集束干预策略预防中心静脉导管相关性血流感染的效果

Clinical effects of bundle intervention strategy on the prevention of CVC-related bloodstream infections

目的 研究集束干预策略对预防ICU中心静脉导管相关性血流感染（ CRBSI）的临床意义. 方法 将入住ICU留置中心静脉导管的847例患者按时段分组：2008年6月—2010年6月411例共计5 760个导管留置日,采用常规护理方法,为对照组;2010年9月—2012年9月436例共计6 110个导管留置日,施行集束干预策略,为观察组. 比较两组置管部位和置管时间的差异,以及CRBSI发生率.结果 观察组留置导管时间为（8 ±3）d,明显短于对照组的（13 ±7）d,差异有统计学意义（t=2.672,P=0. 008）. 观察组436例置管患者,共留置6 110个导管留置日,有14例患者发生了CRBSI,发生率为2. 3/千导管留置日;对照组411例置管患者,共留置5 760个导管留置日,有38例患者发生了CRBSI,发生率为6. 6/千导管留置日;两组CRBSI发生率比较,差异有统计学意义（χ2 =12. 60,P=0. 002）. 结论 集束干预策略能有效降低CRBSI的发生率。

Objective To study the clinical effects of bundle intervention strategy on the prevention of CVC-related bloodstream infections. Methods A total of 847 patients were enrolled, of whom 411 cases received central venous catheterization （ CVC） from June 2008 to June 2010 were allocated to control group with 5760 catheter days and traditional central venous catheter care. While a total of 436 cases from September 2010 to September 2012 were allocated to observation group with 6110 catheter days and performed bundle intervention strategy. The site and duration of CVC, and incidence of CVC-related bloodstream infections between two groups were compared. Results The length of catheter indwelling in the observation group was （ 8 ± 3 ） d which was shorter than （13 ± 7）d in the control group （t=2. 672,P=0. 008）. A total of 436 patients of observation group had total 6 110 d catheter indwelling time, in whom14 cases happened CRBSI with incidence rate 2. 3 per one thousand catheter day;411 patients of the control group had 5 760 d catheter indwelling time, in whom 38 cases occurred CRBSI with incidence rate 6. 6 per one thousand catheter day; the difference of CRBSI rate in two groups had statistical significance （χ2 =12. 60,P =0. 002）. Conclusions The implementation of bundle intervention strategy can effectively minimize the incidence of CVC-related bloodstream infections.