质量控制图在重症医学科医院感染质量控制中的应用实践  

Application of quality control chart in quality control for nosocomial infection in intensive care unit

作　　者：程玉梅[1] 刘媛怡[1] 王迪芬[1] 

机构地区：[1]贵州医科大学附属医院重症医学科,贵州省重症医学质控中心,贵州贵阳550004

出　　处：《中华危重病急救医学》2017年第2期172-176,共5页Chinese Critical Care Medicine

基　　金：贵州省科技攻关项目（黔科合SY[2010]3079号）;贵州省高层次人才科研项目（TZJF-2011-25）;国家临床重点专科建设项目（2011-170）;贵州省临床重点学科建设项目（2011-52）

摘　　要：目的运用质量控制图监控重症医学科（ICU）中感染发生情况，探讨控制图在ICU医院感染（院感）管理中的应用价值。方法2011年10月至2016年6月贵州医科大学附属医院ICU每月对呼吸机相关性肺炎（VAP）、中心静脉导管相关性血流感染（CLABSI）、导尿管相关性泌尿道感染（CAUTI），即＂三管＂感染进行监测并记录，应用Excel软件录入数据，使用SPSS软件分析数据，根据数据性质导出控制图以进行院感监控，及时发现问题并采取措施。结果2011年10月至2016年6月每月新收患者23～103例、中位数45.00（39.00，55.50）例，每月新发VAP 0～7例、中位数3.00（1.00，4.00）例，VAP发生率为0～22.58例/千通气日、中位数8.62（3.28，12.10）例/千通气日；每月新发CLABSI 0～3例、中位数0.00（0.00，1.00）例，CLABSI发生率为0～14.82例/千导管日、中位数0.00（0.00，5.38）例/千导管日；每月新发CAUTI 0～8例、中位数1.00（0.00，2.00）例，CAUTI发生率为0～14.06例/千导管日、中位数3.02（0.00，5.86）例/千导管日。连续监测每月＂三管＂感染发生率各57个数据点，有部分数据点落在警戒限外，其中仅有1个CAUTI感染率数据点落在控制限外，其他数据点均落在控制限内，且无异常排列，三者均处在受控状态。根据控制图可以科学直观地分析院感发生情况，并及时就存在的问题进行讨论，制定整改方案，将＂三管＂感染控制在受控状态。结论控制图具有操作简便、结果直观、发现问题及时的特点，可作为ICU院感的日常监控，值得推广。ObjectiveTo explore the application value of control chart in the management of nosocomial infection in intensive care unit （ICU） by using quality control chart to monitor the infections in ICU.MethodsFrom October 2011 to June 2016, ventilator-associated pneumonia （VAP）, central line-associated bloodstream infection （CLABSI） and catheter-associated urinary tract infection （CAUTI）, namely the three catheters, occurred in ICU of the Affiliated Hospital of Guizhou Medical University were monitored and recorded monthly, then the data was imput into the Excel, and the data was analyzed using SPSS. According to the properties of the data, control chart was derived for monitoring nosocomial infections, finding out problems and for taking actions on time.ResultsFrom October 2011 to June 2016, the numbers of new patients in ICU were 23-103 cases per month and the median was 45.00 （39.00, 55.50） cases per month. The numbers of new VAP patients were 0-7 cases per month which median was 3.00 （1.00, 4.00） cases per month and the VAP rates were 0-22.58 cases per 1？000 ventilation-days which median was 8.62 （3.28, 12.10） cases per 1？000 ventilation-days. The numbers of new CLABSI patients were 0-3 cases per month which median was 0.00 （0.00, 1.00） cases per month and the CLABSI rates were 0-14.82 cases per 1？000 catheter-days which median was 0.00 （0.00, 5.38） cases per 1？000 catheter-days. The numbers of new CAUTI patients were 0-8 cases per month which median was 1.00 （0.00, 2.00） cases per month and the CAUTI rates were 0-14.06 cases per 1？000 catheter-days which median was 3.02 （0.00, 5.86） cases per 1？000 catheter-days. 57 points of the three catheter-associated infections incidences were continuously monitored monthly, in which some data points overstepped the warning limit, only 1 CAUTI infection incidence overstepped the control limit, the other monthly three catheter-associated infections incidences were in the control range and had no abnormal arrangement occurre

关 键 词：质量控制图 p图 重症医学科 医院感染 

分 类 号：R197.323[医药卫生—卫生事业管理] R459.7[医药卫生—公共卫生与预防医学]