规范化护理干预措施对预防ICU 术后医院获得性感染的效果研究

Effect of standardized nursing interventions on prevention of postoperative hospital-acquired infection in surgery patients of ICU

目的评价规范化护理措施对重症监护室(ICU)外科手术患者是否发生医院获得性感染(HAI)的干预效果。方法选取2015年1月-2016年12月首都医科大学附属北京潞河医院入住ICU的外科手术患者546例为研究对象,对其中2016年入住的253例患者采取规范化护理干预措施,将其中入住超过48 h的患者纳入研究组;2015年入住的293例患者采用常规护理,将其中入住超过48 h的患者纳入对照组。观察两组患者HAI情况及器械相关感染[呼吸机相关性肺炎(ventilator-associated pneumonia,VAP),导管相关血流感染(catheter-related blood stream infection,CRBSI),导尿管相关尿路感染(catheter-associated urinary tract infection,CAUTI)]发生率,使用Epi-Table收集数据,采用Fisher精确检验进行统计分析。结果对照组和研究组在ICU治疗超过48 h患者分别为124例(42.32%)和88例(34.78%),HAI的发病率分别为21.77%(27/124)和7.95%(7/88),研究组患者HAI发病率低于对照组,比较差异有统计学意义(P=0.008);对照组发生HAI的27例患者,包括12例VAP、8例CRBSI和7例CAUTI。研究组发生HAI的7例患者,包括2例VAP、3例CRBSI和2例CAUTI。研究组患者器械相关感染中VAP发病率低于对照组,比较差异有统计学意义(P<0.05),CRBSI和CAUTI发病率比较差异不明显。结论根据ICU的特点采取严格的护理感染预防控制干预措施能够有效降低HAI的发病率。

OBJECTIVE To observe the effect of standardized nursing interventions on prevention of hospital-acquired infection(HAI)in surgery patients of intensive care unit(ICU).METHODS A total of 546 patients who received surgeries in ICUs of Beijing Luhe Hospital Capital Medical University from Jan 2015 to Dec 2016 were enrolled in the study,253 patients who were treated with standardized nursing interventions and hospitalized for more than 48 hours in 2016 were assigned as the observation group,and 293 patients who were treated with conventional nursing and hospitalized for more than 48 hours in 2015 were set as the control group.The incidence rates of ventilator-associated pneumonia(VAP),catheter-related bloodstream infection(CRBSI)and catheter-associated urinary trac infection(CAUTI)were observed and compared between the two groups of patients.The data were collected by using Epi-Table,and the different between the two groups of data was observed with the use of Fisher exact test.RESULTS There were 124(42.32%)patients who were treated in ICUs for more than 48 hours in 2015 and 88(34.87%)patients in 2016;the incidence rate of HAI was 21.77%(27/124)in 2015,7.95%(7/88)in 2016.Totally 27 patients had HAI in the control group,including 12 cases of VAP,8 cases of CRBSI and 7 cases of CAUTI;totally 7 patients had HAI in the observation group,including 2 cases of VAP,3 cases of CRBSI and 2 cases of CAUTI.Among the patients with device-related infection,the incidence rate of VAP of the observation group was lower than that of the control group,and there was significant differences(P<0.05);there were no significant differences in the incidence rates of CRBSI and CAUTI.CONCLUSION It is an effective way to take rigid nursing interventions according to the characteristics of infection in the ICUs so as to reduce the incidence of HAI.