每日质量核查对ICU重症患者院内感染的影响  

The effect of daily quality checklist on intensive care unit severe patients with hospital associated infection

作　　者：滕洪云 程秀玲[1] 杨万杰[1] 王伟[1] 张桂娟[1] 王玉梅[1] 魏秀华[1] Teng Hongyun;Cheng Xiuling;Yang Wanjie;Wang Wei;Zhang Guijuan;Wang Yumei;Wei Xiuhua(Department of Critical Care Medicine,the Fifth Center Hospital in Tianjin,Tianjin 300457,Chin)

机构地区：[1]天津市第五中心医院重症医学科,300457

出　　处：《中国中西医结合急救杂志》2018年第3期297-301,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市滨海新区医药卫生科技项目（2012BWKL002）

摘　　要：目的探讨应用每日质量核查单对重症加强治疗病房（ICU）患者院内感染发生率的影响。方法采用历史对照研究方法，选取天津市第五中心医院2016年6月至2017年5月收治的应用每13质量核查单的286例行机械通气（MV）重症患者作为试验组，选取2015年6月至2016年5月收治的未使用每日质量核查单的291例重症患者作为对照组。对照组只进行常规治疗、日常护理与查房；试验组严格执行重症核查单制度，每日由医生和当班护士应用质量核查单对患者进行评估和核查，共包括镇静镇痛、MV、血糖控制、营养等16项内容。比较两组患者呼吸机相关性肺炎（VAP）、血管内导管相关血流感染（CRBSI）、导尿管相关泌尿系感染（CAUTI）的发生率、28d病死率、MV时间及ICU住院时间的差异。结果与对照组比较，试验组VAP、CRBSI及CAUTI发生率均明显降低（VAP：1．78％D比5．09‰，CRBSI：1．46％。比5．21‰，CAUTI：1．39‰比4．41‰，均P〈0．05），MV时间和ICU住院时问均明显缩短[MV时间（d）：7．81±2．74比10．62±3．67，ICU住院时间（d）：8．40±1．94比11．35±2．47，均P〈0．05]，28d病死率有降低趋势[5．24％（15／286）比6．19％（18／291）]，但两组比较差异无统计学意义（P〉0．05）。结论应用每日质量核查单可有效降低ICU患者院内感染的发生率，缩短MV时间和ICU住院时间。Objective To investigate the effect of daily quality checklist on intensive care unit （ICU） the incidence of severe patients with hospital associated infection （HAI）. Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation （MV） and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia （VAP）, catheter-related bloodstream infection （CRBSI）, catheter-associated urinary tract infection （CAUTI）, 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased （VAP： 1.78‰ vs. 5.09%0, CRBSh 1.46‰ vs. 5.21‰ ; CAUTI： 1.39‰ vs. 4.41‰, all P 〈 0.05）, the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV （days）： 7.8±2.74 vs. 10.62 ± 3.67, the length of ICU stay （days）： 8.40± 1.94 vs. 11.35 ± 2.47, both P 〈 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% （15/286） vs. 6.19% （18/291）], but no statistical significant difference was seen （P 〉 0.05）. Conclusion Implementation of daily quality checklist can effectively decrease the incidence

关 键 词：重症加强治疗病房 质量核查单 每日核查评估 重症患者 院内感染 

分 类 号：R193[医药卫生—卫生事业管理]