ICU导尿管相关泌尿系感染危险因素分析及护理对策

Analysis of risk factors of catheter-associated urinary tract infection in ICU and the nursing countermeasures

目的探讨ICU患者导尿管相关泌尿系感染(CAUTI)的危险因素,为针对性采取有效的护理措施提供科学依据。方法目标性监测2012年4月—2014年3月收住本院ICU的患者,观察并统计留置尿管时机、留置天数、尿管维护、会阴护理、尿液性状及尿培养结果等。结果 1421例留置尿管患者中发生泌尿系感染92例,急诊入院患者留置尿管、留置尿管超过7d、会阴护理每日2次以下是泌尿系感染的高危因素(P<0.05)。92例患者共分离病原菌153株,其中23例为多重耐药菌,前3位的病原菌分别是肺炎克雷伯菌17.65%、白色念珠菌15.69%、大肠埃希菌9.80%。结论缩短尿管留置时间、急诊置管患者加强无菌技术、正确维护尿管、保证引流装置密闭性、加强会阴护理、切实落实多重耐药菌隔离措施,是有效预防导尿管相关泌尿系感染的护理策略。

Objective To discuss the risk factors of ICU patients with catheter-associate-durinary tract infection （CAUTI）so as to provide scientific basis for effective nursing measures. Methods ICU patients from April 2012 to March 2014 in our hospital were monitored,and in-dwelling catheter chances,indwelling catheter days,maintenance of urinary catheter,perineum nursing,the urine property,urine culture results were observed.Results 92 cases of urinary tract infection occurred in 1421 urinary catheter indwelling patients.Patients in emergency department with indwelling catheter more than 7 days and perineum nursing less than 2 times a day had more risk factors of urinary tract infection （P 〈0.05）.A total of 153 pathogenic bacteria were separated in 92 patients.Among these pathogenic bacteria,23 cases were multiple drug-resistant bacteria. The top three pathogens were 17.65% of klebsiella,15.69% of candidaalbicans and 9.80% of es-cherichia coli.Conclusion Effective nursing strategies are to shorten the urine tube indwelling time,improve the technique of emergency patients with catheter,correctly maintain urine tube,en-sure the drainage device sealability,strengthen the perineum nursing,apply multiple drug-resis-tant bacteria isolation measures so as to prevent catheter-associated urinary tract infection.