维持性血液透析病人导管相关性感染预防护理质量评价指标体系的构建与应用

Construction and application of quality evaluation index system for catheter related infections prevention and nursing in maintenance hemodialysis patients

目的:构建维持性血液透析(MHD)病人导管相关性感染预防护理质量评价指标体系,探究其应用效果。方法:成立研究小组,通过文献查询、焦点小组访谈和专家函询构建MHD病人导管相关性感染预防护理质量评价指标体系。选取合肥市第二人民医院肾内科2021年8月—2022年10月收治的120例MHD病人纳入研究,采用随机数字表法分为对照组和试验组,各60例。对照组实施透析室常规护理干预,试验组基于导管相关性感染预防护理质量评价指标体系优化预防护理内容,比较两组病人导管相关性感染发生情况。结果:两轮专家函询问卷有效回收率均为100.00%。两轮专家函询权威系数(Cr)为0.858和0.879,肯德尔和谐系数为0.261和0.236(P<0.05);最终确定MHD病人导管相关性感染预防护理质量评价指标体系包括3个一级指标、8个二级指标、17个三级指标。将构建好的指标体系应用于临床实践,试验组病人导管相关性感染总发生率明显低于对照组,导管留置时间明显长于对照组,差异有统计学意义(P<0.05)。结论:MHD病人导管相关性感染预防护理质量评价指标体系具有较高的科学性和全面性,应用于临床可大大降低导管相关性感染发生率,延长导管留置时间。

Objective:To construct a quality evaluation index system for the prevention of catheter-related infections in maintenance hemodialysis(MHD)patients and explore its application effect.Methods:A research group was established to construct a quality evaluation index system for the prevention and nursing of catheter-related infections in MHD patients through literature review,focus group interviews,and expert inquiries.120 MHD patients admitted to the Department of Nephrology at the Second People's Hospital of Hefei from August 2021 to October 2022 were selected for the study.They were evenly divided into a control group and an experimental group using a random number table method,with 60 patients in each group.The control group received routine nursing intervention in the dialysis room,while the experimental group optimized the prevention nursing content based on the quality evaluation index system of catheter-related infection prevention nursing.The incidence of catheter-related infections in the two groups of patients was compared.Results:The effective response rates for both rounds of expert inquiry questionnaires were 100.00%.The authority coefficients(Cr)of two rounds of expert inquiry were 0.858 and 0.879,and Kendall's W values were 0.261 and 0.236(P<0.05);the final determination of the catheter related infections prevention nursing quality evaluation index system for MHD patients includes 3 primary indicators,8 secondary indicators,and 17 tertiary indicators.The application of the constructed indicator system in clinical practice showed that the total incidence of catheter-related infections in the experimental group was significantly lower than that in the control group,and the catheter retention time was significantly longer than that in the control group,with statistical significance(P<0.05).Conclusion:The quality evaluation index system for the prevention and nursing of catheter-related infections in MHD patients has high scientificity and comprehensiveness.Its application in clinical practice can greatly reduce the incidence of catheter-related infections and prolong catheter retention time.