应用DMAIC法降低导尿管相关尿路感染的效果观察

Observation on the effect of DMAIC in reducing catheter-related urinary tract infection

目的探讨DMAIC(界定、测量、分析、改进、控制)法改进ICU患者留置导尿管护理流程,降低导尿管相关尿路感染的效果。方法采用回顾性病例对照方法,选取天津市第一中心医院综合ICU2018年1-12月收治并留置导尿管的578例患者为研究对象。2018年1-6月收治的283例患者为对照组,2018年7-12月收治的295例患者为观察组。对照组应用常规方法,观察组应用六西格玛管理的DMAIC法,比较2组各项措施执行的正确率及尿管使用率和感染率等指标。结果对照组早期拔管评估执行率、尿液收集正确率、尿管固定正确率、尿管清洁正确率、集尿袋位置正确率分别为60.42%(171/283)、69.61%(197/283)、79.86%(226/283)、89.40%(253/283)、92.58%(262/283),观察组分别为80.34%(237/295)、90.85%(268/295)、94.92%(280/295)、96.27%(284/295)、97.97%(289/295),差异均有统计学意义(χ2=9.411~41.415,P<0.01);观察组导尿管使用率为75.31%(3856/5120),与对照组的82.60%(4098/4961)比较差异有统计学意义(χ2=80.475,P<0.01);观察组导尿管相关尿路感染发生率为0.26‰(1/3856),对照组为1.95‰(8/4098),2组比较差异有统计学意义(χ2=5.832,P<0.05)。结论DMAIC法能够提高护理流程的正确率,优化留置导尿管的护理流程,降低导尿管相关尿路感染发生率。

Objective To explore the effect of DMAIC(Define, Measure, Analyze, Improve, Control) in reducing catheter-related urinary tract infection. Methods A retrospective case control method was used to select 578 patients admitted and treated in comprehensive ICU of Tianjin First Central Hospital from January to December 2018 with catheters as research objects.The 283 patients from January to June 2018 were the control group, and 295 patients from July to December 2018 were the observation group.Routine methods were used in the control group, and DMAIC method with 6 sigma management was used in the observation group. The correct rate of implementation of each measure, the utilization rate of urinary catheter and the infection rate between the two groups were compared. Results Implementation rate of early extubation assessment, urine collection accuracy, urine tube fixed correctly, urine tube cleaning time, urine collection bags location accuracy were 60.42%(171/283), 69.61%(197/283), 79.86%(226/283), 89.40%(253/283), 92.58%(262/283)in the control group, 80.34%(237/295), 90.85%(268/295), 94.92%(280/295), 96.27%(284/295), 97.97%(289/295) in the observation group, the differences were statistically significant (χ2= 9.411-41.415, P < 0.01). The rate of urinary catheter usage was 75.31%(3 856/5 120) in the observation group and 82.60%(4 098/4 961) in the control group, the differences was statistically significant (χ2=80.475, P < 0.01). The rate of catheter associated urinary tract infection was 0.26‰(1/3 856) in the observation group and 1.95 ‰(8/4 098) in the control group, the differences was statistically significant (χ2=5.832, P< 0.05). Conclusions DMAIC can improve the accuracy of nursing measures, optimize the catheter care process, and reduce catheter-related urinary tract infections.