ICU血培养送检质量改善成效分析

目的 改善ICU血培养送检质量,提高病原菌检出率,降低污染率,更快速有效地指导临床诊断及用药.方法 2010年3-5月医院感染控制医学部以ICU为试点,通过科内教育、定期反馈、行政推动等手段开展血培养送检质量改善计划,并对结果进行评估.结果 2010年7-12月ICU血培养送检率为66.4％,显著高于2009年7-12月的38.6％；ICU血培养在培养标本中的构成比由2009同期的26.9％,上升至51.6％;2010年下半年双套或3套血培养送检率为63.5％,显著高于2009年的34.5％；2010年下半年ICU血培养污染率与2009年同期相比显著降低,由2.7％降至1.6％,阳性率显著升高,由6.3％上升至10.9％；导管血的送检比率显著上升,2010年7-12月诊断导管相关性血流感染(CRBSI) 63例,比2009年同期增加200.0％.结论 通过开展血培养质量改善项目,有效地改善了ICU血培养的送检质量,降低了血培养的污染率,提高了可疑致病菌的检出率,以及导管相关性血流感染的诊断率,同时也促进了实验室的规范建设.

Cost-effectiveness analysis of quality improvement projects of blood culture in ICU

OBJECTIVE To improve the quality of blood culture in ICU and the isolation rate of suspected pathogens and reduce the contamination rate,so as to guide the clinical diagnosis and treatment more quickly and effectively.METHODS Under the lead of hospital infection control department,ICU was taken as a pilot,the quality improvement programs of blood culture were carried out by education,regular feedback,administrative and other measures between Mar and May 2010,and the results were assessed.RESULTS It was associated with the significant submission rate to blood culture(66.4%) in the second half of 2010 as compared with the second half of 2009(38.6%);the proportion of blood culture has increased from 26.9% to 51.6% in 2009;the submission rate of two blood cultures or three culture was 63.5% in the second half of 2010,which was significantly higher than 34.5%in 2009;compared with the same period in 2009,the contamination rate of blood culture was significantly lower in the second half of 2010,decreasing from 2.7% to 1.6%,the positive rate significantly increased from 6.3% to 10.9%;the ratio of submission of catheter blood was significantly increased,there were 63 cases confirmed as catheter-related bloodstream infections(CRBSI)in 2010 with an increase of 200.0% as compared with 2009.CONCLUSION The quality of blood culture in ICU has been effectively improved through quality improvement projects with the contamination rate reduced and the detection rate of the suspected pathogens raised as well as the diagnosis rate of CRBSI improved,meanwhile,it promotes the standardized construction of laboratory.