锁骨下静脉置管敷料更换时清洁消毒方法的改良

Improve cleaning and disinfectant methods for subclavian vein catheterization dressing change

目的探讨改良锁骨下静脉置管敷料更换时清洁消毒的方法(简称换药方法),对预防相关感染的效果。方法选择2012年1—6月某院重症监护室行右锁骨下静脉置管的患者120例,按置管日期分为对照组(单日)和实验组(双日)各60例。对照组采用传统的换药方法:2%碘酊消毒穿刺点及周围皮肤一遍,75%乙醇脱碘一遍;实验组采用改良换药方法:先用生理盐水擦拭穿刺点及周围皮肤3遍,清洁导管,再避开穿刺点用75%乙醇消毒周围皮肤3遍,用0.5%碘伏消毒穿刺点及周围皮肤3遍,最后消毒导管。对比两组相关感染率。结果实验组局部感染率为5.00%,导管相关性血流感染(CRBSI)率为1.67%,均显著低于对照组(分别为16.67%和13.33%),差异均有统计学意义(均P<0.05)。结论改良换药方法比传统换药方法效果好,能有效预防局部感染与CRBSI的发生。

Objective To evaluate the effect of improved cleaning and disinfection method for subclavian venipuncture dressing change to prevent catheter-associated infection. Methods 120 hospitalized patients with right subclavian venipuncture at an intensive care unit in January-June 2012 were divided into control group （n= 60）and experi-mental group（n= 60）according to venipuncture date. Control group adopted conventional dressing change ：disin-fected skin at and around puncture point by 2% iodine tincture,then used 75% alcohol for deiodination;experimental group adopted improved dressing change ：Wiped skin at and around puncture point three times by normal saline, cleaned catheter,disinfected skin around puncture point （avoid puncture point）three times by 75% alcohol,disinfected skin at and around puncture point three times by 0 .5% iodine tincture ,then disinfected catheter . Associated infection rate between two groups were compared . Results Focal infection rate and CRBI rate of experimental group were both lower than control group（5.00% vs 16.67% ;1.67% vs 13.33% ）,the difference was statistically different （P〈 0.05 ）. Conclusion Effect of improved dressing method is better than the conventional dressing method,it can effectively prevent occurrence of focal infection and CRBI.