锁骨下静脉置管敷料更换时清洁消毒方法的改良

Improve cleaning and disinfectant methods for subclavian vein catheterization dressing change

摘要:

目的探讨改良锁骨下静脉置管敷料更换时清洁消毒的方法（简称换药方法），对预防相关感染的效果。方法选择2012年1—6月某院重症监护室行右锁骨下静脉置管的患者120例，按置管日期分为对照组（单日）和实验组（双日）各60例。对照组采用传统的换药方法：2%碘酊消毒穿刺点及周围皮肤一遍，75％乙醇脱碘一遍；实验组采用改良换药方法：先用生理盐水擦拭穿刺点及周围皮肤3遍，清洁导管，再避开穿刺点用75％乙醇消毒周围皮肤3遍，用0.5%碘伏消毒穿刺点及周围皮肤3遍，最后消毒导管。对比两组相关感染率。结果实验组局部感染率为5.00%，导管相关性血流感染（CRBSI）率为1.67%，均显著低于对照组（分别为16.67%和13.33%），差异均有统计学意义（均P＜0.05）。结论改良换药方法比传统换药方法效果好，能有效预防局部感染与CRBSI的发生。

Abstract:

ObjectiveTo evaluate the effect of improved cleaning and disinfection method for subclavian venipuncture dressing change to prevent catheterassociated infection. Methods120 hospitalized patients with right subclavian venipuncture at an intensive care unit in JanuaryJune 2012 were divided into control group (n=60) and  experimental  group(n=60) according to venipuncture date. Control group adopted conventional dressing change : disinfected skin at and around puncture point by 2% iodine tincture, then used 75% alcohol for deiodination ; experimental  group adopted improved dressing change : Wiped skin at and around puncture point three times by normal saline, cleaned catheter, disinfected skin around puncture point (avoid puncture point) three times by 75% alcohol,  disinfected skin at and around puncture point three times by 0.5% iodine tincture , then disinfected catheter . Associated infection rate between two groups were compared . ResultsFocal infection rate and CRBI rate of experimental group were both lower than control group(5.00% vs 16.67% ;1.67% vs 13.33%), the difference was statistically different (P< 0.05). ConclusionEffect of improved dressing method is better than the conventional dressing method, it can effectively prevent occurrence of focal infection and CRBI.