ICU导管相关医院感染目标性监测及质量改进效果分析

Targeted monitoring of catheter-related nosocomial infections in ICU patients and effect of quality improvement

目的了解ICU患者导管相关医院感染,分析危险因素,采取相应干预措施,降低ICU患者医院感染率。方法采用前瞻性目标性监测方法对2010年1月-2012年12月入住ICU>48h的1 590例患者进行目标监测,填写统一调查表;2011年7月-2012年12月在以前感染控制措施的基础上,采取导管相关感染集束干预措施,并分析改进效果;采用Epidata3.1软件建立数据库,应用SPSS17.0统计软件进行统计分析。结果采取干预措施前患者留置导管总天数为16 469d,发生医院感染255例,千日感染率为15.48‰,其中呼吸机相关性肺炎(VAP)、中心静脉导管相关性血流感染(CRBSI)、导尿管相关尿路感染(CAUTI)的发生率分别为27.81‰、8.68‰、10.83‰;干预后留置导管总天数为15 201d,发生医院感染181例,千日感染率为11.91‰,较干预前明显降低,且VAP干预效果显著(P<0.05)。结论相关导管的使用可造成较高的医院感染,采取导管相关感染集束干预措施可以有效预防医院感染的发生。

OBJECTIVE To understand the incidence of catheter-related nosocomial infections in the ICU patients, analyze the risk factors, and take corresponding intervention measures so as to reduce the incidence of nosocomial infections. METHODS By means of the prospective targeted surveillance method, the targeted surveillance was performed for 1 590 patients who were hospitalized the ICU for more than 48 hours from Jan 2010 to Dec 2012, then the uniform questionnaire tables were filled out~ the cluster interventions to the catheter-related infections were taken on the basis of the previous control measures from Jul 2011 to Dec 2012, the improvement effect was analyzed, the database was set up by using Epidata3.1 software, and the statistical analysis was performed with the use of SPSS17.0 software. RESULTS Before the intervention measures were taken, the total number of the catheter indwelling days was 16 469 days, the nosocomial infections occurred in 255 cases, the thousand-day infec- tion rate was 15.48‰, the incidence rates of the ventilator-associated pneumonia （VAP）, central venous catheter- related bloodstream infections （CRBSI）, and catheter-associated urinary tract infections （CAUTI） were 27. 81‰, 81 68‰, and 10.83‰, respectively. After the intervention measures were taken, the total number of the catheter indwelling days was 15 201 days, the nosocomial infections occurred in 181 cases, and the thousand-day infection rate was 11.91‰, which was significantly reduced, and the effects of the interventions to VAP were significant （P〈0.05）. CONCLUSION The incidence of the catheter-related nosocomial infections is high, and it is an effec- tive way to take cluster interventions to the catheter-related infections so as to prevention the nosocomial infections.