ICU导尿管相关尿路感染预防及影响因素分析  

Prevention of catheter-related urinary tract infection in ICU and influencing factors

作　　者：李海峰 于力娜 贾辰 张岩东 刘运喜[2] 曹晋桂[3] 姚娟[4] 杨婧[5] 张群[6] 柴明珍[7] 范珊红[8] 张晓东[9] 庄英杰[10] 王芳[11] 邢玉斌[12] 梅卫玲[13] 李晓予 王效雷[15] 陆辉 

机构地区：[1]解放军第二0二医院感染控制科,辽宁沈阳110003 [2]解放军总医院感染管理与疾病控制科,北京100853 [3]空军总医院感染控制科,北京100142 [4]新疆军区总医院疾病预防控制科,新疆乌鲁木齐830000 [5]沈阳军区总医院感染控制科,辽宁沈阳110840 [6]第二军医大学第二附属医院感染管理科,上海200003 [7]第二军医大学第三附属医院感染管理科,上海200438 [8]第四军医大学唐都医院疾病预防控制科,陕西西安710038 [9]海军总医院感染控制科,北京100048 [10]解放军第302医院疾病预防控制科,北京100039 [11]解放军第309医院疾病预防控制科,北京100091 [12]解放军总医院海南分院感染管理与疾病控制科,海南三亚572000 [13]解放军第113医院感染控制科,浙江宁波315040 [14]解放军第一五三中心疾病预防控制科,河南郑州450042 [15]解放军第81医院感染控制科,江苏南京210002

出　　处：《中华医院感染学杂志》2017年第13期2897-2899,2911,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：目的通过开展"全军医院感染预防与控制能力建设项目"导尿管相关尿路感染(CAUTI)的监测与控制项目,探讨预防控制措施,以减少CAUTI的发生。方法采用前瞻性研究,对2015年4月-2016年3月中15所医院20个ICU中留置导尿管≥2d的住院患者进行CAUTI监测,并采用多因素logistic分析发生CAUTI的危险因素,数据采用SPSS17.0软件进行统计分析。结果共收集合格病例3635例,住院总日数64032d,留置导尿管总日数46727d,导尿管使用率为72.97%,发生CAUTI 202例,CAUTI发病率为5.56%,千日感染率为4.32‰;多因素logistic回归分析显示,年龄、住院天数、置管天数是CAUTI的独立危险因素;置管相关防控措施依从性中,是否具有置管指征,严格执行无菌操作等6项措施患者间CAUTI发病率比较,差异均有统计学意义(P<0.05);干预期与基线观察期相比,患者CAUTI发病率由6.93%降至4.19%,差异有统计学意义(P<0.05);置管相关防控措施依从性中,医务人员严格执行无菌操作、使用个人专用的收集装置、每日评估插管的必要性并有记录合格率均有所提高,差异均有统计学意义(P<0.05)。结论通过项目的开展,ICU管理工作的重点从"事后把关"转移到"事前预防",CAUTI的防控取得了良好的干预效果。OBJECTIVE To conduct＇The while army nosocomial infection control and prevention capacity-building program＇for monitoring and control of catheter-associated urinary tract infection（CAUTI）and put forward the prevention measures so as to reduce the incidence of CAUTI.METHODS By means of prospective survey,the CAUTI was monitored for 20 hospitalized ICU patients who were treated with catheter indwelling for no less than2 days in 15 hospitals from Apr 2015 to Mar 2016,the risk factors for the CAUTI were analyzed by using multivariate logistic analysis,and the statistical analysis of data was performed with the use of SPSS17.0software.RESULTS A total of 3635 patients were eligible for enrollment,with the total hospitalization days 64032 days,total catheter indwelling days 4627 days,the utilization rate of catheters 72.97%.Totally 202 patients had the CAUTI,with the incidence of CAUTI 5.56%,the thousand-day infection rate 4.32‰.The multivariate logistic regression analysis indicated that the age,length of hospital stay,and catheter indwelling days were the independent risk factors for the CAUTI.There was significant difference in the incidence of CAUTI among the patients who were treated with 6catheter-related prevention measures such as with or without catheter indwelling indications and with or without implementation of aseptic operations（P〈0.05）.The incidence of CAUTI was decreased from 6.93% in baseline observation period to 4.19% in intervention period,and there was significant difference（P〈0.05）.Among the compliance of catheter-related prevention measures,there was significant difference in the strict execution of aseptic operations,use of specialized dedicated collection device,or daily assessment of necessity of catheter indwelling and record of qualified rate（P〈0.05）.CONCLUSIONIt is an effective way to conduct the program and transfer the key point of ICU management from the ＂gatekeeper＂ to ＂prevention＂ so as to achieve remarkable intervention effect on prevention of the CAUT

关 键 词：重症监护室 导尿管相关尿路感染 危险因素 防控措施 

分 类 号：R691.3[医药卫生—泌尿科学]