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

1.	陈香美. 血液净化标准操作规程（2021 版）. 北京: 人民卫生出版社, 2021: 179.
2.	王小芳, 徐文芳, 祝春红, 等. ICU 连续性肾脏替代疗法治疗患者预防医院感染的管理措施. 中华医院感染学杂志, 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.	中华人民共和国卫生部. 医院隔离技术规范: WS/T 311－2009. 北京: 中国标准出版社, 2009: 1-21.
5.	国家卫生健康委办公厅. 新型冠状病毒感染的肺炎防控中常见医用防护用品使用范围指引（试行）. 中国护理管理, 2020, 20(2): 164.
6.	中华医学会《中华全科医师杂志》编辑委员会, 《基层血液净化中心（室）新型冠状病毒感染防控建议》制订专家组. 基层血液净化中心（室）新型冠状病毒感染防控建议. 中华全科医师杂志, 2020, 19(3): 193-197.
7.	中华医学会肾脏病学分会专家组. 中华医学会肾脏病学分会关于血液净化中心（室）新型冠状病毒感染的防控建议. 中华肾脏病杂志, 2020, 36(2): 82-84.
8.	国家卫生健康委. 新型冠状病毒感染的肺炎病例转运工作方案（试行）. 医师在线, 2020, 10(5): 38.
9.	中华人民共和国卫生部. 血源性病原体职业接触防护导则: 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.	中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识（第 2 版）. 中国血液净化, 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.	赵宇亮, 杨济桥, 张凌, 等. 枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的 Meta 分析. 中华肾脏病杂志, 2013, 29(8): 574-582.
25.	孙红, 陈利芬, 郭彩霞, 等. 临床静脉导管维护操作专家共识. 中华护理杂志, 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.	中华人民共和国卫生部. 医疗机构消毒技术规范: WS/T 367－2012. 北京: 中国标准出版社, 2012: 1-36.
35.	潘夏蓁, 林碎钗, 屈敏吉, 等. 连续性血液净化治疗中管路采血对检验结果的影响. 中华护理杂志, 2013, 48(11): 1007-1008.
36.	张晓梅, 秦毅, 陈瑜, 等. 经中心静脉通路装置采血的最佳证据总结. 中华护理杂志, 2022, 57(9): 1134-1140.
37.	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 医院消毒卫生标准: 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.	中华人民共和国国家卫生健康委. 关于印发医疗机构内新型冠状病毒感染预防与控制技术指南（第三版）的通知. 中华人民共和国国家卫生健康委员会公报, 2021(9): 5-18.
42.	中华人民共和国国家卫生健康委员会. 医疗机构环境表面清洁与消毒管理规范: WS/T 512－2016, 2017: 1-10.
43.	中华人民共和国国家卫生健康委员会. 国家卫生健康委关于印发三级医院评审标准（2020 年版）的通知. 中华人民共和国国家卫生健康委员会公报, 2020(12): 149-192.
44.	上海市人民政府. 上海市消毒管理办法. 上海市人民政府公报, 2023(2): 3-8.
45.	陈辉, 巴衣尔策策克, 张威, 等. 新型冠状病毒肺炎院外急救防控策略与转运实践. 中国急救复苏与灾害医学杂志, 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.	邸红军, 施月仙, 臧红新, 等. 医务人员针刺伤预防策略的最佳证据总结. 中华护理杂志, 2017, 52(1): 93-98.
48.	童辉, 张仲华, 王李胜, 等. 综合医院血液净化中心应对新型冠状病毒肺炎疫情的管控实践. 护理学杂志, 2020, 35(22): 67-70.
49.	陈美恋, 高燕, 郭维, 等. 新型冠状病毒肺炎患者床旁血液净化治疗的感染防控. 北京大学学报(医学版), 2020, 52(3): 414-419.
50.	张漱洁, 李允勃. 对《污水综合排放标准》中有关医院污水排放标准的商榷. 环境与健康杂志, 2000, 17(5): 2.
51.	汪晖, 曾铁英, 吴欣娟, 等. 重型危重症新型冠状病毒肺炎患者整体护理专家共识. 中华护理杂志, 2020, 55(3): 481-486.
52.	中华护理学会血液净化专业委员会, 上海市护理学会血液净化专业委员会. 血液透析安全注射临床实践专家共识. 中华护理杂志, 2022, 57(7): 785-790.

1. 陈香美. 血液净化标准操作规程（2021 版）. 北京: 人民卫生出版社, 2021: 179.
2. 王小芳, 徐文芳, 祝春红, 等. ICU 连续性肾脏替代疗法治疗患者预防医院感染的管理措施. 中华医院感染学杂志, 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. 中华人民共和国卫生部. 医院隔离技术规范: WS/T 311－2009. 北京: 中国标准出版社, 2009: 1-21.
5. 国家卫生健康委办公厅. 新型冠状病毒感染的肺炎防控中常见医用防护用品使用范围指引（试行）. 中国护理管理, 2020, 20(2): 164.
6. 中华医学会《中华全科医师杂志》编辑委员会, 《基层血液净化中心（室）新型冠状病毒感染防控建议》制订专家组. 基层血液净化中心（室）新型冠状病毒感染防控建议. 中华全科医师杂志, 2020, 19(3): 193-197.
7. 中华医学会肾脏病学分会专家组. 中华医学会肾脏病学分会关于血液净化中心（室）新型冠状病毒感染的防控建议. 中华肾脏病杂志, 2020, 36(2): 82-84.
8. 国家卫生健康委. 新型冠状病毒感染的肺炎病例转运工作方案（试行）. 医师在线, 2020, 10(5): 38.
9. 中华人民共和国卫生部. 血源性病原体职业接触防护导则: 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. 中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识（第 2 版）. 中国血液净化, 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. 赵宇亮, 杨济桥, 张凌, 等. 枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的 Meta 分析. 中华肾脏病杂志, 2013, 29(8): 574-582.
25. 孙红, 陈利芬, 郭彩霞, 等. 临床静脉导管维护操作专家共识. 中华护理杂志, 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. 中华人民共和国卫生部. 医疗机构消毒技术规范: WS/T 367－2012. 北京: 中国标准出版社, 2012: 1-36.
35. 潘夏蓁, 林碎钗, 屈敏吉, 等. 连续性血液净化治疗中管路采血对检验结果的影响. 中华护理杂志, 2013, 48(11): 1007-1008.
36. 张晓梅, 秦毅, 陈瑜, 等. 经中心静脉通路装置采血的最佳证据总结. 中华护理杂志, 2022, 57(9): 1134-1140.
37. 中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 医院消毒卫生标准: 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. 中华人民共和国国家卫生健康委. 关于印发医疗机构内新型冠状病毒感染预防与控制技术指南（第三版）的通知. 中华人民共和国国家卫生健康委员会公报, 2021(9): 5-18.
42. 中华人民共和国国家卫生健康委员会. 医疗机构环境表面清洁与消毒管理规范: WS/T 512－2016, 2017: 1-10.
43. 中华人民共和国国家卫生健康委员会. 国家卫生健康委关于印发三级医院评审标准（2020 年版）的通知. 中华人民共和国国家卫生健康委员会公报, 2020(12): 149-192.
44. 上海市人民政府. 上海市消毒管理办法. 上海市人民政府公报, 2023(2): 3-8.
45. 陈辉, 巴衣尔策策克, 张威, 等. 新型冠状病毒肺炎院外急救防控策略与转运实践. 中国急救复苏与灾害医学杂志, 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. 邸红军, 施月仙, 臧红新, 等. 医务人员针刺伤预防策略的最佳证据总结. 中华护理杂志, 2017, 52(1): 93-98.
48. 童辉, 张仲华, 王李胜, 等. 综合医院血液净化中心应对新型冠状病毒肺炎疫情的管控实践. 护理学杂志, 2020, 35(22): 67-70.
49. 陈美恋, 高燕, 郭维, 等. 新型冠状病毒肺炎患者床旁血液净化治疗的感染防控. 北京大学学报(医学版), 2020, 52(3): 414-419.
50. 张漱洁, 李允勃. 对《污水综合排放标准》中有关医院污水排放标准的商榷. 环境与健康杂志, 2000, 17(5): 2.
51. 汪晖, 曾铁英, 吴欣娟, 等. 重型危重症新型冠状病毒肺炎患者整体护理专家共识. 中华护理杂志, 2020, 55(3): 481-486.
52. 中华护理学会血液净化专业委员会, 上海市护理学会血液净化专业委员会. 血液透析安全注射临床实践专家共识. 中华护理杂志, 2022, 57(7): 785-790.

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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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