导尿管相关泌尿系感染院感防控指标体系构建及实证研究  

Establishment of prevention and control system for urinary catheter-associated urinary system infection and empirical study

作　　者：赵会杰[1] 王力红[1] 赵霞[1] 马文晖[1] 冀冰心[2] 王思[3] 耿晓莉 马春梅[5] 张燕[6] 于春妮[7] 周佳琦 ZHAO Hui-jie;WANG Li-hong;ZHAO Xia;MA Wen-hui;JI Bing-xin;WANG Si;GENG Xiao-li;MA Chun-mei;ZHANG Yan;YU Chun-ni;ZHOU Jia-qi(Xuan Wu Hospital Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院感染管理处,北京100053 [2]首都医科大学宣武医院医务处,北京100053 [3]首都医科大学宣武医院护理部,北京100053 [4]首都医科大学宣武医院普通外科,北京100053 [5]首都医科大学宣武医院神经外科,北京100053 [6]首都医科大学宣武医院功能神经外科,北京100053 [7]首都医科大学宣武医院呼吸科,北京100053 [8]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华医院感染学杂志》2023年第18期2875-2880,共6页Chinese Journal of Nosocomiology

基　　金：北京市卫生健康委高层次公共卫生技术人才建设项目培养计划(学科骨干-01-007)。

摘　　要：目的构建适合导尿管相关泌尿系感染(CAUTI)院感防控指标体系,为降低CAUTI感染发病率提供可借鉴的依据。方法采用文献分析、德尔菲法及层次分析法,确定CAUTI院感防控指标体系。根据风险矩阵筛选出高风险区的指标条目作为干预措施的核心措施,组建院感防控督导组应用信息化督导APP对临床核心干预措施进行督导。结果两轮函询问卷有效回收率100%,专家对指标判断依据平均值为0.95,专家熟悉程度平均值为0.93,专家权威系数平均值为0.94;第二轮专家肯德尔和谐系数在0.137~0.610,变异系数0.01~0.19;最终确定CAUTI院感防控指标体系为一级指标3个,二级指标15个,三级指标25个;干预后手卫生依从性、每日评估尿管必要性、尿管双固定、按说明书更换导尿管及排便污染正确清洁消毒会阴部及尿管的执行率较干预前均有提升(P<0.05),CAUTI千日感染率由干预前2.68‰降至1‰,差异具有统计学意义(χ^(2)=3.316,P<0.001)。结论构建CAUTI院感防控指标体系科学可靠,对有效降低CAUTI发病率,提高核心干预措施的执行率提供参考。OBJECTIVE To establish the suitable prevention and control system for catheter-associated urinary tract infection(CAUTI)so as to reduce the incidence of CAUTI.METHODS The prevention and control index system for CAUTI was determined by means of literature analysis,Delphi method and analytic hierarchy process.The index items of high-risk areas were screened out based on the risk matrix and were selected as the core measures of intervention measures.A hospital infection prevention and control supervision team was set up to use the information supervision APP to supervise the core clinical intervention measures.RESULTS The rate of effective recovery was 10o%for the two rounds of correspondence questionnaires,the mean value of expert index judgement was 0.95,the mean value of expert familiarity was 0.93,and the mean value of expert authority coefficient was 0.94.The Kendall harmony coefficient of the second round of experts was 0.137-0.610,and the coefficient of variation was 0.01-0.19.The prevention and control index system for CAUTI was finally determined,including 3 first-lev-el indicators,15 second-level indicators and 25 third-level indicators.The hand hygiene compliance and implementation rates of daily assessment of necessity of urinary catheter,double fixation of urinary catheter,replacement of urinary catheter and removal of pollutants based on specifications and correct cleaning and disinfection of perineum and urinary catheter were higher after the intervention than before the intervention(P<0.05).The thousand-day infection rate of CAUTI was decreased from 2.68%o before the intervention to 1%o after the intervention,and there was significant difference(χ^(2)=3.316,P<0.001).CONCLUSION The prevention and control index system for CAUTIis scientific and reliable,it can effectively reduce the incidence of CAUTI and raise the implementation rates of core intervention measures.

关 键 词：导尿管相关泌尿系感染 院感防控 指标体系构建 实证研究 德尔菲法 管理 

分 类 号：R691.3[医药卫生—泌尿科学]