基于突破性系列质量改进模式在预防无隧道和涤纶套透析导管相关血流感染中的应用

Application of breakthrough series quality improvement model in preventing blood flow infections related to non-cuffed catheters

目的探讨基于突破性系列(BTS)质量改进模式在留置无隧道和涤纶套透析导管(NCC)患者导管相关血流感染预防中的应用效果。方法采用非同期前后对照研究方法,便利抽样法选取天津市4所医院2022年1-9月采用常规护理方案的NCC患者作为对照组,选取2023年2-10月采用基于BTS质量改进模式护理方案的NCC患者作为观察组。比较2组NCC患者相关血流感染发生率、护理人员NCC相关血流感染预防关键措施执行情况及患者满意度。结果对照组纳入的984例患者中男687例,女297例,年龄(62.43±13.77)岁;观察组纳入的959例患者中男651例,女308例,年龄(61.96±13.89)岁。应用改进模式后,观察组NCC相关血流感染发生率为0.12‰(1/8676),低于对照组的0.71‰(7/9827),差异有统计学意义(χ^(2)=4.37,P<0.05);观察组NCC相关血流感染预防关键措施执行率中导管出口部位护理为90.00%(54/60)、最大化无菌屏障为91.67%(55/60),均高于对照组的70.37%(38/54)和75.93%(41/54),差异均有统计学意义(χ^(2)=7.03、5.30,均P<0.05);观察组患者总满意度为92.91%(891/959),高于对照组的58.64%(577/984),差异有统计学意义(χ^(2)=15.28,P<0.05)。结论实施BTS质量改进模式有助于提升留置NCC透析患者的护理质量,改善患者结局。

Objective To explore the application effect of breakthrough series(BTS)quality improvement model in the prevention of catheter-related bloodstream infection in hospitalized patients with indwelling non-cuffed catheter(NCC).Methods Using a non synchronous pre and post control study method,convenience sampling was used to select NCC patients from four hospitals in Tianjin from January to September 2022 who received conventional nursing plans as the control group,and NCC patients from February to October 2023 who received nursing plans based on the BTS quality improvement model as the observation group.Compared the incidence of NCC related bloodstream infections between two groups of patients,the implementation of key preventive measures for NCC related bloodstream infections by nursing staff,and patient satisfaction.Results Among the 984 patients included in the control group,there were 687 males and 297 females,aged(62.43±13.77)years old;among the 959 patients included in the observation group,there were 651 males and 308 females,aged(61.96±13.89)years old.After applying the improved model,the incidence of NCC related bloodstream infections in the observation group was 0.12‰(1/8676),lower than the control group′s 0.71‰(7/9827),and the difference was statistically significant(χ^(2)=4.37,P<0.05);the implementation rate of key measures for preventing NCC related bloodstream infections in the observation group was 90.00%(54/60)for catheter outlet care and 91.67%(55/60)for maximizing sterile barrier,both higher than 70.37%(38/54)and 75.93%(41/54)in the control group,with statistical significance(χ^(2)=7.03,5.30,both P<0.05);the total satisfaction rate of patients in the observation group was 92.91%(891/959),which was higher than 58.64%(577/984)in the control group,and the difference was statistically significant(χ2=15.28,P<0.05).Conclusions The implementation of BTS quality improvement model is helpful to improve the nursing quality of patients with indwelling NCC dialysis and improve the patient outcomes.