妇科手术患者导尿管相关尿路感染防控效果研究

A Study on Apply Combined Intervention to Prevent Urinary Tract Infections of Gynecological Surgery

目的通过开展妇科手术患者导尿管相关尿路感染(CAUTI)组合式干预(Bundle措施),防控CAUTI的发生并探讨其效果。方法对2015年1月-2018年12月医院妇科病区收治的留置导尿管≥1d的住院手术患者进行CAUTI监测,采用SPSS19.0统计软件对监测结果进行分析,2017年开始实施组合式干预,对比干预前后CAUTI感染情况及主要病原菌变化。结果2015年1月—2018年12月共监测收集12722例留置导尿管患者,留置导尿管患者总住院日数为121037天,导尿管插管总天数为21442天,导尿管插管总使用率为17.72%,干预前导尿管插管使用率为17.51%,干预后导尿管插管使用率为17.91%。共监测到CAUTI44例,检出45株病原菌,其中多重耐药菌6株,前三位的耐药菌为大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌。落实Bundle措施后CAUTI感染率由2.68‰降为1.45‰,差别具有统计学意义(χ^2=3.95,P=0.04)。干预前后手卫生依从率分别为86.87%,92.10%,差异具有统计学意义(χ^2=14.93,P=0.00)。结论通过开展导尿管相关尿路感染(CAUTI)组合式干预,能明显降低妇科手术患者CAUTI感染率。

Objective To study the prevention and control project of the catheter-related urinary tract infection (CAUTI) with intervention (Bundle measure) in Gynecology and discuss the efficacy of prevention and control measures. Methods The CAUTI was monitored for patients with Gynecological surgery who were treated with catheter indwelling for no less than 1 day from January 2015 to December 2018. SPSS 19.0 statistical software was used to analyze the monitoring results and compare the changes of CAUTI infection with combined intervention from 2017. Results A total of 12 772 patients with urethral catheter were monitored ,with the total hospitalization days 121 037 days,total catheter indwelling days 21 442 days, the utilization rate of, Catheters 17.72%,The rate of catheter intubation before and after intervention was17.51% and 17.91% respectively.There were 44 cases of CAUTI were monitored and 45 strains of pathogenic bacteria were isolated, among which 6 strains were multidrugresistant bacteria. The top three UTI dropped from 2.68‰ to 1.45‰, with a statistically significant difference (χ^ 2=3.95, P =0.04). The compliance rate of hand hygiene after intervention was effective (92.10% vs 86.87%), and the difference was statistically significant (χ^ 2=14.93, P =0.00). Conclusion By carrying out combined interventions, the infection rate of CAUTI can be significantly reduced.