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目的探讨基于循证医学证据的集束化干预策略对重症监护病房(ICU)中央导管相关血流感染(CLABSI)发病率的影响。方法采用前瞻设计、多中心合作的方法,对全国41所医院54个ICU进行研究,2013年10月1日—2014年9月30日所有入住ICU并留置中央静脉导管(CVC)的患者作为监测对象。2013年10月—2014年3月收集基线资料作为干预前资料;2014年4—9月各参与医院进行干预措施的持续推广,此间收集的资料作为干预后资料,对干预前后资料进行比较。结果干预前后中央静脉导管使用率(44.18%VS44.63%)比较,差异有统计学意义(χ2=5.526,P=0.019)。干预前后CLABSI发病率比较,差异无统计学意义[RR及95%CI为0.82(0.59-1.13),P=0.10]。干预前后置管部位构成比较,差异有统计学意义(χ2=76.264,P<0.001),干预后股静脉置管(17.25%VS 13.72%)及两个及以上部位置管(2.27%VS 1.44%)的置管比例有所降低。干预后,手卫生的执行率和正确率分别为79.73%、91.47%,均高于干预前的76.14%、74.26%(均P<0.001);干预前后皮肤消毒剂构成比较,差异有统计学意义(χ2=3.861,P<0.001),其中氯己定乙醇所占比例升高(29.62%VS 50.56%)。除每日评估并记录外,其他防控措施的依从性干预前后比较,差异均有统计学意义(均P<0.001);使用无菌大铺巾、置管者着装合格、端口消毒合格率均有不同程度提高。结论插管干预和维护干预两者结合的集束化干预策略得到有效落实,但其对CLABSI的干预效果有待更进一步研究。
Objective To explore the impact of cluster intervention strategy based on evidence-based medical evidence on the incidence of central catheter-related bloodstream infections (ICA) in the intensive care unit (ICU). Methods Fifty-four ICU in 41 hospitals in China were studied with prospective design and multicentre cooperation. All patients admitted to the ICU with central venous catheter (CVC) were monitored from October 1, 2013 to September 30, 2014 Object From October 2013 to March 2014, baseline data were collected as pre-intervention data; from April to September 2014, all participating hospitals participated in the continuous promotion of interventions. The data collected here were used as the post-intervention data to compare the data before and after the intervention. Results Before and after intervention, the rate of central venous catheter (44.18% VS 44.63%) was significantly different (χ2 = 5.526, P = 0.019). There was no significant difference in the incidence of CLABSI between before and after intervention [RR and 95% CI 0.82 (0.59-1.13), P = 0.10]. Before and after intervention, there were significant differences between the two groups (2.27% VS 1.44%) after intervention (χ2 = 76.264, P <0.001) ) Of the catheter ratio decreased. After intervention, the implementation rate and correct rate of hand hygiene were 79.73% and 91.47% respectively, both higher than 76.14% and 74.26% before intervention (all P <0.001). The differences of the composition of skin disinfectants before and after intervention were statistically significant (χ2 = 3.861, P <0.001), among which the proportion of chlorhexidine ethanol increased (29.62% VS 50.56%). In addition to the daily assessment and record, the other control measures were compared before and after the intervention, the differences were statistically significant (all P <0.001); use of sterile large shop towels, catheterization dress code, port disinfection pass rate There are different levels of improvement. Conclusion The cluster intervention strategy combining intubation and maintenance interventions has been effectively implemented. However, its intervention effect on CLABSI remains to be further studied.