综合医院ICU中心静脉导管相关性血流感染发生率及危险因素

目的了解ICU中心静脉导管相关性血流感染(CRBSI)的发病率及危险因素,为制定预防控制措施提供依据。方法采用前瞻性调查方法对江苏省19所三级综合医院ICU中心静脉置管的患者进行监测,并对置管后的维护进行全过程管理;通过logistic回归分析模型,对CRBSI的相关因素进行分析。结果 CRBSI的发病密度为3.82/1000导管日,调查时间段中后三个季度CRBSI的发生率分别为2.55%、3.30%和2.99%,明显低于监测开始的4.73%,综合ICU CRBSI的发生率为3.50%,高于专科ICU的1.74%,导管留置天数和置管地点是CRBSI的独立危险因素。结论开展ICU医院感染目标性监测有助于降低CRBSI发病率,注重中心静脉导管置管后的维护和操作时的最大无菌屏障是降低CRBSI发生率的重要措施,缩短中心静脉导管留置时间可以减少CRBSI的概率。

Incidence of central venous catheter-related bloodstream infections in general ICU and risk factors

OBJECTIVE To understand the incidence and the related risk factors of catheter-related blood stream infections(CRBSI) in ICU,and provide the bases for making prevention and control measures.METHODS By means of the prospective surveillance,the patients with central venous catheter(CVC)in ICU of 19 general hospitals were surveyed.After inserting the central venous catheter,the entire process of nursing care was supervised,then the related factors of CRBSI were analyzed with unconditional univariate and multivariate logistic regression analysis models.RESULTS The incidence of CRBSI was 3.82 per 1000 catheter days.The incidence of CRBSI in the last three seasons were 2.55%,3.30%,and 2.99%,respectively,significantly lower than 4.73% of the first season.The incidence of the comprehensive ICU was 3.50%,higher than 1.74% of the special ICU;The CVC duration and the inserting CVC site were the independent risk factors associated with CRBSI.CONCLUSION It is helpful to reduce the incidence of CRBSI through developing the targeted surveillance of nosocomial infections in ICU,the emphasis on the maintenance after CVC and the maximum sterile barrier are the important measures to reduce the incidence of CRBSI,and to shorten the duration of CVC may reduce the CRBSI.