重症监护病房导管相关性血液感染的危险因素与预防控制措施  

Study on the Risk Factors and Preventive Measures of Catheter-related Blood Stream Infection in Intensive Care Unit

作　　者：袁咏梅[1] 周慧珠[1] 

机构地区：[1]南通大学附属医院感染管理科,江苏南通226001

出　　处：《中华医院感染学杂志》2009年第21期2857-2859,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析重症监护病房(ICU)导管相关性血液感染(CRBSI)的危险因素,探讨有效预防与控制感染的方法。方法对2008年1-12月入住ICU的患者进行前瞻性目标性监测,分析导管相关性血液感染的危险因素。结果共调查257例次,发生医院感染147例次,例次感染率为57.20%,其中导管相关血液感染36例次,例次感染率为14.00%,占感染的24.49%,导管相关性血液感染的日感染率为16.57‰,明显高于普通病房;检出的病原菌以G-菌为主,占54.05%,G+菌次之,占37.84%,真菌占8.11%;特殊耐药菌检出11株,其中ESBLs阳性菌6株,MRS 5株。结论导管相关性血液感染与导管放置时间、置管部位、医护人员的操作、患者机体免疫功能及静脉高营养药物的应用有关;严格无菌技术操作,合理选择置管部位,缩短导管留置时间,保持导管通畅,是有效预防CRBSI发生的关键。OBJECTIVE To analyze the risk factors of the Catheter-Related Blood Stream Infection （CRBSI） in the intensive care unit （ICU）, and to approach effective methods for preventing the CRBSI in ICU. METHODS With the method of objective investigation, all patients in ICU from Jan, 2008 to Dec, 2008 were studied. The risk factors of CRBSI were investigated. RESULTS 257 patients entered the study. A total of 147 cases suffered from the nosocomial infection （NI）. The incidence rate of the NI was 57.2%. Among these, 36 cases were dignosised of the CRBSI, and the case-infection rate was 14.07%. The number of CRBSI account for 24.49% of the patients who suffered from the NI. The nosocomial infection rate perday the CRBSI was 16. 57‰. It was significantly higher than that of the general wards＇. The pathogen detection showed the main pathogen was the G^＋ bacteria, accounting for 54.04%. Then was the G^- bacteria, accounting for 37.84%. The fungus accounted for 8.11%. 11 unusual drug resistance bacteria were found （6 ESBLs positive bacteria and 5 MRS bacteria）. CONCLUSIONS The incidence of the CRBSI is related to the following reasons： days and the sites of the catheter being placed, the procedure the medical personnel done, the immune function of the patients, and the utilization or unutilization of the high-nutrition drugs through the vein. According to these reasons, strict aseptic technique, reasonable choice of the catheter site, shortening the duration the catheter insertion, and maintaining catheter unobstructed are the keys to prevent the incidence of the CRBSI.

关 键 词：导管相关 血液感染 危险因素 预防与控制 

分 类 号：R181.32[医药卫生—流行病学]