持续质量改进对ICU中心静脉导管相关性血流感染的效果评价

Effect of continuous quality improvement on central venous catheterrelated bloodstream infections in ICU

目的了解ICU中心静脉导管相关性血流感染(CRBSI)的发病率趋势,探讨持续质量改进措施对ICU中心静脉置管相关性感染的效果。方法将2012年1-12月ICU行中心静脉置管66例患者作为对照组,未实施持续质量改进措施;将2013年1-12月ICU行中心静脉置管74例患者作为观察组,实施持续质量改进措施,观察两组发生导管相关性血流感染情况。结果观察组CRBSI发生率为0.96‰,对照组为5.09‰,观察组明显低于对照组,两组比较差异有统计学意义(χ2=5.22,P<0.05)。结论通过实施严格的最大无菌屏障,正确选择皮肤消毒剂,合理更换敷料,增加医护人员的宣教力度,实施氯己定洗浴等持续质量改进的措施,可减少ICU中心静脉置管患者CRBSI的发生。

OBJECTIVE To understand the incidence of central venous catheter-related bloodstream infections （CRBSI） in ICU and observe the effect of continuous quality improvement on the CRBSI. METHODS Totally 66 patients who received the central venous catheterization in ICU from Jan to Dec 2012 were chosen as the control group, for which the continuous quality improvement was not adopted; while 74 patients who underwent the cen- tral venous catheterization in ICU from Jan to Dec 2013 were assigned as the observation group, for which the con- tinuous quality improvement was adopted, and the incidence of the catheter-related bloodstream infections was ob- served and compared between the two groups. RESULTS The incidence of CRBSI was 0.96‰ in the observation group, significantly lower than 5.09‰ in the control group, the difference between the two groups was significant （x2 =5.22,P〈0.05）. CONCLUSION The incidence of CRBSI in the ICU patients can be reduced through the im- plementation of the continuous quality improvement measures such as strict maximum sterile barrier, reasonable selection of skin disinfectants, correct change of dressing, enhancement of propaganda to the medical staff, and chlorhexidine bath.