目标性监测与多模式促进策略对降低导尿管相关尿路感染的效果

Effect of targeted monitoring and multi-modular improvement strategy in reducing catheter-associated urinary tract infection

摘要:

目的 评价目标性监测与多模式促进策略应用于导尿管相关尿路感染（CAUTI）的防控效果。 方法 选取某三级甲等医院2018年1月—2022年12月临床科室留置导尿管患者为研究对象，分析连续5年目标性监测结果及病原菌分布，并根据目标性监测结果实施多模式促进策略，比较实施前后CAUTI发生情况、防控措施培训效果及执行情况。 结果 多模式促进策略实施前后，医务人员手卫生依从率、防控措施知晓率、防控措施执行率均显著提高（均P < 0.001）；目标性监测结果显示，留置导尿管患者尿培养和尿常规日送检率连续5年呈上升趋势（P < 0.05）；5年共发生CAUTI 397例，综合ICU和外科ICU CAUTI日发病率均连续5年呈降低趋势（均P < 0.05），普通病房5年CAUTI日发病率比较，差异无统计学意义（P=0.088）；共检出431株病原菌，以革兰阴性菌为主，导尿管留置患者多重耐药菌感染日发生率为0.12‰；多模式促进策略实施后各科室CAUTI日发病率均显著降低（P < 0.05）。 结论 目标性监测有助于发现CAUTI高风险科室，多模式促进策略可提高CAUTI各环节防控质量，降低CAUTI发病率，值得临床推广应用。

Abstract:

Objective To evaluate the effect of targeted monitoring and multi-modular improvement strategy on the prevention and control of catheter-associated urinary tract infection (CAUTI). Methods Patients with indwe-lling urinary catheter in a tertiary first-class hospital from January 2018 to December 2022 were selected as the research subjects. Targeted monitoring results and distribution of pathogenic bacteria in 5 consecutive years were analyzed, and a multi-modular improvement strategy based on the targeted monitoring results was implemented. The occurrence of CAUTI before and after implementation, status and effectiveness of training in prevention and control measures were compared respectively. Results Before and after the implementation of the multi-modular improvement strategy, health care workers' compliance rate of hand hygiene, awareness rate of prevention and control measures, and implementation rate of prevention and control measures all increased significantly (all P < 0.001). Targeted monitoring results showed that daily test rates of urine culture and routine urine from patients with indwelling catheters have been on the rise in 5 consecutive years (P < 0.05). A total of 397 cases of CAUTI occurred in the past 5 years. Incidences of CAUTI in general intensive care unit(ICU) and surgical ICU showed decreasing trends in 5 consecutive years (all P < 0.05). Incidence of CAUTI in general wards showed no statistically significant difference in 5 years (P=0.088). A total of 431 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria. Daily incidence of multidrug-resistant organism infection in patients with indwelling catheters was 0.12‰. After the implementation of the multi-modular improvement strategy, incidence of CAUTI in all departments reduced significantly (P < 0.05). Conclusion Targeted monitoring can help identify departments with high-risk of CAUTI, multi-modular improvement strategy can raise the quality of prevention and control of CAUTI in all occasions, reduce the incidence of CAUTI, and is worthy of clinical promotion and application.