重症监护病房中央导管相关血流感染的干预研究  

Study on intervention in central line-associated bloodstream infection in intensive care units

作　　者：曾翠[1] 李六亿[2] 贾会学[2] 张秀月[3] 侯铁英[4] 宗志勇[5] 李卫光[6] 杨怀[7] 杨芸[8] 刘运喜[9] 文建国[10] 陆群[11] 姜亦虹[12] 谢金兰[13] 吴安华[1] 

机构地区：[1]中南大学湘雅医院,湖南长沙410008 [2]北京大学第一医院,北京100034 [3]中国医科大学附属盛京医院,辽宁沈阳110004 [4]广东省人民医院,广东广州510008 [5]四川大学华西医院,四川成都610041 [6]山东省立医院,山东济南250021 [7]贵州省人民医院,贵州贵阳550002 [8]山西医学科学院山西大医院,山西太原030001 [9]解放军总医院,北京100853 [10]郑州大学第一附属医院,河南郑州450052 [11]浙江大学医学院附属第二医院,浙江杭州310009 [12]南京大学医学院附属鼓楼医院,江苏南京210008 [13]苏北人民医院,江苏扬州225001

出　　处：《中国感染控制杂志》2015年第8期535-539,共5页Chinese Journal of Infection Control

基　　金：中国医院协会医院感染预防与控制能力建设项目(CHA-2012-XSPX-0629-1)

摘　　要：目的探讨基于循证医学证据的集束化干预策略对重症监护病房(ICU)中央导管相关血流感染(CLABSI)发病率的影响。方法采用前瞻设计、多中心合作的方法,对全国41所医院54个ICU进行研究,2013年10月1日—2014年9月30日所有入住ICU并留置中央静脉导管(CVC)的患者作为监测对象。2013年10月—2014年3月收集基线资料作为干预前资料;2014年4—9月各参与医院进行干预措施的持续推广,此间收集的资料作为干预后资料,对干预前后资料进行比较。结果干预前后中央静脉导管使用率(44.18%VS44.63%)比较,差异有统计学意义(χ2=5.526,P=0.019)。干预前后CLABSI发病率比较,差异无统计学意义[RR及95%CI为0.82(0.59-1.13),P=0.10]。干预前后置管部位构成比较,差异有统计学意义(χ2=76.264,P<0.001),干预后股静脉置管(17.25%VS 13.72%)及两个及以上部位置管(2.27%VS 1.44%)的置管比例有所降低。干预后,手卫生的执行率和正确率分别为79.73%、91.47%,均高于干预前的76.14%、74.26%(均P<0.001);干预前后皮肤消毒剂构成比较,差异有统计学意义(χ2=3.861,P<0.001),其中氯己定乙醇所占比例升高(29.62%VS 50.56%)。除每日评估并记录外,其他防控措施的依从性干预前后比较,差异均有统计学意义(均P<0.001);使用无菌大铺巾、置管者着装合格、端口消毒合格率均有不同程度提高。结论插管干预和维护干预两者结合的集束化干预策略得到有效落实,但其对CLABSI的干预效果有待更进一步研究。Objective To evaluate the effect of evidence-based bundle intervention strategy on reducing the incidence of central line-associated bloodstream infection（CLABSI）.Methods Prospective and multicenter study was adopted,patients admitted to 54 intensive care units（ICUs）of 41 hospitals and with central venous catheters（CVCs）between October 1,2013 and September 30,2014 were monitored.Baseline data between October 2013 and March 2014 were collected as pre-intervention data;from April to September 2014,the participated hospitals performed intervention strategy,post-intervention data were compared with pre-intervention data.Results The usage rate of CVCs before and after intervention was significantly different（44.18% vs 44.63%,χ^2=5.526,P=0.019）.Incidence of CLABSI before and after intervention was not significantly different（RR,0.82[95%CI,0.59-1.13],P=0.10）.Constituent ratio of catheter insertion sites between pre-and post-intervention was significantly different（χ^2=76.264,P〈0.001）,femoral vein catheterization rate as well as proportion of two and above catheter insertion sites after intervention decreased（17.25% VS 13.72%;2.27% VS 1.44%,respectively）;hand hygiene implementation rate and accuracy rate after intervention were both higher than before intervention（79.73% vs76.14%,P〈0.001;91.47% vs 74.26%,P〈0.001,respectively）;constituent ratio of skin disinfectant application before and after intervention was significantly different（χ^2=3.861,P〈0.001）,proportion of chlorhexidine ethanol increased（29.62% VS 50.56%）;except daily assessment and record,compliance to other prevention and control measures before and after intervention were all significantly different（all P〈0.001）;utilization rate of maximal sterile barrier,qualified rate of dressing of operators,and port disinfection were all significantly enhanced.Conclusion Bundle intervention in intubation and maintenance are implemented effectively,but intervention effect on CLABSI needs further study.

关 键 词：中央静脉导管 导管相关血流感染 重症监护病房 集束化干预 医院感染 感染控制 

分 类 号：R181.32[医药卫生—流行病学]