重症监护病房中心静脉导管相关血流感染控制与干预的多中心研究  

Multicenter study of prevention and intervention to central line-associated bloodstream infections in intensive care units

作　　者：吴镝[1] 崔霞[1] 马文杰[1] 刘运喜[2] 邢玉斌[3] 曹晋桂[1] 李海峰[4] 罗爱武 张群[6] 柴明珍[7] 张波[8] 陈炜[9] 史皆然[10] 翟红岩[11] 冉素平[12] 祝丙华[13] 高延新[14] 王志刚 王芳[16] 杨慧宁[17] 梅卫玲[18] 程文琴 

机构地区：[1]空军总医院感染控制科,北京100142 [2]解放军总医院感染管理与疾病控制科,北京100853 [3]解放军总医院海南分院感染管理与疾病控制科,海南三亚572013 [4]解放军第202医院感染控制科,辽宁沈阳110003 [5]广州总医院疾病预防控制科,广东广州510010 [6]第二军医大学长征医院感染控制科,上海200003 [7]第二军医大学东方肝胆外科医院感染控制科,上海201805 [8]第三军医大学西南医院感染控制科,重庆400038 [9]第三军医大学新桥医院院感科,重庆400042 [10]第四军医大学西京医院疾病预防控制科,陕西西安710132 [11]解放军第307医院感染控制科,北京100071 [12]解放军第306医院感染控制科,北京100101 [13]解放军第305医院感染控制科,北京100017 [14]乌鲁木齐总医院感染控制科,新疆乌鲁木齐830000 [15]陆军总医院感染控制科,北京100700 [16]解放军第309医院感染控制科,北京100193 [17]中国人民武装警察部队总医院感染控制科,北京100039 [18]解放军第113医院感染控制科,浙江宁波315040 [19]火箭军总医院疾病预防控制科,北京100088

出　　处：《中华医院感染学杂志》2017年第13期2889-2892,共4页Chinese Journal of Nosocomiology

基　　金：中国医院协会中国医院感染监测信息化建设基金资助项目(CHA-2016-026-053)

摘　　要：目的通过对多中心重症监护病房(ICU)中心静脉导管相关血流感染(CLABSI)情况的调查,采取相应的控制与干预方法,以降低其感染率。方法 2015年4月-2015年9月对全军19家医院的22个ICU的患者进行基线调查作为干预前的资料;2015年9月对相关人员进行干预措施培训;2015年10月-2016年5月进行插管干预和维护干预方法作为干预后资料,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,置管部位构成比,手卫生的依从性和正确率,皮肤消毒剂构成,每日评估并记录,使用无菌大铺巾、置管者着装合格、端口消毒合格率的比较,差异有统计学意义(P<0.05);干预前后CLABSI千日发病率比较,差异无统计学意义。结论插管干预组合和维护干预组合两者结合,提高中心静脉置管使用过程中的安全性,对降低CLABSI的发生还有待更进一步研究。OBJECTIVE To investigate the prevalence of central line-associated bloodstream infections（CLABSI）in multicenter intensive care units（ICUs）s）and take targeted control and intervention measures so as to reduce the infection rate.METHODS The baseline survey was conducted for 22 ICU patients who were treated in 19 military hospitals from Apr 2015 to Sep 2015,and the data were collected as the pre-intervention data.The intervention measures training was carried out for related staff in Sep,2015,the interventions to intubation and maintenance interventions were conducted from Oct 2015 to May 2016,and the data were collected as the post-intervention data.The pre-intervention data and post-intervention data were compared.RESULTS There was significant difference in the utilization rate of central venous catheters,constituent ratio of catheterization sites,compliance and correct rate of hand hygiene,daily assessment and record,use of sterile towel,qualified rate of dressing,or qualified rate of disinfection of ports before and after the intervention（P〈0.05）.There was no significant difference in the thousand-day morbidity rate of CLABSI before and after the intervention.CONCLUSIONThe intervention to catheterization combined with maintenance of catheters may improve the safety of use of central venous catheters,,and it is necessary to further study the measures to reduce the incidence of CLABSI.

关 键 词：中心静脉导管 导管相关血流感染 干预措施 

分 类 号：R378[医药卫生—病原生物学]