根因分析法在降低中心静脉导管相关性感染中的应用

The application of root cause analytical method in reducing infections related to central venous catheter

目的通过根因分析减少中心静脉置管后相关性感染的发生率,提高置管患者的安全性。方法调查2012、2013年行中心静脉置管各768、838例患者资料,对2012年发生中心静脉导管感染患者,运用根因分析方法进行近端原因、根本原因分析,制定中心静脉导管的评估和监控机制,改进导管的置管与维护方法,强化对护士的培训和对患者及家属的宣教,于2013年对改进效果进行追踪。结果 2012年中心静脉导管相关性感染84例,感染率10.9%,2013年中心静脉导管相关性感染46例,感染率为5.5%,两年感染率差异有统计学意义(P<0.05);2013年置管部位感染和导管相关性血流感染(CRBSI)发生率分别为3.5%和2.0%,低于2012年的7.8%和3.1%,差异有统计学意义(P<0.05);留置中心静脉导管日感染率由7.2‰下降至3.5‰。结论根因分析法为更加系统、有效地降低中心静脉导管相关性血流感染的发生率,提供了的科学途径。

OBJECTIVE To reduce the incidence of central venous catheter-related infections and improve the safety of the patients with central venous catheter by root cause analytical method. METHODS The clinical data of 768 cases and 838 cases treated with central venous catheter in 2012 and 2013 were investigated. Through using the method of root cause analysis to analyze proximal causes and root causes for the 84 cases of catheter-related infections in 2012, the central venous catheter assessment and monitoring mechanism were set to improve the catheter insertion method and the maintenance method, and strengthen the training of nurses and the mission to patients and their families. The effect was traced in 2013. RESULTS There were 84 cases with central venous catheter-related infections in 2012; the infection rate was 10. 9%. And in 2013, this number was 46 cases; the infection rate was 5.5 %. The differences of the two yearsr infection rate was significant（P〈0.05）. The insertion site infection and catheter-related infection （CRBSI） incidence of 2013 were 29（3.5M）and 17（2.0~）, lower than those of 2012 , 60 （7.8 %） and 24 （3.1%）, there was significant differences （P〈0.05）. According to the days of the central catheter indwelling statistics, the daily infection rate fell from 7.2/1000 to 3.5/1000. CONCLUSION Root cause analytical method can provide a scientific way for systematically and effectively reducing the occurrence of central venous catheter-related infections.