三级甲等医院ICU中心静脉导管相关血流感染防控护理实践现况

The nursing prevention and control of Central Line-Associated Blood Stream Infections in ICUs of tertiary grade A hospitals

目的 :调查三级甲等医院ICU中心静脉导管相关血流感染(Central Line-AssociatedBloodStreamInfections,CLABSI)三级质量控制中的共性问题,为进一步制订干预措施、促进护理质量持续改进提供依据。方法 :基于Donabedian三维质量结构模型,借鉴《预防血管内导管相关血流感染过程质控工具包(推荐版)》中四大指引量表,自行编制ICU中心静脉导管相关血流感染防控护理实践调查问卷,采用便利抽样法于2023年9月—10月对中华护理学会医院感染管理专业委员会委员所在三级甲等医院ICU进行问卷调查分析。结果 :共129家医院的215个ICU完成调查,护理实践结构维度中,156个(72.56%)ICU定期进行CLABSI培训;过程维度中,护士执行率低于80%的项目有10项(31.25%),其中52个(24.19%)ICU在CVC穿刺时使用超声引导,59个(27.44%)ICU采用指南推荐的思乐扣固定导管,55个(25.58%)ICU使用葡萄糖氯己定抗菌敷料。结果维度中,193个(89.77%)ICU填写了CLABSI发生率。结论 :目前CLABSI防控聚焦导管置管和维护过程中的结构、过程及结果环节,但调研发现临床仍未形成同质化的防控措施。建议进一步加强过程质控管理,以期更好地改进护理质量。

Objective:To explore the common issues in the tertiary quality control of Central Line-Associated Blood Stream Infections(CLABSI)in ICUs of tertiary grade A hospital,and to provide basis for further development of intervention measures and continuous improvement of nursing quality.Methods:Based on the Donabedian three-dimensional quality structure model and referring to the four guideline scales in the Quality Control Toolkit for the Prevention of Intravascular Catheter-related Bloodstream Infections(Recommended version),We make the questionnaire about the nursing pratices of the prevention and control of bloodstream infections associated with ICU central venous catheters.From September to October 2023,a questionnaire survey was conducted among the members of the hospital Infection Prevention and Control Committee of the Chinese Nursing Association and their organizations in the ICU of tertiary grade A hospital.Results:A total of 215 ICUs in 129 hospitals participated in the survey.Among the dimensions of nursing practice structure,156 ICUs(72.56%)conducted regular sensory control training.In the process dimension,the nurse implementation rate was lower than 80%in 9 projects(28.13%),of which 52 ICUs(24.19%)used ultrasound guidance during CVC puncture,59 ICUs(27.44%)used the guideline recommended Selectol fixed catheter,and 55 ICUs(25.58%)used glucochlorhexidine antibacterial dressing.The incidence of CLABSI was reported in 193 ICUs(89.77%).Conclusion:At present,the structure,process,and results of CLABSI focused catheter catheterization and maintenance for prevention and control are involved,but it is found that no homogeneous prevention and control measures have been formed in clinical practice.It is suggested to further strengthen the process quality control management to better improve the quality of nursing.