24家综合医院ICU中心静脉导管(CVC)置管感染防控措施依从性的前瞻性研究

Adherence to infection prevention and control measures for central venous catheters among intensive care units(ICU)in 24 general hospitals:aprospective study

目的了解中心静脉导管(CVC)置管临床实践(CLIP)依从性。方法采用前瞻性研究设计,对2017年3月1日-2017年3月31日期间的江苏省12个省辖市开展调查,选择依从性较好的三级和二级医院。观察均在成人ICU中开展,通过统一培训的观察员观察CLIP依从性结果,通过手机软件调查,调查结果自动上传终端数据库。结果共有24家医院参与本次调查,共观察CVC置管572次;其中三级综合医院487次占85.14%和二级医院85次占14.86%;置管前手卫生和皮肤消毒依从性较高,分别为94.41%和100.00%,最大无菌屏障依从性最低为77.27%,其中无菌隔离衣的依从性最低为87.9%;穿刺前消毒剂干燥和最大无菌屏障依从性医生分别为90.16%、75.79%,低于护士的98.44%、89.06%(P=0.028、P=0.017)。结论 ICU中CVC置管CLIP依从性不高,尤其是医生,需要加强培训、督查和反馈,从而预防导管相关血流感染,保障患者安全。

OBJECTIVE To understand the adherence to central line insertion practices（CLIP）.METHODS A prospective study was designed to investigate 12 provincial municipalities in Jiangsu province from Mar.1,2017 to Mar.31,2017,and tertiary and secondary hospitals with good compliance were selected.Among adult ICUs,prospective study was performed to observe the CLIP compliance results through unified training observers.Through the survey via the mobile phone software,the survey results were automatically uploaded to the terminal database.RESULTS A total of 24 hospitals participated in the survey with 572 CVC insertions were recorded.Among them,there were 487（85.14%）insertions in tertiary hospitals and 85（14.86%）insertions in secondary hospitals.Preoperative hand hygiene and skin disinfection compliance were high,which were 94.41%and 100%.The maximum aseptic barrier（MSB）compliance was 77.3% and 87.9% for sterile gown.Compared with nurses（98.44% and89.06%）,skin prep agent completely dried before insertion and MSB from doctors（90.16% and 75.79%）were significantly lower（P=0.028 and 0.017,respectively）.CONCLUSION Among ICU,adherence to CLIP is not high especially the doctors,which needs to strengthen the training,supervision and feedback,so as to prevent catheter-related bloodstream infection,and ensure the patients safety.