179所三级医院ICU导尿管相关尿路感染防控护理实践的调查  

Investigation of nursing practice for the prevention and control of catheter-associated urinary tract infection in ICUs of 179 tertiary hospitals

作　　者：刘晨霞 王霞[2] 邵欣[3] 刘聚源[4] 蔡虻[4] LIU Chenxia;WANG Xia;SHAO Xin;LIU Juyuan;CAI Meng

机构地区：[1]北京医院手术室/国家老年医学中心/中国医学科学院老年医学研究院,北京市100730 [2]北京医院手术室/国家老年医学中心/中国医学科学院老年医学研究院护理部,北京市100730 [3]北京医院手术室/国家老年医学中心/中国医学科学院老年医学研究院重症监护病房,北京市100730 [4]北京医院手术室/国家老年医学中心/中国医学科学院老年医学研究院医院感染管理处,北京市100730

出　　处：《中华护理杂志》2022年第22期2750-2757,共8页Chinese Journal of Nursing

基　　金：国家卫生健康委卫生发展研究中心科研课题(2020-53)。

摘　　要：目的调查26个省(区、市)三级医院ICU导尿管相关尿路感染(catheter-associated urinary tract infection,CAUTI)防控的护理实践现状,查找存在的薄弱环节,以便更好地指导临床护理实践。方法采用便利抽样法,利用自行设计的CAUTI防控护理实践现况调查问卷,于2021年9月22日—30日对26个省(区、市)179所三级医院ICU护士进行调查。问卷内容包括ICU基本情况、CAUTI防控的相关制度、流程与培训以及重点环节防控情况3个方面。结果共回收问卷436份,有效问卷368份,有效问卷回收率为84.40%。其中,330名(89.67%)被调查者所在科室常规进行CAUTI数据监测,仅有212名(57.61%)被调查者填写了上一年度CAUTI发生率,发生率中位数为0.86‰。置管环节,218个(59.24%)ICU有置管时的核查表,203个(55.16%)ICU常规使用硅胶导尿管,360个(97.83%)ICU有置管时的消毒操作规范,置管前使用的清洁消毒剂以含有效碘1000~2000 mg/L聚维酮碘溶液为主(89.95%);导管维护环节,245个(66.58%)ICU有导尿管维护期间集束化措施核查表,237个(64.40%)ICU有每日审核留置导尿管必要性的提醒单/系统,258个(70.11%)ICU每周更换1次引流装置,168个(45.65%)ICU常规使用碘制剂进行尿道口清洁,57个(15.49%)ICU置管期间常规进行膀胱冲洗,292个(79.35%)ICU拔管前夹闭导尿管进行膀胱功能训练。不同ICU在最近3年本病区是否有关于CAUTI的持续改进措施和改进项目以及留取少量尿培养标本的方法3个方面比较,差异具有统计学意义(P<0.05)。结论目前各ICU在预防CAUTI的制度和流程上已较完善,但导尿管的留置和维护环节的防控措施有待进一步细化和规范,建议进一步加强CAUTI防控的相关培训与考核,切实降低CAUTI的发生率。Objective To explore the current status of nursing practice in the prevention and control of catheter-associated urinary tract infection(CAUTI)in ICUs of tertiary hospitals in 26 provinces(municipalities/autonomous regions),and find out the existing weaknesses to better guide clinical nursing practice.Methods Using the convenient sampling method and self-designed“Questionnaire on the Current Nursing Practice for the Prevention and Control of Catheter-associated Urinary Tract Infection”,the survey was conducted on nurses in 368 ICUs in 179 tertiary hospitals in 26 provinces(municipalities/autonomous regions)from September 22 to 30,2021.The questionnaire includes 3 parts,namely the basic situation of the ICU,relevant systems,processes and training and key aspects of CAUTI prevention and control.Results A total of 436 questionnaires were collected,with 368 valid questionnaires and an efficiency of 84.40%.Among them,330(89.67%)respondents reported that they routinely monitored CAUTI data in ICUs.However,only 212(57.61%)filled in the incidence of CAUTI in the previous year,with a median of 0.86‰.In the urinary catheter indwelling process,218(59.24%)ICUs had a catheter indwelling checklist;silicone catheter is routinely used in 203(55.16%)ICUs;360(97.83%)ICUs had disinfection specifications,and the cleaning and disinfectant before urinary catheter placement is mainly povidone-iodine solution containing 1000~2000 mg/L of available iodine(89.95%).In the urinary catheter maintenance process,245(66.58%)ICUs had a checklist of bundled measures;237(64.40%)ICUs had a reminder sheet/system for daily review of the necessity of indwelling urinary catheters;258(70.11%)ICUs routinely replaced the drainage device once a week;168(45.65%)ICUs cleaned the urethra with iodine preparations;57(15.49%)ICUs had bladder irrigation routinely;292(79.35%)ICUs clamped urinary catheter for bladder function training before extubation.There were statistically significant differences in continuous improvement measures,improvement projects in

关 键 词：重症监护病房 导尿管相关尿路感染 感染控制 护理实践 

分 类 号：R473.6[医药卫生—护理学]