血液透析长期留置导管隧道口病原菌分布及其感染防治对策

Pathogen distribution on tunnel portal of hemodialysis long-term indwelling catheter and infection control measures

目的分析血液透析长期留置导管隧道口常见病原菌分布情况,以采取积极有效的措施,预防或减少感染的发生。方法对201 1-01-2012-12在我科行血液透析长期留置导管隧道口分泌物细菌培养阳性的87例患者的病原菌分布及药敏结果进行分析,观察临床感染发生情况,并采取相应的防治措施预防感染。结果共分离出87株病原菌,其中革兰阳性菌79株,占90.8%,革兰阴性菌8株,占9.2%;革兰阳性菌中表皮葡萄球菌有42株,其中耐甲氧西林表皮葡萄球菌(MRSEP)32株,占74.4%。87例患者中,2011年发生导管隧道口感染11例(12.6%),2012年发生导管隧道口感染4例(4.6%),2012年感染发生率较2011年明显下降,差异有统计学意义(P<0.05)。结论血液透析患者机体免疫功能下降,容易发生导管相关性感染。护士严格执行无菌操作,用碘伏纱布湿敷中心静脉导管置管口,并加强透析室环境及物品清洁消毒,可以减少导管相关性感染的发生。

Objective To analyze the pathogen distribution on tunnel portal of hemodialysis long-term indwel ing catheter and to explore effective infection control measures. Methods The distribution and drug susceptibility of bacterial strains isolated from long-term indwelling catheter tunnel portal were analyzed in 87 patients undergoing hemodialysis from January 2011 to De-cember 2012. Results Out of 87 pathogen isolates 79 were Gram-positive bacteria, accounting for 90.8%; 8 were Gram-nega-tive bacteria, accounting for 9.2%. Forty two strains of Staphylococcus Epidermidis （MRSEP） were identified, including 32 strains of methicillin-resistant MRSEP, accounted for 74.4% . The infection rate of long-term indwel ing catheter tunnel portal for hemodialysis patients was 12.6% （11/87） in 2011, while the infection rate was 4.6% （4/87）in 2012 , the difference of infection rate was statistical y significant （P〈0.05）. Conclusion The decline of hemodialysis patients＇s immune function prone to catheter-re-lated infections. The measurse to reduce hemodialysis patients infection incidence include nurse strict implementation of aseptic, wet dressing central venous catheters mouth using povidone-iodine gauze, and to strengthen environmental and articles clean-ing and disinfection.