基于FOCUS-PDCA护理程序的集束化干预策略预防CRBSI的临床应用效果

The Clinical Application Effect of Bundles of Care Based on FOCUS-PDCA Nursing Program on the Prevention of CRBSI

目的:探讨运用FOCUS-PDCA护理程序的集束化干预策略预防中心静脉导管相关性血流感染(CRBSI)的临床应用效果。方法:基于FOCUS-PDCA程序,通过发现问题、成立小组、查找原因、明确规范,有目标、有计划地进行ICU-CRBSI护理持续质量改进。建立ICU-CRBSI质量控制小组,将CRBSI失效模式评估方法引入FOCUS-PDCA程序管理,引入清单管理方法对CRBSI置管操作和导管维护进行质量管理,应用最佳证据的集束化干预策略控制CRBSI感染的发生。结果:基于FOCUS-PDCA护理程序的集束化干预策略实施后,ICU-CRBSI质量控制小组成员的手卫生、皮肤消毒、接头消毒执行率提高;2015年~2017年ICU-CRBSI频次呈现逐年下降趋势,差异有统计学意义(均P<0.05);置管天数明显下降,且波动幅度降低。结论:采用集束化干预策略能有效减低CRBSI的发生率,减少患者的置管天数。

Objective: To explore the clinical application effect of bundles of care based on FOCUS-PDCA nursing program on the prevention of catheter related blood stream infection (CRBSI).Methods: Based on the FOCUS-PDCA procedure, ICU-CRBSI continuous quality improvement was achieved with targeted and planned results by identifying problems, establishing teams, finding causes, and defining specifications.Established ICU-CRBSI quality control team was established.CRBSI failure mode assessment method was introduced into FOCUS-PDCA program management.Inventory management method was imported to manage the quality of CRBSI catheterization operation and catheter maintenance.CRBSI infection was controlled by bundles of care based on the best evidences.Results: When the bundles of care based on FOCUS-PDCA nursing program was conducted, the hand hygiene, skin disinfection, and joint disinfection implementation rates were improved.The frequency of ICU-CRBSI from 2015 to 2017 has been reduced year by year (All P <0.05).After the intervention of cluster care, the days of tube placement decreased obviously, with a depression of fluctuation range.Conclusion: Cluster intervention strategy can effectively reduce the frequency of ICU-CRBSI, and shorten the catheter detaining time.