某医院导管相关性感染预防措施执行情况及感染率评价分析

目的调查3间ICU各导管感染核心预防措施的执行情况、导管使用率及相关感染率等。方法采用回顾性分析对中心重症监护室(ICU)、神经重症监护室(NICU)、急诊监护室(EICU)置管患者进行每日现场评价。结果253例住院置管患者中,ICU执行率最低为89.3%,EICU为92.8%,NICU为95.4%;3种防控方案之间总体有差异;呼吸机相关性肺炎(VAP)导管感染率为6.01‰,中心静脉导管及尿导管感染率分别为1.75‰和1.15‰;2019年执行规范与2014年未执行规范相比较,VAP导管组和尿导管组有明显差异,中心静脉导管组无明显差异;尿导管使用率较高为90.61%,而VAP和中心静脉导管使用率分别为61.60%和33.73%;检出耐碳青酶烯类肠杆菌科细菌(CRE) 8株,分别检出产KPC-2的肺炎克雷伯菌及产NDM-5的大肠埃希菌。结论加强导管的每日评估,掌握器械相关感染的特点、易感因素、病原菌流行病学及综合防控措施是减少导管相关感染的有效方法。

Analysis on the implementation rate and infection rate of catheter-related infection prevention measures in a hospital

Objective The implementation of core prevention measures,the use rate of catheters and the related infection rate in three ICU Wards are investigated. Methods Retrospective analysis was used to evaluate the patients who used ventilator,central vein catheter and indwelling catheter in ICU,NICU and EICU. Results Among the 253 inpatients,the lowest implementation rate was 89. 3% in ICU,92. 8% in EICU and 95. 4% in ICU. Pearson χ² test was applied to the three prevention and control programs and it showed that there was a general difference between different schemes;the infection rate of ventilator-associated pneumonia catheter was 6. 01 ‰,the infection rate of central venous catheter and urinary catheter were 1. 75 ‰ and 1. 15 ‰ respectively. Compared with the implementation of the standard in 2019 and the non implementation of the standard in 2014,there was a significant difference between the ventilator-associated catheter group,and there was no significant difference between the central venous catheter group. There were significant differences between the two groups: the utilization rate of urinary catheter was 90. 61%,while that of ventilator-associated pneumonia and central venous catheter was 61. 60% and 33. 73%,respectively. Eight strains of CRE were detected;Klebsiella pneumoniae producing kpc-2 and Escherichia coli producing ndm-5 were detected respectively. Conclusion It is an effective way to reduce catheter-related infection to strengthen the daily evaluation of catheter,master the characteristics of device related infection,susceptibility factors,pathogen epidemiology and comprehensive prevention and control measures.