回溯性研究比較使用開放式與封閉式　周邊靜脈導管之相關血流感染

Risk factors for bloodstream infections and differences in medical expenditures between open-system and closed-system needleless connectors: A retrospective study in a medical center

本研究比較使用兩種靜脈連接管之合併症與原發性血流感染，並比較兩者成本效益。採回溯性時間序列病歷資料分析，收集台灣南部某醫學中心感染科病房2016至2018年間有靜脈注射的病人共1,070人，其中a mounted open system MOS（Open-system）組439人使用開放式連接管，a compact closed system COS（Closed-system）組631人使用封閉式連接管。結果MOS組的導管使用時間（9.9±8.1天）明顯長於COS組（8.7±6.3天）；p＝.014。MOS組經歷的靜脈腫漏次數（0.7±1.4次）比COS組（0.3±0.9次）多得多；p<.001。兩組住院期間靜脈炎的發生頻率無顯著差異（p＝.068）。在研究期間，共有4例病人經歷了原發性血流感染，MOS組3例（0.7％），COS組1例（0.2％）；p＝.191，所有感染都是由革蘭氏陰性菌引起的。羅吉斯回歸分析顯示血流感染與導管使用時間（p＝.006）和靜脈炎的發生（p＝.046）之間存在顯著相關性。計算MOS組中相關血流感染額外支出為NT 15,094／天，COS組為NT 8,781／天。由於樣本量較小，MOS組和COS組之間的原發性血流感染發生率沒有顯著差異。雖然COS組便利性及花費時間優於MOS組，但多變項分析結果無法推論支持任一種醫材裝置。故減少周邊導管使用人日及靜脈炎的發生，才是預防原發性血流感染的照護重點。

Purpose: Closed-system (COS) needleless connectors (NCs) have been found to reduce the risk of microbial infection compared to open-system (MOS)devices, according to previous studies. However, the cost-effectiveness and risk of venous complications and primary bloodstream infections (BSIs) have not been previously reported in Taiwan. Methods: A retrospective time-series analysis of medical records was performed on 1,070 patients who had received intravenous injections between November 01, 2016 and October 31, 2018, in an infectious disease ward at a medical center in southern Taiwan. The MOS group consisted of 439 patients who had used MOS NCs, while the COS group consisted of 631 patients who had used COS NCs. The extra medical expenditures were calculated among patients with primary BSIs. Thereafter, logistic regression analysis was used to analyze the risk factors for patients with primary BSIs. Results: The MOS group had a significantly longer duration of catheter use compared with the COS group (MOS, 9.9±8.1 days; COS, 8.7±6.3 days; p = 0.014). Regarding the frequency of venous swelling, the MOS group experienced significantly greater frequency of venous swelling than the COS group (MOS, 0.7±1.4 times; COS, 0.3±0.9 times; p <0.001). In contrast, no significant differences were found in terms of phlebitis frequency between the two groups (p = 0.068). During the study period, a total of four patients had experienced primary BSIs (three in the MOS group [0.7%] and one in the COS group [0.2%]; p = 0.191). All primary BSIs were caused by gram-negative bacteria. Logistic regression analysis showed that there was a significant correlation between primary BSIs and the duration of catheter use and between primary BSIs and the occurrence of phlebitis. Additional expenditures for the primary BSIs cost NT15,094 per day in the MOS group and NT8,781 per day in the COS group. Conclusion: There were no significant differences in the occurrence rate of primary BSIs between the MOS and COS groups due to the small sample size. The adaptation of the COS group was preferred over the MOS group because of its superior convenience and lower time consumption. However, the results of the multivariate analysis showed no superiority of one medical device over the other. Reducing the duration of catheter use and the occurrence of phlebitis are key factors in preventing primary bloodstream infections.