项目管理法在内科重症监护病房导尿管相关尿路感染防控中的临床实践

Clinical practice of prevention and control for catheter-associated urinary tract infection in medical intensive care unit: based on project management method

摘要:

目的 通过项目管理法制定预防留置导尿管相关尿路感染(CAUTI)的方案, 并评价其在内科重症监护病房(MICU)留置导尿管患者CAUTI防控中的应用效果。 方法 选择某院MICU收治的153例留置导尿管患者, 2021年7月—2022年3月患者为对照组(78例), 采用常规方法进行护理; 2022年7—12月患者为干预组(75例), 采用项目管理法完善的护理措施进行干预。比较两组患者导尿管留置日数、住院日数、CAUTI发生率; 同时比较干预组带入导尿管患者与本科室留置导尿管患者在三个质量周期主要指标的差异。 结果 干预组患者留置导尿管日数短于对照组[(9.51±2.57)d VS (11.10±2.82)d], 差异有统计学意义(t=8.207, P=0.038);两组患者住院日数比较, 差异无统计学意义(P＞0.365)。患者导尿管留置日数: 第二质量周期短于第一质量周期, 第三质量周期短于第二质量周期, 差异均有统计学意义(均P＜0.05)。干预组留置导尿管患者CAUTI总体发生率低于对照组(20.00% VS 24.36%), 差异有统计学意义(χ²=6.937, P=0.026)。第一、二质量周期: 带入与本科留置导尿管患者留置日数比较, 差异均有统计学意义(均P＜0.05);干预组、第一和第二质量周期: 带入与本科留置导尿管患者CAUTI发生率比较, 差异均有统计学意义(均P＜0.05)。 结论 应用项目管理法可降低MICU留置导尿管患者CAUTI的发生率, 减少留置导尿管日数, 提升留置导尿管全流程的护理质量。

Abstract:

Objective To develop a scheme for preventing catheter-associated urinary tract infection (CAUTI) based on project management method, and evaluate its application effect on the prevention and control of CAUTI in patients with indwelling urinary catheters in the medical intensive care unit (MICU). Methods A total of 153 patients with indwelling urinary catheters admitted to the MICU of a hospital were selected for analysis. Patients from July 2021 to March 2022 were set as the control group (n=78), adopting routine nursing methods. Patients from July to December 2022 were set as the intervention group (n=75), and intervened with nursing measures of project management. Catheterization days, length of hospital stay, and incidence of CAUTI between two groups of patients were compared. Difference in the main indicators of patients with brought catheters and those receiving catheters in this department in the intervention group during three quality cycles was compared. Results The duration of indwelling urinary catheters in the intervention group was shorter than that in the control group ([9.51±2.57] days vs [11.10±2.82] days), with a statistically significant difference (t=8.207, P=0.038). There was no statistically significant difference in the length of hospital stay between two groups of patients (P>0.365). In terms of catheterization days of patients, those in the second quality cycle was shorter than in the first quality cycle, and those in the third quality cycle was shorter than in the second quality cycle, both with statistically significant differences (both P < 0.05). The overall incidence of CAUTI in patients with indwelling catheters in the intervention group was shorter than that of the control group(20.00% vs 24.36%), with statistically significant differences (χ²=6.937, P=0.026). Catheterization days between patients with brought catheters and those receiving catheters in this department were statistically significantly different both in the first and second quality cycles (both P < 0.05). The incidences of CAUTI between patients with brought catheters and those receiving catheters in this department were significantly different in the intervention group, as well as in the first and second quality cycles, respectively (all P < 0.05). Conclusion The application of project management method can reduce the incidence of CAUTI and catheterization duration of patients with indwelling urinary catheters in MICU, and improve the nursing quality of the entire process of indwelling catheters.