PICU导管相关性泌尿系感染的预防

Prevention of catheter-related urinary system infection in PICU

目的探讨临床护理路径方法在重症监护患儿留置导尿中的效果,最大限度减少泌尿系统医院感染的发生。方法将2008年6月-2009年6月住院的46例留置导尿患儿作为对照组,2009年6月-2010年6月住院的67例留置导尿的患儿作为观察组,观察组采用常规方法行留置导尿;对照组采取临床护理路径方法对患儿进行规范化的护理;两组患儿留置导尿前均进行评估,尽量避免不必要的留置导尿。结果观察组有1例患儿在住院期间发生泌尿系统医院感染,感染率1.49%,1例患儿在拔管后不能自行排尿,再次插管,再次插管率为1.49%;对照组有6例患儿在住院期间发生泌尿系统医院感染,感染率13.04%,4例患儿在拔管后不能自行排尿,再次插管,再次插管率为8.70%;观察组护理方法明显优于对照组,差异有统计学意义(P<0.01)。结论临床护理路径方法有利于重症监护患儿留置导尿的护理,减少了留置导尿患儿拔管后不能自行排尿而再次插管的风险,能有效地减少导管相关性泌尿系统医院感染的发生。

OBJECTIVE To approach the clinical nursing pathway in intensive care in children with the effect of catheterization, minimize the occurrence of nosocomial infection in the urinary system. METHODS A total of 46 cases of hospitalized children in our department from Jun 2008 to Jun 2009 with indwelling catheter as the control group, 67 cases of hospitalized children from Jun 2009 to Jun 2010 with indwelling catheter as the observation group. Observation group line catheterization using conventional method, control group with a standardized method of care by clinical nursing pathway. Two groups were assessed before catheterization, try to avoid unnecessary catheterization. RESULTS Observation group, 1 patient proceed the nosocomial infection in the urinary system, 1 patient could not urinate after extubation, re-intubation~ Control group, 6 patient proceed the nosocomial infection in the urinary system, 4 patient could not urinate after extubation, re-intubation~ Nursing observation group than the control group, this difference has satistically significant（P^0. 01）. CONCLUSION Clinical pathway is conducive to clinical nursing intensive care nursing children with indwelling catheter. It can reduce the risk of re-intubation which can not urinate after extubation and is effective in reducing the incidence of nosocomial infection in the urinary system.