导管相关性血流感染预防措施依从性调查及执行效果评价

Investigation of the compliance of preventive measures of catheter-related bloodstream infections and evaluation of the practices

目的了解成人监护中心静脉导管相关血流感染（CLABSI）的集束化预防措施依从性现状,并评价其执行效果。方法对2012年10月~2013年6月入住外科监护室（SICU）、急诊监护室（EICU）、心脏监护室（CCU）和呼吸监护室（RCU）时间〉48 h的病例进行目标性监测,填写CLABSI相关监测信息并如实填写临床对于置管患者执行5大循证预防措施的情况,包括手卫生、置管时最大无菌屏障、2.0%氯己定皮肤消毒、选取适宜置管部位和每日评估尽早拔管。比较各监护室预防措施依从性及CLABSI感染率。结果各监护室对预防措施总依从性为74.5%,CLABSI感染率为6.4‰;其中,RCU预防措施依从性最低（60.2%）,感染率最高（10.5‰）;SICU预防措施依从性最高（84.4%）,感染率最低（2.1‰）,差异有统计学意义（P〈0.05）。结论目标性监测和有效的干预可以减少CLABSI的发生率。

Objective To understand the compliance status of cluster prevention of central line associated bloodstream infection （CLABSI） in adult intensive care unit, and to evaluate the effects of execution. Methods By means of the tar-geted surveillance method, the targeted surveillance was performed for patients who were hospitalized the SICU, EICU, CCU and RCU for more than 48 hours from October 2012 to June 2013. Then filled the CLABSI monitoring information and the compliance of 5 evidence-based preventive practices, which included hand hygiene, maximum sterile barrier, 2% chlorhexidine skin disinfection, daily evaluation and promptly remove any intravascular catheter that is no longer essential. The compliance of preventive measures and the infection incidence of CLABSI were compared. Results The compliance status of the preventive measures was 74.5%, the incidence rates of CLABSI was 6.4‰; the lowest compli-ance of preventive measures was RCU which was 60.2%, meanwhile, the infection incidence of RCU was the highest , which was 10.5‰; SICU had the highest compliance of preventive measures, which was 84.4%, and the infection inci-dence rates was the lowest, which was 2.1‰.（P〈 0.05）. Conclusion The targeted monitoring and the effectively pre-venting can reduce the incidence rates of CLABSI.