医院感染防控网格化管理模式降低ICU中心静脉导管相关血流感染的效能评估

Efficiency of grid management mode of nosocomial infection prevention and control in reducing incidence of central venous catheter-associated bloodstream infection in ICU patients

目的评估医院感染网格化质量控制管理体系降低重症监护室(ICU)患者中心静脉导管相关血流感染(CLABSI)发生的有效性。方法选取2021年1月-2023年12月连云港市第一人民医院综合ICU中心静脉置管≥48 h的患者为研究对象,根据是否实行医院感染网格化质量控制管理体系分为干预前期(2021年)、干预期(2022年)和维持期(2023年),比较干预前后中心静脉导管使用率、CLABSI发生率和病原菌分布特征。结果通过组建网格化管理团队、优化集束化防控措施、明确网格管理者职责和建立循证化培训及考核机制的医院感染网格化质量控制管理体系的实施,2021-2023年ICU中心静脉导管使用率分别为67.77%、63.09%和51.22%,CLABSI发生率从3.15‰降至2022年的0.75‰(P=0.001),2023年的0.94‰(P=0.002);CLABSI患者共检出病原菌29株,以革兰阳性菌为主,占比55.17%,多药耐药菌13株,以耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)最常见。结论网格化质量控制管理体系能够显著降低ICU患者CLABSI的风险,有助于加强医院感染的预防和控制工作。

OBJECTIVE To evaluate the effectiveness of the grid-based quality control management system in reducing the incidence of central venous catheter-associated bloodstream infection(CABSI)in the intensive care unit(ICU)patients.METHODS The patients who were treated with central venous catheters for no less than 48 hours in comprehensive ICU of the First People′s Hospital of Lianyungang from Jan 2021 to Dec 2023 were recruited as the research subjects and were divided into the pre-intervention period group(2021),the intervention period group(2022)and the maintenance period group(2023)according to the factor whether the grid-based quality control management system was carried out.The utilization rate of central venous catheter,incidence of CABSI and species of pathogens were observed and compared before and after the intervention.RESULTS The grid management team was established,the cluster prevention and control measures were optimized,the duties of the grid infection control staff were made clear,and the evidence-based training and grid-based quality control management system of assessment mechanism were established.After all of the above strategies were carried out,the utilization rate of central venous catheter of the ICU patients was 67.77%in 2021,63.09%in 2022,51.22%in 2023.The incidence rate of CABSI was decreased from 3.15‰in 2021 to 0.75‰(P=0.001)in 2022 and 0.94‰in 2023(P=0.002).Totally 29 strains of pathogens were isolated from the patients with CABSI,55.17%of which were gram-positive bacteria;there were 13 strains of multidrug-resistant organisms,and methicillin-resistant coagulase-negative Staphylococcus(MRCNS)was the most common.CONCLUSION The grid-based quality control strategies can remarkably reduce the risk of CABSI in the ICU patients and facilitate the prevention and control of nosocomial infection.