手卫生质量持续改进对ICU中心静脉导管相关血流感染发生率的影响

Influence of continual improvement of hand hygiene quality on incidence rate of ICU central venous catheter related bloodstream infection

目的了解医务人员手卫生依从性和ICU中心静脉导管相关血流感染(CRBSI)发生情况,评价提高医务人员手卫生依从性对CRBSI的影响,为进一步降低CRBSI发生率提供依据。方法收集2013—2014年实施卫生持续质量改进措施前后医务人员手卫生依从性情况,分析入住ICU的611例中心静脉置管患者CRBSI发生率,比较患者CRBSI的发生率变化。结果干预前医务人员手消毒剂使用量为10.65 ml/床日,手卫生依从率为28.32%,正确洗手率为56.79%,患者CRBSI发生率为4.08‰;干预后医务人员手消毒剂使用量为30.25 ml/床日,手卫生依从率为62.25%,正确洗手率为90.57%,患者CRBSI的发生率为1.11‰。干预前后CRBSI发生率差异有统计学意义(χ2=17.576 9,P<0.01)。结论医务人员手卫生持续质量改进能降低CRBSI的发生率。

[Objective]To understand the hand hygiene compliance of medical staff and occurrence of ICU central venous catheter related bloodstream infection（CRBSI）,evaluate the influence of medical staff hand hygiene compliance on CRBSI,and provide the basis for further reducing the incidence rate of CRBSI. [Methods]The hand hygiene compliance of medical staff before and after implementing hand hygiene continuous quality improvement from 2013-2014 was collected. The incidence rates of CRBSI among 611 cases of placing central venous tube patients in ICU were analyzed,and the change of CRBSI incidence rate was compared. [Results]Before intervention,the usage amount of disinfector among medical staff was 10.65 ml/bed day,compliance rate of hand hygiene was 28.32%,correct rate of hand washing was 56.79%,and the incidence rate of CRBSI was 4.08‰. After intervention,the usage amount of disinfector among medical staff was 30.25 ml/bed day,compliance rate of hand hygiene was62.25%,correct rate of hand washing was 90.57%,and the incidence rate of CRBSI was 1.11‰. The difference of CRBSI incidence rate before and after intervention was statistically significant（χ2 =17.576 9,P 〈0.01）. [Conclusion]The continual improvement of hand hygiene quality among medical staff can reduce the incidence rate of CRBSI.