集束化干预策略在预防ICU中心静脉导管相关血流感染中的应用

Effect of central line bundle on the prevention of central venous catheterrelated bloodstream infection in an intensive care unit

摘要:

目的探讨集束化干预策略预防重症监护室(ICU)中心静脉导管相关血流感染（CRBSI）的效果。方法采用前瞻性和回顾性调查相结合的方法，选择2011年3月—2012年2月某院ICU留置中心静脉导管, 实施集束化干预策略的179例患者作为试验组；2010年1—12月该ICU留置中心静脉导管, 未实施集束化干预策略的198例患者作为对照组，比较两组CRBSI发生情况。结果试验组 CRBSI发生率为3.34‰，显著低于对照组的9.42‰（χ2=5.340，P=0.021）；且试验组住院时间明显缩短［（26.43±7.16）d vs （33.25±8.51）d；t=8.35,P＜0.001］，发生CRBSI的时间显著延长［（10.11±2.34）d vs （6.23±1.92）d；t=17.703, P＜0.001］，手消毒液消耗量明显增加［41.2 mL/患者日 vs 3.5 mL/患者日；t=34.469,P＜0.001］。结论在ICU实施中心静脉导管集束化干预策略能有效降低CRBSI的发生率, 有利于CRBSI的防治。

关键词:

中心静脉导管;导管相关血流感染;中心静脉导管相关血流感染;集束化干预;医院感染;感染控制

Abstract:

ObjectiveTo explore the effect of central line bundle (CLB) on the prevention of central venous catheterrelated bloodstream infection （CRBSI） in an intensive care unit(ICU).MethodsA combination method of retrospective and prospective survey was adopted to compare and analyze the occurrence of CRBSI in two groups of patients, 179 patients in treatment group with central venous catheters (CVCs) from March 2011 to February 2012 implemented CLB, 198 patients in control group with CVCs from January 2010 to December 2010 didn't implement CLB.ResultsThe incidence of CRBSI in treatment group was significantly lower than control group (3.34‰ vs 9.42‰;χ2=5.340,P=0.021); the length of hospital stay was significantly shorter than that in control group(［26.43±7.16］d vs［33.25±8.51］d;t=8.35,P＜0.001）,the onset of CRBSI was significantly later than that of control group (［10.11±2.34）］d vs（6.23±1.92）d; t=17.703,P＜0.001）, the consumption of hand disinfectant increased significantly in treatment group (41.2 mL/ patients day vs 3.5 mL/ patients day；t=34.469,P<0.001）.ConclusionThe implementation of central line bundle in ICU can effectively reduce the incidence of CRBSI, and is helpful for the prevention and control of CRBSI.

Key words:

central venous catheter; catheterrelated bloodstream infection; central venous catheterrelated bloodstream infection; central line bundle; healthcareassociated infection;infection control