深静脉置管患者感染危险因素分析

Risk factors for deep venous catheter-associated infections

目的探讨深静脉置管患者感染的危险因素,并制定相关护理干预措施,以降低深静脉置管感染的发生率,从而提高患者治愈率。方法收集2011-2013年深静脉置管患者212例,采集其导管内、外及对侧外周静脉血进行细菌培养,对检验结果进行统计分析,同一例患者采集3次静脉血。结果 212例患者取样本均合格有效,能得到准确的实验室结果及相关临床资料;在212例患者中发生感染14例,感染率6.6%,所有感染患者经过治疗痊愈出院;深静脉置管时间<5d感染率2.6%,≥20d感染率66.7%;导管内、外血液细菌培养阳性率分别为20.3%、23.1%,明显高于外周静脉血阳性率的9.9%,组间比较差异有统计学意义(P<0.05);金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌为主要致病菌,其感染率分别为21.4%、21.4%、14.3%。结论深静脉置管是导致细菌感染的重要因素,且置管时间越长、细菌感染概率越高,因此严格控制置管时间尤为重要,同时,对深静脉置管患者采取针对性的护理,减少导管污染机会,降低深静脉置管感染率。

OBJECTIVE To explore the risk factors for deep venous catheter-related infections and put forward cor- responding nursing intervention measures so as to reduce the incidence of deep venous catheter-related infections and improve the healing rate. METHODS A total of 212 patients who underwent the deep venous catheter indwell- ing from 2011 to 2013 were enrolled in the study, then the peripheral venous blood was sampled from the internal, external, and opposite sides of the catheters for the bacterial culture, the test results were statistically analyzed , and the blood was sampled three times from each patient. RESULTS All the samples obtained from 212 patients were so eligible that the accurate laboratory results and relevant clinical data could be acquired. Of the 212 patients, the infections occurred in 14 cases with the infection rate of 6.6%, and the patients with infections were cured and discharged after the treatment. The incidence of infections was 2.6% in the patients with the time of deep venous catheter indwelling less than 5 days, 66.7% in the patients with the time of deep venous catheter indwelling no less than 20 days. The positive rate of bacterial culture was 20.3 % for the blood from internal sides of catheters, 23.1% for the blood from the external sides of catheters, significantly higher than 9.90% for the periph- eral venous blood, and there was significant difference between group （P〈0.05）. The Staphylococcus aureus, Escherichia coli, and Staphylococcus epidermidis were the predominant species of pathogens, and the incidence rates of infections were 21.4%, 21.4%, and 14.3%, respectively. CONCLUSION The deep venous catheter in- dwelling is an important factor for the bacterial infections, the longer the time of catheter indwelling, the higher the incidence of bacterial infections is; therefore, it is necessary to strictly control the time of catheter indwelling, take targeted nursing interventions, and reduce the opportunistic contamination of catheters so as to reduce the in- cidence of deep venous catheter-related infections.