect Control, 2015, 43(7): 686-689.
41.	中華人民共和國國家衛生健康委. 關于印發醫療機構內新型冠狀病毒感染預防與控制技術指南（第三版）的通知. 中華人民共和國國家衛生健康委員會公報, 2021(9): 5-18.
42.	中華人民共和國國家衛生健康委員會. 醫療機構環境表面清潔與消毒管理規范: WS/T 512－2016, 2017: 1-10.
43.	中華人民共和國國家衛生健康委員會. 國家衛生健康委關于印發三級醫院評審標準（2020 年版）的通知. 中華人民共和國國家衛生健康委員會公報, 2020(12): 149-192.
44.	上海市人民政府. 上海市消毒管理辦法. 上海市人民政府公報, 2023(2): 3-8.
45.	陳輝, 巴衣爾策策克, 張威, 等. 新型冠狀病毒肺炎院外急救防控策略與轉運實踐. 中國急救復蘇與災害醫學雜志, 2021, 16(8): 866-870, 879.
46.	Cheung K, Ho SC, Ching SS, et al. Analysis of needlestick injuries among nursing students in Hong Kong. Accid Anal Prev, 2010, 42(6): 1744-1750.
47.	邸紅軍, 施月仙, 臧紅新, 等. 醫務人員針刺傷預防策略的最佳證據總結. 中華護理雜志, 2017, 52(1): 93-98.
48.	童輝, 張仲華, 王李勝, 等. 綜合醫院血液凈化中心應對新型冠狀病毒肺炎疫情的管控實踐. 護理學雜志, 2020, 35(22): 67-70.
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1. 陳香美. 血液凈化標準操作規程（2021 版）. 北京: 人民衛生出版社, 2021: 179.
2. 王小芳, 徐文芳, 祝春紅, 等. ICU 連續性腎臟替代療法治療患者預防醫院感染的管理措施. 中華醫院感染學雜志, 2013, 23(16): 3889-3890, 3893.
3. Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest, 2006, 129(1): 174-181.
4. 中華人民共和國衛生部. 醫院隔離技術規范: WS/T 311－2009. 北京: 中國標準出版社, 2009: 1-21.
5. 國家衛生健康委辦公廳. 新型冠狀病毒感染的肺炎防控中常見醫用防護用品使用范圍指引（試行）. 中國護理管理, 2020, 20(2): 164.
6. 中華醫學會《中華全科醫師雜志》編輯委員會, 《基層血液凈化中心（室）新型冠狀病毒感染防控建議》制訂專家組. 基層血液凈化中心（室）新型冠狀病毒感染防控建議. 中華全科醫師雜志, 2020, 19(3): 193-197.
7. 中華醫學會腎臟病學分會專家組. 中華醫學會腎臟病學分會關于血液凈化中心（室）新型冠狀病毒感染的防控建議. 中華腎臟病雜志, 2020, 36(2): 82-84.
8. 國家衛生健康委. 新型冠狀病毒感染的肺炎病例轉運工作方案（試行）. 醫師在線, 2020, 10(5): 38.
9. 中華人民共和國衛生部. 血源性病原體職業接觸防護導則: GBZ/T 213－2008, 2009: 1-26.
10. Warren DK, Zack JE, Cox MJ, et al. An educational intervention to prevent catheter-associated bloodstream infections in a non-teaching, community medical center. Crit Care Med, 2003, 31(7): 1959-1963.
11. Warren DK, Zack JE, Mayfield JL, et al. The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest, 2004, 126(5): 1612-1618.
12. Warren DK, Cosgrove SE, Diekema DJ, et al. A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol, 2006, 27(7): 662-669.
13. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol, 2002, 23(12 Suppl): S3-S40.
14. Bischoff WE, Reynolds TM, Sessler CN, et al. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med, 2000, 160(7): 1017-1021.
15. Mimoz O, Lucet JC, Kerforne T, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet, 2015, 386(10008): 2069-2077.
16. Mimoz O, Pieroni L, Lawrence C, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med, 1996, 24(11): 1818-1823.
17. Maki DG, Stolz SS, Wheeler S, et al. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med, 1994, 22(11): 1729-1737.
18. Froehlich CD, Rigby MR, Rosenberg ES, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med, 2009, 37(3): 1090-1096.
19. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.
20. Rasero L, Degl’Innocenti M, Mocali M, et al. Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized, multicenter study. The Italian Nurse Bone Marrow Transplant Group (GITMO). Haematologica, 2000, 85(3): 275-259.
21. Zakrzewska-Bode A, Muytjens HL, Liem KD, et al. Mupirocin resistance in coagulase-negative staphylococci, after topical prophylaxis for the reduction of colonization of central venous catheters. J Hosp Infect, 1995, 31(3): 189-193.
22. 中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識（第 2 版）. 中國血液凈化, 2019, 18(6): 365-381.
23. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis, 2011, 52(9): e162-e193.
24. 趙宇亮, 楊濟橋, 張凌, 等. 枸櫞酸和肝素封管液預防血液透析長期留置導管相關感染的 Meta 分析. 中華腎臟病雜志, 2013, 29(8): 574-582.
25. 孫紅, 陳利芬, 郭彩霞, 等. 臨床靜脈導管維護操作專家共識. 中華護理雜志, 2019, 54(9): 1334-1342.
26. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis, 2009, 49(1): 1-45.
27. Coupez E, Timsit JF, Ruckly S, et al. Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?. Crit Care, 2016, 20(1): 230.
28. Flowers RH 3rd, Schwenzer KJ, Kopel RF, et al. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. A randomized, controlled trial. JAMA, 1989, 261(6): 878-883.
29. Robbins J, Cromwell P, Korones DN. Swimming and central venous catheter-related infections in the child with cancer. J Pediatr Oncol Nurs, 1999, 16(1): 51-56.
30. Seguin J, Fletcher MA, Landers S, et al. Umbilical venous catheterizations: audit by the Study Group for Complications of Perinatal Care. Am J Perinatol, 1994, 11(1): 67-70.
31. Loisel DB, Smith MM, MacDonald MG, et al. Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. J Perinatol, 1996, 16(6): 461-466.
32. Boo NY, Wong NC, Zulkifli SS, et al. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health, 1999, 35(5): 460-465.
33. Wang F, Dai M, Zhao Y, et al. Reliability of monitoring acid-base and electrolyte parameters through circuit lines during regional citrate anticoagulation-continuous renal replacement therapy. Nurs Crit Care, 2022, 27(5): 646-651.
34. 中華人民共和國衛生部. 醫療機構消毒技術規范: WS/T 367－2012. 北京: 中國標準出版社, 2012: 1-36.
35. 潘夏蓁, 林碎釵, 屈敏吉, 等. 連續性血液凈化治療中管路采血對檢驗結果的影響. 中華護理雜志, 2013, 48(11): 1007-1008.
36. 張曉梅, 秦毅, 陳瑜, 等. 經中心靜脈通路裝置采血的最佳證據總結. 中華護理雜志, 2022, 57(9): 1134-1140.
37. 中華人民共和國國家質量監督檢驗檢疫總局, 中國國家標準化管理委員會. 醫院消毒衛生標準: GB 15982－2012, 2012: 1-12.
38. Kellum J, Bellomo R, Ronco C. Continuous renal replacement therapy. New York: Oxford University Press, Inc: 2010: 247-251.
39. Ali S, Moore G, Wilson AP. Effect of surface coating and finish upon the cleanability of bed rails and the spread of Staphylococcus aureus. J Hosp Infect, 2012, 80(3): 192-198.
40. Trajtman AN, Manickam K, Alfa MJ. Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths. Am J Infect Control, 2015, 43(7): 686-689.
41. 中華人民共和國國家衛生健康委. 關于印發醫療機構內新型冠狀病毒感染預防與控制技術指南（第三版）的通知. 中華人民共和國國家衛生健康委員會公報, 2021(9): 5-18.
42. 中華人民共和國國家衛生健康委員會. 醫療機構環境表面清潔與消毒管理規范: WS/T 512－2016, 2017: 1-10.
43. 中華人民共和國國家衛生健康委員會. 國家衛生健康委關于印發三級醫院評審標準（2020 年版）的通知. 中華人民共和國國家衛生健康委員會公報, 2020(12): 149-192.
44. 上海市人民政府. 上海市消毒管理辦法. 上海市人民政府公報, 2023(2): 3-8.
45. 陳輝, 巴衣爾策策克, 張威, 等. 新型冠狀病毒肺炎院外急救防控策略與轉運實踐. 中國急救復蘇與災害醫學雜志, 2021, 16(8): 866-870, 879.
46. Cheung K, Ho SC, Ching SS, et al. Analysis of needlestick injuries among nursing students in Hong Kong. Accid Anal Prev, 2010, 42(6): 1744-1750.
47. 邸紅軍, 施月仙, 臧紅新, 等. 醫務人員針刺傷預防策略的最佳證據總結. 中華護理雜志, 2017, 52(1): 93-98.
48. 童輝, 張仲華, 王李勝, 等. 綜合醫院血液凈化中心應對新型冠狀病毒肺炎疫情的管控實踐. 護理學雜志, 2020, 35(22): 67-70.
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Blood purification: from renal replacement to organ support

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Expert consensus on hospital infection prevention and control in continuous renal replacement therapy

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