目标性干预预防中心静脉导管相关性血流感染的效果分析

Effect of target intervention on preventing catheter-related bloodstream infection

目的：探讨实施目标性干预预防中心静脉导管相关性血流感染的效果。方法开展导管相关性血流感染的干预措施，通过更换静脉穿刺部位，由高年资麻醉医师实施穿刺，加强无菌操作和手卫生管理，减少股静脉置管和尽早拔除导管等方法，监测导管相关性血流感染的发病率，并与未开展目标性干预前的发病率进行比较。结果开展目标性干预后，导管相关性血流感染发病率由开展前的17．97％下降至4．32％，差异有统计学意义（χ2＝40．82，P＜0．05）。χ2检验和非条件logistic回归分析表明，当置管时间＞10 d，感染发生率显著性增加（χ2＝4．33，P＜0．05）；高年资麻醉医师实施穿刺，患者发生感染的概率明显下降（χ2＝9.21，P＜0．05）；股静脉置管的感染发生率较高（χ2＝7．45，P＜0．05）。结论导管留置时间、操作者不熟练、插管部位是患者发生导管血流感染的高危因素。应针对上述因素制定目标性干预措施，最大限度地建立防护屏障，可降低导管相关性感染的发病率。

Objective To investigate the effectiveness of target intervention in preventing catheter -related bloodstream infection （ CRBSI ） .Methods The targeted monitoring was launched by changing venepuncture site , reinforcing instructions in aseptic insertion technique and hand hygiene supervision ,avoiding femoral access and remo-ving unnecessary catheters ,venous puncture implemented by high qualification anesthesiologist ,then the incidence of CRBSI before and after the project was compared .Results The incidence of CRBSI after the project decreased signif-icantly from 17.97%to 4.32%,the difference was statistically significant （χ2 =40.82,P〈0.05）.Chi-square test and logistic regression analysis showed that the incidence of infection was increased in patients with catheter for longer than 10 days （χ2 =4.33,P〈0.05）,the incidence of CRBSI was decreased in patients that central venous puncture implemented by high qualification anesthesiologist （χ2 =9.21,P〈0.05）,and patients received catheter indwelling into femoral vein had increased incidence of CRBS （χ2 =7.45,P〈0.05）.Conclusion Indwelling catheter time, unskilled operator ,catheter site are risk factors in patients with CRBSI .In response to these factors ,we should develop interventions to maximize establish a protective barrier , improve the quality of the medical operation , prevent the occurrence of CRBSI more efficiently .