中国导尿管相关尿路感染预防与控制工作的调查分析

Prevention and control of catheterassociated urinary tract infection in China

摘要:

目的了解我国开展医院感染管理工作30年来导尿管相关尿路感染（CAUTI）的预防与控制现状。方法采用随机整群抽样方法抽取全国13个省市的165所二、三级医院，发放调查问卷，调查内容包括：开展CAUTI监测的时间、范围、方法、数据反馈以及日发病率等情况。结果165所医院中已开展CAUTI目标性监测的医院占92.12%（152/165），三级医院开展率为98.08%（102/104），高于二级医院的81.97%（50/61），差异有统计学意义（χ2=13.748，P＜0.001）。大部分医院仅在全部或部分重症监护病房（ICU）开展，占82.24%（125/152）。69.08%（105/152）的医院由医院感染管理专职人员、医院感染监控医生和监控护士三者共同负责监测。95.39%的医院（145/152）采用临床表现与实验室检查相结合的方式诊断CAUTI。98.68%（150/152）的医院已逐步推行严格掌握留置导尿管指征、医务人员手卫生、不频繁更换留置导尿管以及每日评估插管必要性等干预措施。75.66%（115/152）的医院将监测结果向全院进行反馈。监测开展首年（2010年以前）、2010年及2015年CAUTI日发病率分别为3.10‰、4.72‰及1.89‰。结论30年来，我国在开展CAUTI监测工作上已取得一定成效，CAUTI监测逐步规范化和科学化，但各级医疗机构发展仍不均衡，有待于进一步完善。

Abstract:

ObjectiveTo realize the current situation of prevention and control of catheterassociated urinary tract infection (CAUTI) since the development of healthcareassociated infection(HAI) management  in China in the recent 30 years. MethodsRandom cluster sampling was used to select 165 secondary and tertiary hospitals in 13 provinces and cities in China,  questionnaires were filled in, the content included time, scope, method, data feedback, and incidence of CAUTI monitoring. ResultsOf 165 hospitals, 92.12% (152/165)  have implemented targeted monitoring, the implementation rate in tertiary hospitals was higher than secondary hospitals (98.08%［102/104］ vs  81.97%［50/61］,  χ2=13.748，P＜0.001）. Most hospitals (82.24%［125/152］）only implemented monitoring in intensive care units(ICUs)  or partial ICUs. HAI management professionals, HAI control doctors and nurses in 69.08%（105/152）of hospitals jointly took responsibility for CAUTI monitoring. 95.39% (145/152）of hospitals diagnosed CAUTI by combination of clinical manifestations and laboratory examination results. 98.68%（150/152）of hospitals have gradually implemented intervention measures, such as strictly mastering the indications of urinary indwelling catheters, hand hygiene of health care workers, nonfrequent change of urinary indwelling catheters, and necessity for daily assessment of catheterization. 75.66% (115/152) of hospitals conducted feedback of monitored results to the whole hospital. Incidences of CAUTI in pre2010, 2010, and 2015 were 3.10‰, 4.72‰, and 1.89‰  respectively. ConclusionIn the recent 30 years, monitoring on CAUTI in China has obtained achievement, CAUTI monitoring is gradually standardized and scientific, but the development at all levels of medical institutions is still imbalance,  which needs to be improved further.