使用Chlorhexidine擦澡對中心導管相關血流感染之統合分析

Chlorhexidine Bed-Bath Improves CLABSI: A Meta-Analysis

背景 中心導管在加護病房是常見的處置，一旦中心導管相關血流感染發生，會造成住院天數延長及醫療 成本的增加。 目的 本研究運用系統性回顧與統合分析，探討加護病房以2% chlorhexidine（CHG）擦澡能否降低中心導 管相關血流感染（central line-associated bloodstream infections, CLABSI）。 方法 以關鍵字搜尋有CHG及肥皂──水二組不同擦澡的研究，以英國公共衛生資源發表的Critical Appraisal Skills Programme進行評讀，文獻品質以Joanna Briggs Institute文獻評讀指南進行評價，共篩選出6篇符合評選標準，並以RevMan 5統計軟體執行資料分析。 結果 本研究顯示研究的樣本間具有同質性（p ＝.002, I2 ＝64%），綜合效量為0.45（95%信賴區間［0.35, 0.58］, p ＜ .001），顯示以CHG擦澡可以降低中心導管相關血流感染的發生。 結　論／ 實務應用 本研究統合分析顯示以CHG擦澡可以降低CLABSI，建議未來加護病房執行中心導管組合式照護時，可考慮搭配使用CHG擦澡，以減少CLABSI之發生。

Background: Central catheters are used primarily in ICU settings. Bloodstream infections in the central line of central catheters have been shown to cause longer hospital stays for patients and result in higher medical costs. Purpose: The present study applies a systematic review and meta-analysis to assess the effect of a 2% chlorhexidine (CHG) bed-bath on the risk of central line-associated bloodstream infections (CLABSI). Methods: The Public Health Resource Unit of England issued the Critical Appraisal Skills Programme and evaluated the standardized crucial appraisal tools from the Joanna Briggs Institute that are used to assess methodological quality. The present study identified 6 studies that met the criteria from a keyword search that included: CHG and soap-water for bed-bath experiment. The experiment used RevMan 5 software to conduct the meta- analysis. Results: The results support the homogeneity (p = .002, I2 = 64%) of the sample. Comprehensive effectiveness was 0.45 (95% CI [0.35, 0.58], p <.001). The CHG bed-bath intervention was shown to effectively reduce CLABSI. Conclusions / Implications for Practice: The meta-analysis indicated that bed-bath with CHG reduces the incidence of CLABSI. We recommend that center catheter bundle care be applied in ICUs in combination with CHG bed-bath in order to reduce the risk of CLABSI.