应用精细化防控措施降低中心静脉导管相关血流感染发病率

Application of precise prevention and control measures in reducing incidence of central venous catheter-related bloodstream infection

目的探讨应用精细化防控措施降低中心静脉导管相关血流感染(CRBSI)的效果。方法选取某三级甲等医院2019年1月—2020年12月中心静脉置管≥48 h的患者。2019年1—12月为干预前期,2019年12月底全院开始实施精细化防控措施,2020年1—12月为干预后期。比较干预前后医务人员CRBSI防控措施执行率和患者CRBSI发病率。结果2020年医务人员CRBSI防控措施执行率为99.06%(191504/193324),高于2019年的87.90%(382550/435194),差异有统计学意义(χ^(2)=21046.64,P<0.001)。2019、2020年分别发生CRBSI 54、11例,两组感染患者性别、年龄、白细胞计数、降钙素原和C反应蛋白水平比较,差异均无统计学意义(均P>0.05)。2019年患者置管总日数为350473 d,CRBSI发病率为0.15‰;2020年置管总日数为186856 d,CRBSI发病率为0.06‰,两组患者CRBSI发病率比较差异有统计学意义(χ^(2)=5.912,P=0.015)。结论实施精细化防控措施可降低中心静脉置管患者CRBSI发病率。

Objective To explore the application effect of precise prevention and control measures on reducing central venous catheter-related bloodstream infection(CRBSI).Methods Patients with central venous catheterization≥48 hours in a tertiary first-class hospital from January 2019 to December 2020 were selected.January to December 2019 was pre-intervention period,the whole hospital began to implement precise prevention and control measures at the end of December 2019,and January to December 2020 was post-intervention period.Implementation rate of CRBSI prevention and control measures of health care workers and incidence of CRBSI among patients before and after intervention was compared.Results The implementation rate of CRBSI prevention and control measures in 2020 was 99.06%(191504/193324),which was higher than 87.90%(382550/435194)in 2019,difference was significant(χ^(2)=21046.64,P<0.001).There were 54 and 11 cases of CRBSI in 2019 and 2020 respectively,there were no significant differences in gender,age,leukocyte count,procalcitonin and C-reactive protein between two groups of patients(all P>0.05).The total catheterization days in 2019 was 350473 days,incidence of CRBSI was 0.15‰;the total catheterization days in 2020 was 186856 days,incidence of CRBSI was 0.06‰,difference in incidence of CRBSI between two groups of patients was significant(χ^(2)=5.912,P=0.015).Conclusion Implementation of precise prevention and control measures can reduce the incidence of central venous CRBSI in patients undergoing central venous catheterization.