集束化干预措施对神经外科ICU导管相关感染发病率的影响  

Impact of bundle intervention measures on incidence of catheter-related infections in ICU patients of neurosurgery department

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作  者:杨亚 黄妹[1] 丁佳燕 傅小芳[1] 郑宇[1] 班海群 YANG Ya;HAUNG Mei;DING Jiayan;FU Xiaofang;ZHENG Yu;BAN Haiqun(Renji Hospital,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区:[1]上海交通大学医学院附属仁济医院感染管理办公室,上海200127

出  处:《中华医院感染学杂志》2025年第6期945-949,共5页Chinese Journal of Nosocomiology

基  金:国家卫生健康委医院管理研究所“医疗质量循证管理持续改进研究项目”(YLZLXZ22K018);上海市浦江人才计划基金资助项目(22PJD041);上海市申康医院发展中心市级医院诊疗技术推广及优化项目(SHDC12024628);上海交通大学医学院院感科研基金资助项目(Jyyg2203)。

摘  要:目的评估集束化干预措施对神经外科重症监护室(NICU)导管相关感染发病率的影响。方法收集2007-2022年上海交通大学医学院附属仁济医院NICU医院感染、导管使用及相关感染数据,采用中断时间序列(ITS)方法分析集束化干预措施降低导管相关感染发病率的效果。结果研究期间,感染发病率下降趋势有统计学意义(趋势χ^(2)=91.978,P<0.001)。ITS分析显示,尿道插管使用率干预后仅存在下降趋势(β_(2)=-0.667,P=0.042);呼吸机插管使用率干预后仅有水平下降(β_(3)=-26.375,P<0.001);中央静脉插管使用率干预前呈下降趋势(β_(1)=-2.525,P<0.001),干预后没有明显变化。中心静脉导管相关血流感染(CLABSI)发病率水平下降(RR=0.268,95%CI:0.124~0.581),但斜率变化无统计学差异(RR=0.912,95%CI:0.730~1.140)。导尿管相关尿路感染(CAUTI)发病率呈下降趋势(RR=0.796,95%CI:0.647~0.975),但水平变化无统计学差异(RR=1.543,95%CI:0.816~3.005)。呼吸机相关肺炎(VAP)发病率呈下降趋势(RR=0.829,95%CI:0.767~0.895),但水平变化无统计学差异(RR=0.817,95%CI:0.595~1.114)。结论集束化干预措施可有效降低导管相关感染的发病率,且不同导管感染发病率在干预后的变化趋势不同,提示在实施集束化干预措施时,需要综合考虑不同导管相关感染的特点,持续优化感染控制策略。OBJECTIVE To evaluate the impact of bundle intervention measures on incidence of catheter-related infections in patients of neurosurgery intensive care unit(NICU).METHODS The related data regarding to incidence rates of hospital-associated infections and utilization rates of catheters were collected from the NICU patients of Renji Hospital,Shanghai Jiaotong University from 2007 to 2022.The effect of the bundle intervention measures on reducing the incidence of catheter-related infections was analyzed by means of interrupted tune series(ITS)method.RESULTS There was significant difference in the decline trend of incidence of the infections during the study(the trendχ^(2)=91.978,P<0.001).ITS analysis showed that the utilization rate of catheters only presented the decline trend after the intervention(β_(2)=-0.667,P=0.042),the utilization rate of ventilator tubes only declined after the intervention(β_(3)=-26.375,P<0.001).Th utilization rate of central venous catheters showed a downward trend before the intervention(β_(1)=-2.525,P<0.001)but did not change significantly after the intervention.The incidence of central line-associated bloodstream infection(CLABSI)was decreased(RR=0.268,95%CI:0.124 to 0.581),however,there was significant difference in the change of slope(RR=0.912,95%CI:0.730 to 1.140).The incidence of catheter-associated urinary tract infection(CAUTI)showed a downward trend(RR=0.796,95%CI:0.647 to 0.975),however,there was no significant difference in the change of the level(RR=1.543,95%CI:0.816 to 3.005).The incidence of ventilator-associated pneumonia(VAP)showed a downward trend(RR=0.829,95%CI:0.767 to 0.895),however,there was no significant difference in the change of the level(RR=0.817,95%CI:0.595 to 1.114).CONCLUSIONS The bundle intervention measures may effectively reduce the incidence of catheter-related infections.The incidence rates of the catheter-related infections vary in the changing trends after the interventions are taken,indicating that it is necessary to comprehensively take the chara

关 键 词:神经外科重症监护室 医院感染 导管相关感染 集束化 干预措施 中断时间序列方法 

分 类 号:R473[医药卫生—护理学]

 

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