Point of view
To reduce the current rates of catheter-related bacteremia after the implementation of the Zero programs: This is the challenge
Reducir las tasas actuales de bacteriemia relacionada con catéter tras la implantación de los programas Zero: este es el reto
L. Lorente
Unidad de Cuidados Intensivos Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
Read
3743
Timeswas read the article
1642
Total PDF
2101
Total HTML
Share statistics
array:24 [ "pii" => "S2173572720300096" "issn" => "21735727" "doi" => "10.1016/j.medine.2019.08.001" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "1385" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2021;45:243-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569119302013" "issn" => "02105691" "doi" => "10.1016/j.medin.2019.08.003" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "1385" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2021;45:243-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 21 "formatos" => array:2 [ "HTML" => 11 "PDF" => 10 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Punto de vista</span>" "titulo" => "Reducir las tasas actuales de bacteriemia relacionada con catéter tras la implantación de los programas Zero: Este es el reto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "245" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "To reduce the current rates of catheter-related bacteremia after the implementation of the Zero programs: This is the challenge" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Lorente" "autores" => array:1 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Lorente" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572720300096" "doi" => "10.1016/j.medine.2019.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300096?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119302013?idApp=WMIE" "url" => "/02105691/0000004500000004/v1_202104150922/S0210569119302013/v1_202104150922/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572721000187" "issn" => "21735727" "doi" => "10.1016/j.medine.2019.08.002" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "1381" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2021;45:246-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Concordance between the oncologist and the intensivist in the decisions of aggressive measures in cancer patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "246" "paginaFinal" => "247" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Concordancia entre el oncólogo y el intensivista en las decisiones de instauración de medidas agresivas en el paciente oncológico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Escudero-Acha, Y. Peñasco, J.C. Rodriguez-Borregan, E. Cuenca Fito, L. Ferreira Freire, A. González-Castro" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Escudero-Acha" ] 1 => array:2 [ "nombre" => "Y." "apellidos" => "Peñasco" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Rodriguez-Borregan" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Cuenca Fito" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Ferreira Freire" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569119301974" "doi" => "10.1016/j.medin.2019.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119301974?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000187?idApp=WMIE" "url" => "/21735727/0000004500000004/v1_202104220744/S2173572721000187/v1_202104220744/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572720300746" "issn" => "21735727" "doi" => "10.1016/j.medine.2020.03.001" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "1403" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2021;45:234-42" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "234" "paginaFinal" => "242" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuidados intensivos orientados a la donación de órganos. Recomendaciones ONT-SEMICYUC" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 827 "Ancho" => 750 "Tamanyo" => 52739 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Brain CT scan revealing a large intraparenchymal hematoma in the right basal ganglia, with midline displacement and invasion and dilatation of the ventricular system.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Escudero Augusto, F. Martínez Soba, B. de la Calle, A. Pérez Blanco, B. Estébanez, J. Velasco, M.J. Sánchez-Carretero, T. Pont, J.M. Pérez Villares, N. Masnou, M.C. Martín Delgado, E. Coll, D. Perojo, D. Uruñuela, B. Domínguez-Gil" "autores" => array:15 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Escudero Augusto" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Martínez Soba" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "de la Calle" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Pérez Blanco" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Estébanez" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Velasco" ] 6 => array:2 [ "nombre" => "M.J." "apellidos" => "Sánchez-Carretero" ] 7 => array:2 [ "nombre" => "T." "apellidos" => "Pont" ] 8 => array:2 [ "nombre" => "J.M." "apellidos" => "Pérez Villares" ] 9 => array:2 [ "nombre" => "N." "apellidos" => "Masnou" ] 10 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín Delgado" ] 11 => array:2 [ "nombre" => "E." "apellidos" => "Coll" ] 12 => array:2 [ "nombre" => "D." "apellidos" => "Perojo" ] 13 => array:2 [ "nombre" => "D." "apellidos" => "Uruñuela" ] 14 => array:2 [ "nombre" => "B." "apellidos" => "Domínguez-Gil" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569119302372" "doi" => "10.1016/j.medin.2019.09.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119302372?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300746?idApp=WMIE" "url" => "/21735727/0000004500000004/v1_202104220744/S2173572720300746/v1_202104220744/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>" "titulo" => "To reduce the current rates of catheter-related bacteremia after the implementation of the Zero programs: This is the challenge" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "245" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "L. Lorente" "autores" => array:1 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "Lorente" "email" => array:1 [ 0 => "lorentemartin@msn.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reducir las tasas actuales de bacteriemia relacionada con catéter tras la implantación de los programas Zero: este es el reto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Current scenario of vascular catheter-related bacteremia</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vascular catheter-related bacteremia (CRB) is associated to increased patient morbidity-mortality and healthcare costs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Different measures have therefore been proposed to try to prevent it.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> A meta-analysis has shown the application of a series of measures to result in an important decrease in the incidence of CRB in many studies worldwide.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Bacteremia Zero project implemented in 2009 reduced the incidence of CRB,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> comprising bloodstream infection of unknown origin and bacteremia secondary to central venous catheter (CVC) placement, from 4.9 to 2.8 cases per 1000 days of CVC, and from 2.7 to 1.4 per 1000 days of CVC, respectively.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These rates have been maintained over time, possibly with the help of implementation of the Pneumonia Zero,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Resistance Zero<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and Urinary tract infection Zero projects.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The measures for the prevention of CRB include adequate hand hygiene, optimum barrier measures, skin disinfection with chlorhexidine, preference for subclavian access, withdrawal of needless catheters, and hygienic handling of catheters.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">During these 10 years of implementation of the Bacteremia Zero project, new evidence has emerged referred to certain non-proposed measures such as CVCs impregnated with antimicrobials, dressing impregnated with chlorhexidine, daily chlorhexidine bathing and capping with antiseptic for needle-free connectors. Such measures have been proposed by the clinical practice guides (CPGs) of the Society for Healthcare Epidemiology of America (SHEA) published in 2014,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the UK Department of Health published in 2014,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the Asia Pacific Society of Infection Control (APSIC) published in 2016<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The challenge therefore arises to continue reducing the current CRB rates.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Catheters impregnated with antimicrobials</span><p id="par0020" class="elsevierStylePara elsevierViewall">The American,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> British<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and Asian CPGs<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> recommend the use of catheters impregnated with antimicrobials if the CRB rates remain high. A meta-analysis published in 2018<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> including 25 randomized clinical trials (RCTs) and 9368 CVCs (4001 standard catheters, 2598 catheters impregnated with chlorhexidine / silver sulfadiazine, 1635 impregnated with silver, and 1134 impregnated with rifampicin and miconazole or minocycline) found CVCs impregnated with chlorhexidine / silver sulfadiazine (odds ratio [OR]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.64; 95% confidence interval [95%CI]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.40–0.96) or antibiotics (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.3; 95%CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.25–0.95) to pose a lesser risk of CRB than standard catheters. However, there were no significant differences between CVCs impregnated with silver and standard catheters (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.77; 95%CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.46–1.27).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Limitations for the use of impregnated CVCs comprise possible allergies to the antimicrobial (isolated cases) or infections caused by microorganisms resistant to the drug (in <span class="elsevierStyleItalic">in vitro</span> studies and animal models).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dressings impregnated with chlorhexidine</span><p id="par0030" class="elsevierStylePara elsevierViewall">The American,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> British<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and Asian CPGs<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> recommend the use of dressings impregnated with chlorhexidine. A meta-analysis published in 2019<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> including 11 RCTs and 10,796 catheters (CVCs, arterial catheters and tunneled catheters) concluded that impregnated dressings reduce the risk of CRB (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.60; 95%CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.42–0.85). However, the studies posed the limitation of including different types of catheters (CVCs, arterial catheters and tunneled catheters) and catheter insertion sites associated with different CRB risks; furthermore, the protective effect for each catheter type and site was not determined.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Dressings impregnated with chlorhexidine also have the inconvenience of possible allergies or infections caused by microorganisms resistant to chlorhexidine. On the other hand, none of the RCTs of the meta-analysis reported the incidence of resistances; only three of the trials reported the incidence of contact dermatitis (approximately 5% and particularly affecting newborn infants with a weight of under 1<span class="elsevierStyleHsp" style=""></span>kg and less than four months of age); and no systemic reactions to chlorhexidine were reported.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Bathing of the patient with chlorhexidine</span><p id="par0040" class="elsevierStylePara elsevierViewall">Bathing of the patient with chlorhexidine is advised by the American<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and Asian CPGs,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and is not analyzed in the British guides.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> A meta-analysis published in 2019<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> involving 26 studies (8 RCTs and 18 observational studies) analyzed the effect of daily bathing with chlorhexidine. Eighteen studies used disposable sponges with 2% chlorhexidine, while 8 studies used chlorhexidine solutions (at a concentration of 4% in 5 studies, 2% in two studies, and 0.9% in one study). The incidence of CRB was seen to be lower with daily chlorhexidine bathing than when soap and water were used (incidence rate ratio<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.59; 95%CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.52–0.68).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The possible limitations referred to the appearance of allergies or infections caused by microorganisms resistant to chlorhexidine were not analyzed in the studies included in the meta-analysis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Capping with 70% isopropyl alcohol for needle-free connectors</span><p id="par0050" class="elsevierStylePara elsevierViewall">The American CPGs<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> recommend this practice, while the British<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and Asian guides do not analyze its use.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> A meta-analysis published in 2017<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> involving 7 observational studies (with a before-after implementation design) recorded a decrease in CRB (incidence rate ratio<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.59; 95%CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.45–0.77) associated to the use of capping with antiseptic versus standard capping – though the appearance of allergies to the antiseptic was not analyzed.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Proposal for reducing the current vascular catheter-related bacteremia rates</span><p id="par0055" class="elsevierStylePara elsevierViewall">As in the case of the Pneumonia Zero project, there are both mandatory measures and optional measures. The four measures for preventing CRB (impregnated CVCs, impregnated dressings, chlorhexidine bathing and capping with antiseptic) could be incorporated to the Bacteremia Zero initiative as optional measures. The current mandatory measures of the Bacteremia Zero project certainly must be maintained, in view of the outcomes they afford. Each individual center should decide the need to adopt optional measures, the types of measures, and the kind of patients in which they should be applied. Optional measures possibly are indicated in those units that despite adequate compliance with the mandatory measures present CRB rates (encompassing bacteremia of unknown origin and secondary to CVC) of over three episodes per 1000 days of CVC, in accordance with the quality standard proposed by the SEMICYUC in 2017 (ht*tps://w*ww.bing.com/search?PC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>WCUG&FORM<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>WCUGDF&q<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>indicadoresdecalidad2017_semicyuc_spa-1.pdf). We could start by adopting some of the mentioned measures, with a view to securing increased efficiency (I personally would recommend impregnated CVCs, which moreover represent the optional measure with the greatest supporting evidence according to the latest CPGs<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a>). Likewise with a view to securing increased efficiency, we could start by applying the chosen optional measure in concrete clinical scenarios: 1) patients at increased risk of CRB (immune depressed subjects, altered skin integrity); 2) vascular accesses posing an increased risk of CRB (jugular vein with tracheostomy or femoral vein)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>; and 3) patients at an increased risk of suffering complications if CRB develops (recent implantation of heart valves or aortic prostheses). Depending on whether or not the quality standard is reached after adopting the optional measure in the selected clinical scenarios, we could decide application of the measure to the rest of the patients, or adopt other optional measures in the selected clinical settings.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Current scenario of vascular catheter-related bacteremia" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Catheters impregnated with antimicrobials" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Dressings impregnated with chlorhexidine" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Bathing of the patient with chlorhexidine" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Capping with 70% isopropyl alcohol for needle-free connectors" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Proposal for reducing the current vascular catheter-related bacteremia rates" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-20" "fechaAceptado" => "2019-08-28" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorente L. Reducir las tasas actuales de bacteriemia relacionada con catéter tras la implantación de los programas Zero: este es el reto. Med Intensiva. 2021;45:243–245.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The level of evidence of each measure for preventing CRB according to each clinical practice guide is indicated in parentheses.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CRB: vascular catheter-related bacteremia; CSD: chlorhexidine / silver sulfadiazine; CVC: central venous catheter; RM: rifampicin - minocycline.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CVCs impregnated with CSD or RM \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dressings impregnated with chlorhexidine \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Daily bathing with chlorhexidine \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Capping with antiseptic for needle-free connectors \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">American guides 2014<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(I) in patients > 2 months if the CRB rates remain high or in the case of a personal history of recurrent CRB or high risk of sequelae due to CRB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(I) in patients > 2 months. Doubtful benefit if daily chlorhexidine bathing is used \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(I) in patients > 2 months. Doubtful benefit if dressing impregnated with chlorhexidine are used \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(I) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">British guides 2014<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(A) if the CRB rates do not decrease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(B) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not analyzed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not analyzed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asian guides 2016<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(IA) if the CRB rates do not decrease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(IB) in patients > 2 months if the CRB rates do not decrease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(IIB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not analyzed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Most recent meta-analyses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis published in 2018<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis published in 2019<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis published in 2019<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis published in 2017<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2579267.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recommendations of different scientific societies and new evidence on measures for the prevention of vascular catheter-related bacteremia (CRB) following implementation of the Bacteremia Zero project.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Chaves" 1 => "J. Garnacho-Montero" 2 => "J.L. Del Pozo" 3 => "E. Bouza" 4 => "J.A. Capdevila" 5 => "M. de Cueto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.09.012" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "volumen" => "42" "paginaInicial" => "5" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29406956" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiseptic measures during the insertion and manipulation of vascular catheters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Lorente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.09.012" "Revista" => array:7 [ "tituloSerie" => "Med Intensiva" "fecha" => "2019" "volumen" => "43" "numero" => "Suppl 1" "paginaInicial" => "39" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30409681" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antisepsis in the handling of vascular access connections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Fernández Moreno" 1 => "M. Píriz Marabaján" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2019" "volumen" => "43" "numero" => "Suppl 1" "paginaInicial" => "44" "paginaFinal" => "47" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Ista" 1 => "B. van der Hoven" 2 => "R.F. Kornelisse" 3 => "C. van der Starre" 4 => "M.C. Vos" 5 => "E. Boersma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(15)00409-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "724" "paginaFinal" => "734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26907734" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacteremia Zero Working Group. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Palomar" 1 => "F. Álvarez-Lerma" 2 => "A. Riera" 3 => "M.T. Díaz" 4 => "F. Torres" 5 => "Y. Agra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3182923622" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "2364" "paginaFinal" => "2372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23939352" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sociedad Española de Medicina Intensiva; Sociedad Española de Enfermería Intensiva. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Álvarez Lerma" 1 => "M. Sánchez García" 2 => "L. Lorente" 3 => "F. Gordo" 4 => "J.M. Añón" 5 => "J. Álvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2013.12.007" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "226" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24594437" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scientific Expert Committee for Zero Resistance Project. Combatting resistance in intensive care: the multimodal approach of the Spanish ICU "Zero Resistance" program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.G. Montero" 1 => "F.Á Lerma" 2 => "P.R. Galleymore" 3 => "M.P. Martínez" 4 => "L.Á Rocha" 5 => "F.B. Gaite" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Crit Care" "fecha" => "2015" "volumen" => "19" "paginaInicial" => "114" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "[8]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de Estudio ENVIN-HELICS. Is a project needed to prevent urinary tract infection in patients admitted to spanish ICUs?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Álvarez Lerma" 1 => "P. Olaechea Astigarraga" 2 => "X. Nuvials" 3 => "R. Gimeno" 4 => "M. Catalán" 5 => "M.P. Gracia Arnillas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.12.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2019" "volumen" => "43" "paginaInicial" => "63" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29426705" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "[9]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Society for Healthcare Epidemiology of America. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Marschall" 1 => "L.A. Mermel" 2 => "M. Fakih" 3 => "L. Hadaway" 4 => "A. Kallen" 5 => "N.P. O’Grady" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/676533" "Revista" => array:6 [ "tituloSerie" => "Infect Control Hosp Epidemiol" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "753" "paginaFinal" => "771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24915204" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "[10]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "UK Department of Health. Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.P. Loveday" 1 => "J.A. Wilson" 2 => "R.J. Pratt" 3 => "M. Golsorkhi" 4 => "A. Tingle" 5 => "A. Bak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect" "fecha" => "2014" "volumen" => "86" "numero" => "Suppl 1" "paginaInicial" => "S1" "paginaFinal" => "70" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "[11]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Ling" 1 => "A. Apisarnthanarak" 2 => "N. Jaggi" 3 => "G. Harrington" 4 => "K. Morikane" 5 => "T.A. Thu le" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13756-016-0116-5" "Revista" => array:5 [ "tituloSerie" => "Antimicrob Resist Infect Control" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27152193" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "[12]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Wang" 1 => "H. Tong" 2 => "H. Liu" 3 => "Y. Wang" 4 => "R. Wang" 5 => "H. Gao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13613-018-0416-4" "Revista" => array:5 [ "tituloSerie" => "Ann Intensive Care" "fecha" => "2018" "volumen" => "8" "paginaInicial" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29904809" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "[13]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chlorhexidine-silver sulfadiazine- or rifampicin-miconazole-impregnated venous catheters decrease the risk of catheter-related bloodstream infection similarly" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Lorente" 1 => "M. Lecuona" 2 => "A. Jiménez" 3 => "L. Raja" 4 => "J. Cabrera" 5 => "O. Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajic.2015.08.014" "Revista" => array:6 [ "tituloSerie" => "Am J Infect Control" "fecha" => "2016" "volumen" => "44" "paginaInicial" => "50" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26412482" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "[14]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Wei" 1 => "Y. Li" 2 => "X. Li" 3 => "L. Bian" 4 => "Z. Wen" 5 => "M. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12879-019-4029-9" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2019" "volumen" => "19" "paginaInicial" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31096918" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "[15]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "J.S. Musuuza" 1 => "P.K. Guru" 2 => "J.C. O’Horo" 3 => "C.M. Bongiorno" 4 => "M.A. Korobkin" 5 => "R.E. Gangnon" 6 => "N. Safdar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2019" "volumen" => "19" "paginaInicial" => "416" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "[16]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.F. Voor In 't Holt" 1 => "O.K. Helder" 2 => "M.C. Vos" 3 => "L. Schafthuizen" 4 => "S. Sülz" 5 => "A. van den Hoogen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijnurstu.2017.01.007" "Revista" => array:6 [ "tituloSerie" => "Int J Nurs Stud" "fecha" => "2017" "volumen" => "69" "paginaInicial" => "34" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28130997" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004500000004/v1_202104220744/S2173572720300096/v1_202104220744/en/main.assets" "Apartado" => array:4 [ "identificador" => "402" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Point of view" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004500000004/v1_202104220744/S2173572720300096/v1_202104220744/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300096?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 41 | 40 | 81 |
| 2024 September | 53 | 25 | 78 |
| 2024 August | 75 | 39 | 114 |
| 2024 July | 52 | 24 | 76 |
| 2024 June | 60 | 46 | 106 |
| 2024 May | 55 | 27 | 82 |
| 2024 April | 77 | 41 | 118 |
| 2024 March | 43 | 27 | 70 |
| 2024 February | 50 | 36 | 86 |
| 2024 January | 45 | 39 | 84 |
| 2023 December | 38 | 38 | 76 |
| 2023 November | 52 | 51 | 103 |
| 2023 October | 48 | 36 | 84 |
| 2023 September | 41 | 37 | 78 |
| 2023 August | 41 | 15 | 56 |
| 2023 July | 48 | 34 | 82 |
| 2023 June | 35 | 14 | 49 |
| 2023 May | 55 | 41 | 96 |
| 2023 April | 37 | 20 | 57 |
| 2023 March | 81 | 59 | 140 |
| 2023 February | 59 | 44 | 103 |
| 2023 January | 54 | 28 | 82 |
| 2022 December | 65 | 40 | 105 |
| 2022 November | 68 | 54 | 122 |
| 2022 October | 66 | 34 | 100 |
| 2022 September | 49 | 37 | 86 |
| 2022 August | 41 | 52 | 93 |
| 2022 July | 49 | 48 | 97 |
| 2022 June | 36 | 41 | 77 |
| 2022 May | 43 | 50 | 93 |
| 2022 April | 51 | 46 | 97 |
| 2022 March | 54 | 43 | 97 |
| 2022 February | 49 | 57 | 106 |
| 2022 January | 42 | 33 | 75 |
| 2021 December | 48 | 50 | 98 |
| 2021 November | 37 | 41 | 78 |
| 2021 October | 70 | 95 | 165 |
| 2021 September | 45 | 47 | 92 |
| 2021 August | 56 | 53 | 109 |
| 2021 July | 4 | 1 | 5 |
| 2020 July | 13 | 9 | 22 |
| 2020 June | 31 | 18 | 49 |
| 2020 May | 21 | 15 | 36 |
| 2020 April | 23 | 17 | 40 |
Show all
