PDCA循环管理模式控制痔上黏膜环切术后导尿管相关尿路感染的研究

PDCA circulation management mode to control catheter-related urinary tract infection after procedure for prolapse and hemorrhoids

目的探讨在痔上黏膜环切(Procedure for prolapsing hemorrhoids,PPH)术后导尿管相关尿路感染预防中应用PDCA[动态循环的管理模式,这个循环主要包括四个阶段:计划(Plan)、实施(Do)、检查(Check)和处理(Action)]循环管理模式的临床效果。方法选择嘉兴学院附属第二医院2018年4月-2019年9月收治PPH术后留置导尿管患者中随机抽取114例,将2018年4月-2019年1月的55例患者设为对照组和2019年2-9月的59例患者设为研究组,两组患者分别实施常规护理和PDCA循环管理模式,对两组患者导尿管相关尿路感染的发生情况进行分析。结果研究组患者在导尿管留置期间相关尿路感染发生率为3.39%(2/59)低于对照组(P=0.035);研究组患者在导尿管留置期间其留置必要性评估、集尿袋出口消毒、会阴部清洁、收集容器个人专用、尿袋清楚完整标识、集尿袋离地高度≥15 cm、插管时消毒、插管时放置最大无菌屏障等指标的执行率分别为94.92%(56/59)、96.61%(57/59)、98.31%(58/59)、100.00%(59/59)、93.22%(55/59)、88.14%(52/59)、100.00%(59/59)、96.61%(57/59)均高于对照组(P<0.001)。结论PPH术后导尿管留置期间对患者实施PDCA循环管理模式,可有效降低导尿管相关尿路感染的发生风险,有利于提高临床护理质量,对于保障治疗效果的顺利发挥具有十分重要的作用。

OBJECTIVE To investigate the effect of PDCA(PDCA is a dynamic circulation management model)in the prevention of catheter-related urinary tract infecion after procedure for prolapsing hemorrhoids(PPH).This cycle mainly includes four stages:the clinical effects of cycle management model of Plan,Do,check,and action.METHODS Totally 114 patients with indwelling catheters after procedure for prolapse and hemorrhoids were randomly selected from the second hospital affiliated to Jiaxing University from Apr.2018 to Jan.2019,and 55 patients from Apr.2018 to Jan.2019 were selected as control group and 59 patients from Feb.to Sep.2019 were set up as study group.Two groups of patients were implemented with routine nursing and PDCA cycle management mode,and the occurrence of urinary tract-related urinary tract infections in the two groups were analyzed.RESULTS The incidence of related urinary tract infections in the study group during the catheter indwelling period was 3.39%(2/59),significantly lower than that in the control group(P=0.035).The percentage of execution rates for indicators such as necessity assessment for indwelling,disinfection of urine collection bag exit,perineal cleaning,personal collection container,clear and complete identification of urine collection bag,height of urine collection bag above ground 15 cm,disinfection during intubation,placement of the largest sterile barrier during intubation was 94.92%(56/59),96.61%(57/59),98.31%(58/59),100.00%(59/59),93.22%(55/59),88.14%(52/59),100.00%(59/59),and 96.61%(57/59),respectively,significantly higher than the control group(P<0.001).CONCLUSION The implementation of PDCA circulation management mode for patients during indwelling catheter after PPH can effectively reduce the risk of urinary tract infections related to urinary catheters,improve the quality of clinical care,and play a very important role in ensuring the smooth development of treatment effects.