实施持续质量改进降低早产儿医院感染的临床研究  

The effect of continuous quality improvement on the reduction of nosocomial infection of premature infants

作　　者：刘淑华[1] 冯丽娟[1] 李莉[1] 范丽莉[1] 蒲伟丛[1] 张玉东 焦建成[1] 马莉[1] Liu Shuhua;Feng Lijuan;Li Li;Fan Lili;Pu Weicong;Zhang Yudong;Jiao Jiancheng;Ma Li(Neonatal Intensive Care Unit,Hebei Children's Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院新生儿重症监护病房,石家庄050031

出　　处：《中华新生儿科杂志（中英文）》2020年第5期321-325,共5页Chinese Journal of Neonatology

基　　金：河北省医学适用技术跟踪项目(GL201664)。

摘　　要：目的评价持续质量改进措施降低新生儿重症监护病房(neonatal intensive care unit,NICU)早产儿医院感染及并发症发生率的效果。方法选择2015年5月至2018年4月河北省儿童医院NICU收治的胎龄<34周且日龄<7 d的早产儿进行前瞻性研究,将2015年5月至2016年4月未实施持续质量改进时收治的早产儿列为基线年组,2016年5月实施降低医院感染相关质量改进措施后至2017年4月收治的早产儿列为干预1组,2017年5月至2018年4月收治的早产儿列为干预2组。应用SPSS 23.0统计软件对3组早产儿医院感染发生率和常见并发症发生率等情况进行统计分析。结果共纳入738例早产儿,其中基线年组216例,干预1组295例,干预2组227例,各组早产儿一般情况比较,差异无统计学意义(P>0.05)。医院感染发生率经质量改进后明显降低,3组分别为15.3%、10.2%、7.5%,干预2组与基线年组比较,差异有统计学意义(P<0.05)。3组共80例早产儿发生医院感染,败血症、呼吸机相关性肺炎、尿路感染所占比例分别为85.0%、13.8%、1.2%。与基线年组比较,干预组手卫生依从率明显提高,经外周中心静脉置管天数缩短,抗生素使用天数明显缩短,差异有统计学意义(P<0.05)。3组支气管肺发育不良、早产儿视网膜病、严重颅内出血或脑室周围白质软化发生率比较,差异无统计学意义(P>0.05)。干预2组总住院时间短于基线年组和干预1组,差异有统计学意义(P<0.05)。结论通过实施持续质量改进措施可降低NICU早产儿医院感染发生率,早产儿相关并发症也可能减少。Objective To evaluate the effect of continuous quality improvement(QI)in reducing the incidence of nosocomial infection(NI)and complications of premature infants in the neonatal intensive care unit(NICU).Method This was a prospective,observational study of preterm neonates before and after QI efforts to reduce NI and complications.Premature infants with gestational age less than 34 weeks and age less than 7 days admitted to NICU in Hebei Children's Hospital from May 2015 to April 2018 were enrolled in the study.The premature infants admitted without continuous QI from May 2015 to April 2016 were taken as the control group,and those admitted from May 2016 to April 2017 after the implementation of QI measures related to NI were included in intervention group 1,and those admitted from May 2017 to April 2018 were included in intervention group 2.The SPSS 23.0 software was used to analyze the incidence of NI and the severe complications,such as bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),periventricular leukomalacia(PVL)and severe intraventricular hemorrhage(IVH)in the three groups.Result A total of 738 premature infants were included in this study,including control group(n=216),intervention group 1(n=295)and intervention group 2(n=227).No significant differences were found in the gestional age,birth weight and other clinical characteristics among the three groups(P>0.05).After QI,the incidence of NI decreased significantly,with 15.3%,10.2%and 7.5%in the three groups respectively.There was significant difference between the intervention group 2 and the control group(P<0.05).A total of 80 premature infants in the three groups developed NI,of which sepsis,ventilator-associated pneumonia and urinary tract infection accounted for 85.0%,13.8%and 1.2%,respectively.Compared with the control group,the compliance rate of hand washing after intervention was significantly improved,the days of peripheral central venous catheterization and the days of antibiotics therapy were significantly shortened,and the dif

关 键 词：重症监护病房 新生儿 医院感染 质量改进 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]