过程质量监测在控制ICU院内感染中的应用

Application of process quality monitoring for the control of hospital infection in ICU

目的 探讨过程质量监测在控制ICU院内感染中的作用.方法 选择2014年4月1日至2015年3月31日入住ICU的265例危重患者作为对照组,严格执行ICU预防中心静脉导管相关血流感染（CRBSI）、留置尿管相关感染（CAUTI）、呼吸机相关性肺炎（VAP）三大集束化策略,定期进行数据统计与分析.选择2015年4月1日至2016年3月31日入住ICU的292例危重患者作为试验组,在对照组实施方法的基础上,增加3项过程质量监测指标,进行质量控制.对2组CRBSI、CAUTI、VAP的发生率、机械通气时间等指标进行比较.结果 试验组和对照组CRBSI的发生率分别为1.79%（5/280）和5.10%（13/255）,差异有统计学意义（χ2=4.504,P=0.034）;试验组和对照组CAUTI的发生率分别为3.48%（10/287）和8.27%（21/254）,差异有统计学意义（χ2=5.708,P=0.017）;试验组和对照组VAP的发生率分别为3.02%（6/199）和10.27%（19/185）,差异有统计学意义（χ2=8.291,P=0.004）;试验组和对照组机械通气时间分别为（2.14±1.40）d和（3.37±2.01）d,差异无统计学意义（P=0.073）;试验组和对照组ICU停留时间分别为（6.04±1.04）d和（11.92±1.90）d,差异有统计学意义（t=-1.840,P=0.024）.试验组中心静脉导管维护达标例次、会阴清洁达标例次和口腔护理达标例次,与CRBSI、CAUTI、VAP发生例数之间的相关系数分别为-0.701、-0.618、-0.677,均具有统计学意义（P〈0.05）.结论 实施过程质量监测能够减少CRBSI、CAUTI、VAP的发生率,建议在ICU工作中推广使用.

Objective To explore the effect of process quality monitoring for hospital infection control of ICU. Methods A total of 265 critically ill patients admitted to ICU were chosen as the control group from April 1, 2014 to March 31, 2015, who were strictly enforced three cluster strategies to prevent catheter related blood stream infection （CRBSI）, catheter-associated urinary tract infection （CAUTI） and ventilator–associated pneumonia （VAP） with periodical data monitoring in ICU. Another 292 critically ill patients admitted to ICU were chosen as the observation group from April 1, 2015 to March 31,2016, who were added 3 measures of process quality monitoring on the basis of implementation method of the control group. The incidence of CRBSI, CAUTI and VAP time were compared between two groups. Results There was statistically significant difference on the incidence rate of the CRBSI between the two groups （χ2=4.504, P=0.034）, which was respectively 1.79%（5/280） and 5.10%（13/255）. There was statistically significant difference in the incidence rate of CAUTI between the two groups （χ2=5.708, P=0.017）, which was respectively 3.48% （10/287） and 8.27% （21/254）. There was statistically significant difference on the incidence rate of VAP between the two groups （χ2=8.291, P=0.004）, which was respectively 3.48% （10/287） and 8.27% （21/254）. Mean time of mechanical ventilation in the observation group and the control group was respectively （2.14±1.40） days and （3.37±2.01） days, there was no significant difference （P=0.073）. Mean time of ICU stay in the observation group and the control group was respectively （6.04±1.04） days and （11.92±1.90） days, there was statistical significance （t=-1.840, P=0.024）. Number of qualified central venous catheter maintenance, perineum clean and oral care had negative relevance with number of patients with CRBSI, CAUTI and VAP, correlation coefficient in the observation group was respectively-0.701,-0.618,-0.677, there was statistical significance （P〈0.05）. Conclusions The implementation of quality monitoring can reduce the number of patients with CRBSI, CAUTI and VAP, which suggests wide application in ICU.