导管相关性血流感染集束预防策略的依从性及其对发生率的影响

Compliance of bundle prevention strategies for catheter-related bloodstream infections and its impact on the incidence

目的了解临床医务人员对导管相关性血流感染(CRBSI)集束预防策略的依从性及其对发生率的影响,以降低ICU医院感染的发生率。方法对2009年10月-2010年10月和2010年11月-2011年11月入住ICU并行中心静脉置管的患者进行观察记录,统计两年医务人员对CRBSI集束预防策略的依从性和CRBSI发生率,分析CRBSI集束预防策略的依从性与其发生率的关系,所有数据应用SPSS13.0软件进行统计分析。结果共收集病例1296例,其中2009年10月-2010年10月628例,感染率为6.1‰,2010年11月-2011年11月668例,感染率为4.2‰;两年患者的年龄、性别、APACHEⅡ评分、住ICU时间差异无统计学意义;两年集束预防策略的依从性分别为:提供最大无菌屏障78.66%、94.16%;穿隔离衣50.32%、76.65%;严格执行无菌操作(操作中严格接头消毒)72.30%、90.12%;首选锁骨下静脉穿刺率43.16%、68.41%,差异均有统计学意义(P<0.05);平均导管留置时间(8.1、5.91)d,差异无统计学意义;第2年集束预防策略依从性提高后,CRBSI的发生率由6.1‰降至4.2‰,差异有统计学意义(χ2=5.714,P<0.05)。结论 CRBSI的集束预防策略能够降低其发生率,临床医务人员应不断提高集束预防策略中各项措施的依从性。

OBJECTIVE To understand the compliance of bundle prevention strategies on catheter-related bloodstream infections（CRBSI）of the medical personnel and explore its impact on the incidence so as to reduce the incidence of the nosocomial infections in the ICU.METHODS The patients who underwent central venous catheterization in the ICU from Oct 2009to Oct 2010and from Nov 2010to Nov 2011were recorded and observed,the compliance of the bundle prevention strategies for CRBSI and the incidence of CRBSI were statically analyzed,the correlation between the compliance of bundle prevention strategies and the incidence of CRBSI was analyzed,the data were statistically analyzed by SPSS10.0software.RESULTS The study included 1296cases of patients,the infections occurred in 628cases during Oct 2009to Oct 2010with the incidence of 6.1‰,and the infection occurred in 668 cases during Nov 2010to Nov 2011with the incidence of 4.2‰;the difference in the age,sex,APACHEII score or ICU stay between the patients in the two periods was not statistically significant;the compliance of bundle prevention strategies during the two years were：maximum sterile barrier provided when operations（78.66% vs 94.16%）,wearing A gown（50.32% vs 76.65%）,strict execution sterile operation（72.30% vs 90.12%）,preferred subclavian vein puncturing rate（43.16% vs 68.41%）,the difference was statistically significant（P 0.05）.The average indwelling catheter time was（8.1vs 5.9 1days）,without statistical difference.After the compliance of bundle prevention strategies was improved in the second year,the incidence of CRBSI decreased from 6.1‰to 4.2‰,the difference was statistically significant（χ2=5.7 1 4,P〈0.0 5）.CONCLUSION The bundle prevention strategies can reduce the incidence of CRBSI.Clinical medical personnel should continue to improve the compliance of the bundle prevention strategies.